EKG Rhythm Strips 07

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Answers

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1st Degree Heart Block

1st Degree Heart Block.   The rhythm is regular.  There is one P wave for each QRS complex but the PR interval is > .20 seconds.  In this strip the QRS complex is wide.   

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3rd Degree Heart Block or Complete Heart Block

3rd Degree Heart Block or Complete Heart Block.    There is no coordination between the atria and the ventricles, both are beating at their own rhythm.  Notice in the 4th QRS complex that a P wave falls within the ST segment of the complex.  Without coordination between the upper and lower chambers of the heart, the cardiac output will fall off.  In addition, when the ventricular rate is slow, the cardiac ouput is insufficient to meet the metabolic needs of the patient and thus the patient may show symptoms of cardiogenic shock.  What is then would be the indicated treatment for this unstable patient?

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Sinus Tachycardia

Sinus Tachycardia.   The rhythm is regular.  There is one P wave for each QRS complex.  The rate is 145.   In general, if the rate is below 150/min the patient is usually asymptomatic.   The treatment is aimed at addressing underlying causes: fever, anxiety, pain, medications.

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Sinus Rhythm with PAC

Sinus Rhythm with PAC.  The rhythm is regular except for the extra beat at the 3rd and 8thcomplex.  The early beat has a P wave that looks different from the other P waves so this would make it a PAC. 

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Sinus Rhythm With PACs

Sinus Rhythm with PACs.    The rhythm is regular except for the extra beat at the 3rd and 8th complex. The early beats have P waves that looks different from the sinus P waves so this indicates that they arise from a different site within the atrium.  Usually the patients are asymptomatic though some may complain of feeling a fluttering sensation in their chest.   I have personally seem more PACs in people with underlying respiratory problems such as COPD.  

Reviewed 2/28/16