EKG Rhythm Strips 69
Identify the following rhythms
a. Normal sinus rhythm with occasional PVCs
b. 1st degree AV block with occasional PVCs
c. Sinus bradycardia with occasional PVCs
d. Sinus arrhythmia with occasional PVCs
2.
a. Normal sinus rhythm with sinus pauses
b. Sinus arrhythmia
c. Mobitz 1
d. Atrial fibrillation with controlled ventricular rate
3.
a. Atrial flutter with rapid ventricular response
b. Wandering atrial pacemaker
c. Atrial fibrillation with slow ventricular response
d. Complete heart block
4.
a. 2nd degree heart block type II
b. Normal sinus rhythm
c. Idioventricular rhythm
d. Sinus bradycardia
5.
a. Sinus arrest with unifocal PVCs
b. Ventricular paced with multifocal PVCs
c. Sinus bradycardia with a couplet of PVCs
d. Sinus rhythm with ventricular escape beats
Answers
1. b. 1st degree AV block with occasional PVCs.
The rhythm is regular and the rate is 65/min. The P waves are uniform and associated with a QRS complex. The PR interval is prolonged. There are no ectopic complexes. PR: .22 sec, QRS: .10 sec, QT: .36 sec.
2. c. Mobitz 1. The rhythm is irregular with a rate of 40/min. The P waves are uniform and upright but there are some dropped P waves. There is progressive lengthening of the PR interval.
No ectopic beats are noted. The 5th complex that follows the dropped beat arrives later in the cycle and appears to be a ventricular escape beat. The 6th complex resumes the cycle. PR: .20/.36 QRS: .12 sec, QT: .44 sec.
The clue to quickly interpreting an AV block is to look at the PR interval and look for grouped beats. If it increases over successive beats then it is a 2nd degree type 1. It the PR interval is consistent then it is a 2nd degree type 2. It the PR interval is inconsistent over successive beats then it is probably a complete heart block.
3. c. Atrial fibrillation with slow ventricular response.
The rhythm is irregular with a rate of 50/min. There are fibrillatory/flutter waves between the QRS complexes. No ectopic beats are noted. The QRS complex has a RSR pattern in lead II. There is 1mm ST depression in lead II and 3mm ST elevation in lead V1. PR: ---, QRS: .12 sec, QT: .52 sec.
Some people would call this rhythm a fib/flutter because it has some characteristics of both an atrial fibrillation and an atrial flutter. Although a left bundle branch block is seen best in I, V5, and V6, it effects can be seen in lead II as well. If this the case, then ST elevation in lead V1 may not be associated with an infarction. A new LBBB in this patient would be of great concern.
4. d. Sinus bradycardia.
The rhythm is regular with a sinus rate of 46/min. The P waves are upright, uniform, and have a corresponding QRS complex. No ectopic beats are present. There ST segment is up slopping and there is some inversion of the T wave. The QT interval is prolonged. PR: .12 sec, QRS: .10 sec, QT: .60 sec.
5. b. Ventricular paced with multifocal PVCs
The rhythm is irregular due to the ventricular ectopy. The rate is 90/min. The P waves are upright and precede the QRS complex. Multifocal PVCs are present. Ventricular pacer spikes are seen before the QRS complexes. PR: .14 sec, QRS: .12 sec, QT: .34 sec.
Reviewed 3/6/16
1.
a. Normal sinus rhythm with occasional PVCs
b. 1st degree AV block with occasional PVCs
c. Sinus bradycardia with occasional PVCs
d. Sinus arrhythmia with occasional PVCs
2.
a. Normal sinus rhythm with sinus pauses
b. Sinus arrhythmia
c. Mobitz 1
d. Atrial fibrillation with controlled ventricular rate
3.
a. Atrial flutter with rapid ventricular response
b. Wandering atrial pacemaker
c. Atrial fibrillation with slow ventricular response
d. Complete heart block
4.
a. 2nd degree heart block type II
b. Normal sinus rhythm
c. Idioventricular rhythm
d. Sinus bradycardia
5.
a. Sinus arrest with unifocal PVCs
b. Ventricular paced with multifocal PVCs
c. Sinus bradycardia with a couplet of PVCs
d. Sinus rhythm with ventricular escape beats
Answers
1. b. 1st degree AV block with occasional PVCs.
The rhythm is regular and the rate is 65/min. The P waves are uniform and associated with a QRS complex. The PR interval is prolonged. There are no ectopic complexes. PR: .22 sec, QRS: .10 sec, QT: .36 sec.
2. c. Mobitz 1. The rhythm is irregular with a rate of 40/min. The P waves are uniform and upright but there are some dropped P waves. There is progressive lengthening of the PR interval.
No ectopic beats are noted. The 5th complex that follows the dropped beat arrives later in the cycle and appears to be a ventricular escape beat. The 6th complex resumes the cycle. PR: .20/.36 QRS: .12 sec, QT: .44 sec.
The clue to quickly interpreting an AV block is to look at the PR interval and look for grouped beats. If it increases over successive beats then it is a 2nd degree type 1. It the PR interval is consistent then it is a 2nd degree type 2. It the PR interval is inconsistent over successive beats then it is probably a complete heart block.
3. c. Atrial fibrillation with slow ventricular response.
The rhythm is irregular with a rate of 50/min. There are fibrillatory/flutter waves between the QRS complexes. No ectopic beats are noted. The QRS complex has a RSR pattern in lead II. There is 1mm ST depression in lead II and 3mm ST elevation in lead V1. PR: ---, QRS: .12 sec, QT: .52 sec.
Some people would call this rhythm a fib/flutter because it has some characteristics of both an atrial fibrillation and an atrial flutter. Although a left bundle branch block is seen best in I, V5, and V6, it effects can be seen in lead II as well. If this the case, then ST elevation in lead V1 may not be associated with an infarction. A new LBBB in this patient would be of great concern.
4. d. Sinus bradycardia.
The rhythm is regular with a sinus rate of 46/min. The P waves are upright, uniform, and have a corresponding QRS complex. No ectopic beats are present. There ST segment is up slopping and there is some inversion of the T wave. The QT interval is prolonged. PR: .12 sec, QRS: .10 sec, QT: .60 sec.
5. b. Ventricular paced with multifocal PVCs
The rhythm is irregular due to the ventricular ectopy. The rate is 90/min. The P waves are upright and precede the QRS complex. Multifocal PVCs are present. Ventricular pacer spikes are seen before the QRS complexes. PR: .14 sec, QRS: .12 sec, QT: .34 sec.
Reviewed 3/6/16
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