EKG Rhythm Strips 21: Fast rhythms

Identify the following rhythms
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Answers

Identify the following rhythms
1.

Multifocal Atrial Tachycardia

 Multifocal Atrial Tachycardia.  The rate is 149.   The rhythm is irregular.  There is an upright P wave before each QRS complex.   The QRS complex is narrow, < .12 sec.   Because the rate is over 100 and there are at least three different P waves of differing morphology, this qualifies the rhythm as a mulifocal atrial tachycardia.  Since this rhythm is ectopic in nature, it probably would not respond to either adenosine or cardioversion.  

2.

Atrial Fibrillation with RVR

Atrial Fibrillation with RVR.  The rate is 150.  The rhythm is irregular.  There are really no identifiable P waves before each QRS complex.  Fibrillatory waves are clearly seen.  The QRS complex is narrow. Because the rate is over 100/min, this rhythm is identified as atrial fibrillation with a rapid ventricular rate.   This rhythm will not usually be converted by adensoine but will slow down so that it can be identified more clearly.  If the rhythm is of new onset, < 24 hours and the patient is unstable, emergent cardioversion may be attempted. 

3.

Atrial Tachycardia

Atrial Tachycardia.  The rate is about 210.   The rhythm is regular.  There are faint, identifiable P waves present. Examine the T waves of the preceeding complexes and you can make out the P waves which are superimposed on the T waves.  The QRS is narrow.  



4.



Junctional Tachycardia

 Junctional Tachycardia.  The rarte is 150.  The rhythm is regular.  There are inverted P waves before each narrow QRS complex.  The inverted P waves are characteristic of a junctional rhythm.  Because the rate is > 100, this makes it a junctional tachycardia. 

5.

Ventricular Tachycardia



Ventricular Tachycardia.   The rate is 187.  The rhythm is regular.  There are no P wave present.  The QRS is wide, > .12 sec.  If the patient had a pulse but was unstable, what would be the treatment of choice?    a.  Amiodarone 300mg IV push.   b.   Defibrillation with 360 J (monophasic)   c. Cardioversion with 100J   d.  Lidocaine 1.5mg/kg.  IV?      If a patient with VT had a pulse but was unstable, the provider would cardiovert the patient at 100 J and increase the joule setting stepwise on subsequent cardioversion attempts.   On the other hand, if the patient were pulseless, then you would defibrillate the patient at 360 J (monophasic).   Lidocaine 1.5mg/kg is indicated for the patient with VT who has a pulse but is only symptomatic.   Amiodarone is the first antiarrhytmic used in a pulseless arrest with VT displayed on the monitor.  But it is used in refractory VT after initial defibrillation attempts and vasoconstrictors have failed to convert the rhythm.  

Reviewed on 3/1/16