Tuesday, December 23, 2014

Practice EKG Strips 373

Identify the following rhythms.

1.












a. Atrial fibrillation with slow ventricular response
b. Sinus bradycardia with sinus arrhythmia
c. Complete heart block
d. Junctional rhythm

2.












a. Atrial fibrillation
b. Sinus tachycardia
c. Atrial flutter
d. SVT

3.












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

4.












a. NSR with a PJC
b. NSR with a PAC
c. NSR with PVC
d. NSR with supraventricular beat

5.











a. 2nd degree heart block type I
b. 2nd degree heart block type II
c. First degree block
d. Complete heart block

Answers
1. a. Atrial fibrillation with slow ventricular response. The rhythm is irregular. The rate is around 40 bpm (The last complex falls outside the 6 second marker). No P waves are seen just some fibrillation. No ectopic beats are seen. The QRS complex is narrow.
2.  c. Atrial flutter with a little rapid ventricular rate. The conduction through the AV node varies so the rhythm is irregular. You can see the flutter waves clearly between the 2nd and 3rd complexes as well as the 8th and 9th complexes.
3. d. Biventricular paced with a couplet. Two pacer spikes before the QRS complex. The 3rd complex also had an atrial paced beat thrown in for good measure. The QRS complex of the ventricular paced beat is usually negative with a T wave that is upright.
4. a. NSR with a PJC is what I am calling it. The PRI on the sinus beats is around .16 sec. On a PAC you would expect the ectopic PRI to be about the same or maybe a little shorter. If you look on the V1 lead you don't really see any indication of a P wave that falls within .16 sec. The other thing I look at is the preceding T wave. Sometimes the P wave of a PAC may be buried within the T wave of the preceding beat. When this occurs, you usually see a change in the amplitude or morphology of that T wave. In this case, The T wave before the ectopic beat looks like the T waves of the other sinus beats. Recall that a the P wave of a PJC may be absent, inverted before the QRS complex, or inverted and follow the QRS complex. In this strip it is absent. That is my story and I am sticking to it.
5. d. Complete heart block.   The P waves and the QRS complexes are dissociated. The atrial rate is around 125 bpm and the ventricular rate is around 62 bpm.   The QRS complexes are 0.10 sec.  The overall rate points towards a underlying junctional escape rhythm and a high degree AV block.

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