Wednesday, January 21, 2015

Practice EKG Strips 392

Identify the following rhythms.

1.









a. Ventricular tachycardia changing to SVT
b. Ventricular tachycardia changing to AIVR
c. Ventricular tachycardia changing to wide complex tachycardia
d. Ventricular tachycardia changing to sinus tachycardia

2.











a. Sinus bradycardia with trigeminal PVCs
b. Sinus rhythm with a 3 beat run of SVT
c. Sinus bradycardia with a run of VT
d. Sinus rhythm with a triplet of PVCs

3.











a. Atrial fibrillation
b. Junctional rhythm
c. Sinus bradycardia
d. Accelerated idioventricular rhythm

4.











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

5.











a. Sinus bradycardia with PACs
b. Sinus bradycardia with sinus arrhythmia
c. Sinus bradycardia with a first degree block
d. Sinus bradycardia with pauses


Answers
1. c. Ventricular tachycardia changing to wide complex tachycardia. Clearly there is VT at the beginning of the strip. This changes to a fast rhythm with a wide QRS complex. We can't be sure if we are seening P waves or T waves because the rate is so fast. Because of the wide QRS complexs, the rhythm does not "fit" the characteristics of SVT which normally has narrow QRS complexes. The RSr appearance of the QRS complexes in the V1 lead do provide us with a clue that the underlying rhythm has a RBBB. This would explain the wide QRS complexes that we see at the end of the VT. In the top lead there is also some ST depression. So we are looking at some SVT with aberrancy or wide complex tachycardia. Adenosine would be a drug to consider for the SVT if the patient is only symptomatic. If the patient is unstable then cardioversion- which might take care of both rhythms in the long run.
2. d. Sinus rhythm with a triplet of PVCs. The rhythm is irregular due to the PVCs. The rate is around 68 bpm. The P waves are positive, upright and are hooked up with a QRS complex. The QRS complexes are wide, .12 sec. The morphology of the PVCs does vary some. Maybe multifocal in origin. PR: .20 sec, QRS. 12 sec, QT: .40 sec
3. b. Junctional rhythm. The rhythm looks regular. The rate is around 48 bpm. Inverted P waves are seen before each QRS complex. The QRS complexes are narrow. No ectopic beats are seen. PR: .10 sec, QRS: .08 sec, QT: .32 sec.
4. a. Atrial paced.  The rhythm is regular with a rate of  75 bpm.   There are pacer spikes seen before each P wave.  The QRS complexes are narrow.  No ectopic beats are seen.  PR: .20.  QRS: .08 sec, QT: .44 sec.
5. b. Sinus bradycardia with sinus arrhythmia.   The rhythm is irregular with a rate of 50 bpm.  There are upright P waves before each QRS complex.  The QRS complexes are narrow.  The T waves are peak.  This may represent hyperkalemia or hyperacute changes.  No ectopic beats are noted.  PR: .20 QRS: .08 sec, QT: .42 sec

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