Tuesday, December 16, 2014

Practice EKG Strips 368

Identify the following rhythms.

1.









a. Atrial fibrillation with RVR
b. Sinus tachycardia
c. Supraventricular tachycardia
d. Ventricular tachycardia

2.











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

3.









a. Ventricular tachycardia
b. Junctional rhythm
c. Idioventricular rhythm
d. Sinus bradycardia

4.









a. NSR with a run of SVT
b. NSR with a run of VT
c. NSR with a run of VF
d. NSR with a run of ST

5.












a. Sinus rhythm with trigeminal PVCs
b. Sinus rhythm with multifocal PACs
c. Sinus rhythm with multiform PVCs
d. Sinus rhythm with uniform PVCs


Answers
1. a. Atrial fibrillation with RVR. The rhythm is irregular. The heart rate is around 190 bpm. No P waves are seen and it looks like some fibrillation may between some of the QRS complexes when the rate slows down. B is incorrect because there are not identifiable P waves. C is incorrect because the rhythm is so irregular. D is not correct because the QRS complexes are narrow. The narrow complexes point towards some that originates above the ventricles.
2.  c. Biventricular paced. Also referred to as cardiac resynchronization therapy. Two pacer spikes are seen just prior to the QRS complexes. One pacer spike for the right ventricle and the other for the left ventricle. By pacing both ventricle there is improve synchronization between the two chambers with an overall improvement in cardiac output and cardiac function.
3. c. Idioventricular rhythm. The rhythm is regular with a ventricular rate around 34 bpm. No P waves are seen. The QRS complexes are wide so this suggests some kind of ventricular escape rhythm. In this case idioventricular rhythm since the rate is between 20 - 40 bmp. If the rate is between 40 - 60 bpm then it is called an accelerated idioventricular rhythm.
4. b. NSR with a run of VT. During the "run" the QRS complexes are organized, wide and fast. No P waves are seen so this rules out a run of ST. The QRS complexes are wide so this rules out a run of SVT. The QRS complexes appear organized so this rules out a run of VF.
5. a. Sinus rhythm with trigeminal PVCs. Unifocal PVCs seen every third beat. More correct to call them trigeminal PVCs

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