EKG Rhythm Strips 62
Identify the following rhythms
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Answers
1.
If you follow the P waves on the first three complexes, you will notice that their association with the QRS complex changes. This is followed by two junctional beats and then by sinus rhythm. This rhythm does not meet all the text book criteria for a 3rd degree block or a junctional rhythm. It is somewhere in between so I chose the safer description of an AV dissociated rhythm.
2.
The rhythm is irregular with a rate of 110/min. No P waves are present. Fibrillatory waves are seen between the QRS complexes. There is a single PVC as well as a couplet. The T wave is inverted in lead II and there is an rSR configuration to the QRS complex in lead V1. PR: ---, QRS: .12 sec, QT: .32 sec
3.
The rhythm is regular with a rate of 60/min. P waves are present and are preceded by an atrial pacing stimulus. No ectopic beats are noted. 1mm ST depression is seen in lead II. PR: .20 sec, QRS: .08 sec, QT: .40 sec.
4.
The rhythm is irregular with a rate of 70/min. The P waves are uniform, upright, and precede the QRS complex. The R-R interval between the 1st and 2nd complex is 0.8 sec and the R-R interval between the 2nd and 3rd complex is .96 sec. There are deep Q waves with ST elevation in lead II which is indicative of an acute MI. A significant Q wave is defined as being > 0.04 sec or 1/3 the height of the R wave. PR: .16 sec, QRS: .10 sec, QT: .36 sec.
5.
The bottom waveform is a pulmonary artery catheter waveform. The rhythm is irregular with many PVCs. The rate is 90/min. The P waves are uniform, upright and have a corresponding QRS complex. Multifocal PVCs are seen. A multifocal couplet makes up the first two complexes. Then PVCs are seen briefly in a bigeminal pattern. PR: .16 sec, QTS .10 sec, QT: .36 sec.
Reviewed 3/2/16
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Answers
1.
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| AV dissociation |
If you follow the P waves on the first three complexes, you will notice that their association with the QRS complex changes. This is followed by two junctional beats and then by sinus rhythm. This rhythm does not meet all the text book criteria for a 3rd degree block or a junctional rhythm. It is somewhere in between so I chose the safer description of an AV dissociated rhythm.
2.
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| Atrial fibrillation with occasional PVCs and a couplet of PVCs |
The rhythm is irregular with a rate of 110/min. No P waves are present. Fibrillatory waves are seen between the QRS complexes. There is a single PVC as well as a couplet. The T wave is inverted in lead II and there is an rSR configuration to the QRS complex in lead V1. PR: ---, QRS: .12 sec, QT: .32 sec
3.
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| Atrial paced rhythm |
The rhythm is regular with a rate of 60/min. P waves are present and are preceded by an atrial pacing stimulus. No ectopic beats are noted. 1mm ST depression is seen in lead II. PR: .20 sec, QRS: .08 sec, QT: .40 sec.
4.
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| Sinus arrhythmia with ST elevation |
The rhythm is irregular with a rate of 70/min. The P waves are uniform, upright, and precede the QRS complex. The R-R interval between the 1st and 2nd complex is 0.8 sec and the R-R interval between the 2nd and 3rd complex is .96 sec. There are deep Q waves with ST elevation in lead II which is indicative of an acute MI. A significant Q wave is defined as being > 0.04 sec or 1/3 the height of the R wave. PR: .16 sec, QRS: .10 sec, QT: .36 sec.
5.
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| NSR with some ventricular bigeminy |
The bottom waveform is a pulmonary artery catheter waveform. The rhythm is irregular with many PVCs. The rate is 90/min. The P waves are uniform, upright and have a corresponding QRS complex. Multifocal PVCs are seen. A multifocal couplet makes up the first two complexes. Then PVCs are seen briefly in a bigeminal pattern. PR: .16 sec, QTS .10 sec, QT: .36 sec.
Reviewed 3/2/16
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