Tuesday, January 27, 2015

Practice EKG Strips 396

Identify the following rhythms.

1.






a. 2nd degree heart block type II
b. Idioventricular rhythm
c. Sinus bradycardia
d. Complete heart block

2.






a. Sinus bradycardia
b. Sinus arrest
c. Atrial fibrillation with slow ventricular response
d. 3rd degree heart block

3.













a. Agonal rhythm
b. Idioventricular rhythm
c. Junctional rhythm
d. Complete heart block

4.










5.













a. Sinus arrhythmia
b. Sinus arrest
c. 3rd degree heart block
d. Junctional rhythm


Answers
1. d. Complete heart block. The ventricular rate is 30 bpm and the atrial rate is 71 bpm. There is no conduction between the atria and the ventricles- each are beating independently of one another. So there is a significant drop in the cardiac output associated with this rhythm. As long as the patient remains at rest sometimes this rhythm is tolerated. However, when increased demand is on the body then the heart is unable to compensate by increasing the cardiac output and the patient becomes hemodynamically unstable.

2. c. Atrial fibrillation with slow ventricular response. The rhythm is irregular. The rate is around 30 bpm. No P waves are seen. So this rules out answers A, B, and D. Sometimes with slow atrial fibrillation the fibrillation is not as coarse and the rhythm tends to look almost regular. Often with a slow atrial fibrillation you are looking at a rhythm that has been caused by too much beta blocker, digoxin, or calcium channel blockers. Witholding these meds will usually restore the rate.

3. a. Agonal rhythm. The rate is around 15 bpm. No P waves are seen. The QRS complexes are wide. There is ST elevation.

4. c. Junctional rhythm. The rhythm is regular. The rate is around 48 bpm. There are P waves but they are inverted. This points toward a pacemaker site below the level of the atrium. The QRS complexes are narrow. No ectopic beats are seen. PR: .12 sec, QRS: .08 sec, QT: .28 sec. Since the rate is between 40 and 60 beats per minute we are looking at a junctional rhythm. Rates between 60 and 100 bpm would be accelerated junctional rhythm. Rates over 100 would be junctional tachycardia

5. b. Sinus arrest. The rhythm is irregular due to long period of sinus arrest. The underlying rhythm has upright P waves so it is sinus in origin. The P waves ae associated with a QRS complex. There is some rather significant ST elevation in this lead. If found in other the continguous leads of III, and aVF it would be significant for an inferior MI. PR: .16 sec, QRS: .08 sec, QT: .40 sec.

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