Monday, January 12, 2015

Practice EKG Strips 385

Identify the following rhythms.

1.














a. First degree block
b. Accelerated junctional rhythm
c. Sinus bradycardia
d. Second degree heart block type II

2.











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

3.














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

4.











a. NSR with trigeminal PVCs
b. NSR with a triplet of PVCs
c. NSR with uniform PVCs
d. NSR with a couplet

5.











a. Atrial fibrillation
b. Junctional rhythm
c. Sinus arrhythmia
d. Sinus bradycardia

Answers
1. First degree block. The rhythm is regular with a rate of about 71 bpm. The P waves are upright and paired with a QRS complex. However, the PR interval is prolonged at .24 sec. No ectopic beats are identified. The QRS complexes are narrow. The bottom rhythm is the arterial blood pressure waveform. The systolic pressure is around 130 mm Hg and the diastolic pressure is around 48 mm Hg. Notice that the ABP waveform is offset from the heart rhythm. This reflects the time it takes for the pressure waveform to travel from the heart to the radial artery.

2.  b. AV paced. There are pacer spikes before the P wave and the QRS complexes.

3. c. Third degree heart block. The R to R interval is fairly regular. There are upright P waves but they are not paired with a QRS complex. On the 2nd complex you can see that the P wave is fused with the R wave of the QRS complex. On the 3rd and 4th complexes the PR interval is not consistent

4. b. NSR with a triplet of PVCs. The rhythm is irregular. The heart rate is around 68 bpm. There are positive P waves that are associated with the QRS complexes. A multifocal triplet of PVCs is seen (the 4th - 6th complexes) which is followed by a short compensatory pause. Afterwards, sinus rhythm resumes

5. c. Sinus arrhythmia. The rhythm is irregular. There are some small P wave before the QRS complexes. The P waves of the first two complexes are very flattened in lead II but they are more distinguishable in lead V1. On the rest of the complexes in lead II you can identify them readily. The overall rate is about 50 bpm. No ectopic beats are seen.

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