EKG Rhythm Strips 71
Identify the following rhythm strips.
a. 1st degree heart block
b. Mobitz 1
c. Mobitz 2
d. 3rd degree heart block
2.
a. Atrial fibrillation with rapid ventricular response
b. Atrial flutter with variable rate
c. Atrial tachycardia
d. Wandering atrial pacemaker
3.
a. Asynchronous atrial paced
b Sinus bradycardia with dual chamber pacing
c. Atrial fibrillation with demand ventricular pacing
d. Atrial fibrillation with unifocal PVCs
4.
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a. Normal sinus rhythm
b. Ventricular paced
c. Atrial paced
d. Biventricular paced
5.
a. Atrial paced
b. Ventricular paced
c. AV paced
d. Biventricular paced
Answers
1. b. Mobitz 1.
The rhythm is irregular with a rate of 40/min. The P waves are uniform and upright but the PR interval increases and there are nonconducted P waves after the 3rd and 6th complexes. No ectopic beats are noted. PR: .28/.44/.52 sec, QRS: .12 sec, QT: .44 sec.
2. b. Atrial flutter with variable rate.
The rhythm is irregular with a ventricular rate of 40/min. There are fibrillatory waves between the QRS complexes. No ectopy is noted. PR: ---, QRS: .08 sec, QT: .44 sec.
3. c. Atrial fibrillation with demand ventricular pacing
The rhythm is irregular with a rate of 60/min. The P waves are absent but fibrillatory waves are seen between the QRS complexes. No ectopic beats are seen. There are two demand ventricular paced beats present with a pacer spike that precedes the QRS complex. The ST segment is down slopping with inversion of the T wave. PR: ---, QRS: .08 sec, QT: .36 sec.
4. a. Normal sinus rhythm.
The rhythm is regular. The rate is 65/min. There are uniform, upright P waves before each QRS complex. No ectopic beats are noted. The QRS complex is wide with an RSR pattern. The ST segment is down slopping with T wave depression. PR: .12 sec, QRS: .186 sec, QT: .40 sec.
This is a really diseased heart. The patient did not have a pacemaker.
5. d. Biventricular paced.
The rhythm is regular with a rate of 88/min. There are P waves present but they vary in morphology. They may be flutter waves. No ectopic beats are noted. Biventricular pacer spikes are noted. PR: ---, QRS: .16 sec, QT: .44 sec
I am puzzled because there are not biventricular pacing spikes noted with each beat. I don't know if there was either a problem with the monitor detecting the pacing stimulus or an inherent pacemaker problem. Any thoughts on this rhythm?
Reviewed 3/8/16
1.
b. Mobitz 1
c. Mobitz 2
d. 3rd degree heart block
2.
b. Atrial flutter with variable rate
c. Atrial tachycardia
d. Wandering atrial pacemaker
3.
b Sinus bradycardia with dual chamber pacing
c. Atrial fibrillation with demand ventricular pacing
d. Atrial fibrillation with unifocal PVCs
4.
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b. Ventricular paced
c. Atrial paced
d. Biventricular paced
5.
b. Ventricular paced
c. AV paced
d. Biventricular paced
Answers
1. b. Mobitz 1.
The rhythm is irregular with a rate of 40/min. The P waves are uniform and upright but the PR interval increases and there are nonconducted P waves after the 3rd and 6th complexes. No ectopic beats are noted. PR: .28/.44/.52 sec, QRS: .12 sec, QT: .44 sec.
2. b. Atrial flutter with variable rate.
The rhythm is irregular with a ventricular rate of 40/min. There are fibrillatory waves between the QRS complexes. No ectopy is noted. PR: ---, QRS: .08 sec, QT: .44 sec.
3. c. Atrial fibrillation with demand ventricular pacing
The rhythm is irregular with a rate of 60/min. The P waves are absent but fibrillatory waves are seen between the QRS complexes. No ectopic beats are seen. There are two demand ventricular paced beats present with a pacer spike that precedes the QRS complex. The ST segment is down slopping with inversion of the T wave. PR: ---, QRS: .08 sec, QT: .36 sec.
4. a. Normal sinus rhythm.
The rhythm is regular. The rate is 65/min. There are uniform, upright P waves before each QRS complex. No ectopic beats are noted. The QRS complex is wide with an RSR pattern. The ST segment is down slopping with T wave depression. PR: .12 sec, QRS: .186 sec, QT: .40 sec.
This is a really diseased heart. The patient did not have a pacemaker.
5. d. Biventricular paced.
The rhythm is regular with a rate of 88/min. There are P waves present but they vary in morphology. They may be flutter waves. No ectopic beats are noted. Biventricular pacer spikes are noted. PR: ---, QRS: .16 sec, QT: .44 sec
I am puzzled because there are not biventricular pacing spikes noted with each beat. I don't know if there was either a problem with the monitor detecting the pacing stimulus or an inherent pacemaker problem. Any thoughts on this rhythm?
Reviewed 3/8/16
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