Thursday, January 29, 2015

Practice EKG Strips 398

Identify the following rhythms.

1.










a. Atrial fibrillation
b. 2nd degree heart block type I
c. First degree block
d. Sinus arrhythmia

2.






a. Atrial flutter
b. Atrial fibrillation
c. Atrial tachycardia
c. Atrial paced


3.









a. AV paced changing to VT
b. AV paced changing to SVT
c. AV paced changing to AIVR
d. AV paced changing to MAT

4.






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

5.










a. Sinus bradycardia changing to AIVR
b. Sinus bradycardia changing to VT
c. Sinus bradycardia with multiple PVCs
d. Sinus bradycardia with SVT

Answers
1. b. 2nd degree heart block type I. The PR interval just gets long (.24 sec), longer (.28 sec), and longer (.32 sec) until there is a nonconducted P wave, seen after the 2nd 4th, and 7th complexes

2. a. Atrial flutter. It looks like 3:1 flutter waves for every QRS complex.

3. C. AV paced changing to AIVR. There is a wide variety of ranges in the rate given to AIVR, 50 – 110 bpm, 40 – 120 bpm , 60 -100 bpm , 60 - 110 bpm. Not everybody is in agreement. The rates for VT are generally are 150 - 120 although some texts describe a slow VT with a rate less than 150. I chose AIVR just because the rate between the complexes is somewhat slow, 108 - 115 bpm. If you chose answer A then that is okay too. The QRS complexes would have to be much more narrow for it to be answer B and there would have to be visible P waves for it to be answer D.

4. c. Sinus bradycardia. Did somebody mention atropine? This is an extreme sinus bradycardia with a rate of 21 bpm. It is sinus because there are upright P waves before each QRS complex. The PR interval is a little prolonged, 0.24 sec. The QRS is wide, .12 sec, and there is an rSR complex in the V1 lead, RBBB. The QT interval is prolonged too, .68 sec

5. a. Sinus bradycardia changing to AIVR. The initial rhythm is slightly irregular with a rate of 55 bpm. The P waves and the QRS complexes are paired up. The P waves are somewhat flattened but are upright. The QRS complexes are wide, 0.12 sec. The 4th beat arrives early and may be an initial PVC but it is followed by some ventricular escape beats. The rate of the escape rhythm is around 50 bpm which is what we would expect for an accelerated idioventricular rhythm. No P waves are seen and the QRS complexes are wide and different looking from the sinus QRS complexes. Answer B is incorrect because the rate is much too slow for VT. Answer C is not correct because the beats arrive LATE in the cardiac cycle, not early or prematurely. Answer D is incorrect because the rate is too slow and the QRS complexes are wide, not narrow

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