Thursday, November 20, 2014

EKG Rhythm Quiz 286

Identify the following rhythms.

1.

a. Junctional rhythm
b. Idioventricular rhythm
c. Sinus bradycardia
d. Third degree heart block

2.

a. Sinus rhythm with PJCs
b. Sinus rhythm with PVCs
c. Sinus rhythm with PACs
d. Sinus arrhythmia with pauses

3.

a. Normal sinus rhythm with ST depression
b. Sinus bradycardia with ST depression
c. First degree block with ST depression
d. Sinus arrhythmia

4.

a. Sinus tachycardia
b. Supraventricular tachycardia
c. Ventricular tachycardia
d. Atrial tachycardia

5.













a. Muscle artifact
b. Torsades de pointes
c. Atrial fibrillation
d. Coarse ventricular fibrillation

6.

a. Sinus rhythm changing to VT
b. Atrial flutter changing to VT
c. Atrial fibrillation changing to VT
d. Sinus tachycardia changing to VT

7.

a. Sinus tachycardia
b. Accelerated junctional rhythm
c. Accelerated Idioventricular rhythm
d. Atrial flutter


8.

a. Junctional rhythm
b. Asystole
c. Agonal rhythm
d. Sinus arrest

9.

a. Sinus arrhythmia
b. Multifocal atrial tachycardia
c. Wandering atrial pacemaker
d. Atrial fibrillation

10.











a. Atrial paced
b. Biventricular paced
c. Dual paced
d. Ventricular paced




Answers

01. b. Idioventricular rhythm  Rate is around 37 bpm so it is within the range of idioventricular rhythm.
02. a. Sinus rhythm with PJCs. I'm not seeing any P waves on the ectopic beats or any changes in the morphology of the T waves on the preceding beats. The PRI of the ectopic beats may be shorter than the sinus beats but not longer. So I am going with PJCs.
03.  a. Normal sinus rhythm with ST depression
04. b. Supraventricular tachycardia. No P waves noted. Narrow QRS complex. Rate is around 150 bpm.
05. d. Coarse ventricular fibrillation. Coarse ventricular fibrillation and polymorphic VT sometimes look the same. However, in a pulseless patient the treatment is the same: Immediate defibrillation with 120 - 200 joules. CPR. Vasopressors: Epinephrine or Vasopressin. Antiarrhythmics: Amiodarone or Lidocaine. Magnesium for suspected Tdp. Bicarb is not routinely used except in a long arrest situation, suspected aspirin overdose, tricyclic overdose, suspected hyperkalemia, or known metabolic acidosis.  With torsades de pointes the QRS amplitude begins small, gets bigger, then gets smaller again. This is followed by a brief period of ventricular slowing or a pause. The cycle repeats it self. The axis of the of the QRS complexes seems to flip from positive to negative with each cycle. It is this changing of the axis which gives torsades its typical appearance. In this strip the axis of the QRS complexes are all positive.
06. a. Sinus rhythm changing to VT. In all honesty there is not enough of the baseline rhythm present to make a good analysis. There are some small P waves present which borderline on 1st degree block but it is hard to make them out. So if you put c. Atrial fibrillation changing to VT that is okay.
07. b. Accelerated junctional rhythm.   Inverted P waves are seen before each QRS complex
08. c. Agonal rhythm.   Very wide and bizarre-looking QRS complexes.  The overall rate is less than 20 bpm.
09. d. Atrial fibrillation.  An irregular, irregular rhythm.  No identifiable P waves are seen.  Fibrillation between the QRS complexes is evident.
10. d. Ventricular paced.  A pacer spike precedes each QRS complex.  This is seen better in the V1 lead.



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