Practice EKG Rhythm Strips 164
Identify the following rhythms.
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Answers
1.
The rhythm is irregular. The rate is 70/min. The P wave are upright and precede the QRS complexes. The PR interval is prolonged. Beginning at the 5th complex the rhythm transitions into a type I block with progressive lengthening of the PR interval and ending with a dropped beat after the 8th complex. The ST segment is down slopping. No ecoptic beats are seen. PR: .24 sec then progressively lengthening, QRS: .08 sec, QT: .44 sec.
2.
This rhythm is irregular and the rate is 110/min. No P waves are present but there are some fibrillatory/flutter waves present. Uncommonly it is called "flutteration." No ectopy is present. PR: ---, QRS: .08 sec, QT: .24 sec.
3.
The rhythm is irregular with a rate of 100/min. Flutter waves are seen between some of the QRS complexes. There is a variable block of 2:1, 3:1, 4:1. The variably is seen best in the V1 lead. No ectopy is noted. PR: ---, QRS: .08 sec, QT: .32 sec.
4.
There is a loose lead in lead II that looks like a polymorphic VT and atrial fibrillation in lead III.
5.
The rhythm is irregular. The rate is 70/min. The P waves are upright and are associated with QRS complexes. A multifocal couplet follows the 2nd complex. This is followed by a pause and sinus rhythm resumes. PR: .20 sec, QRS: .08 sec, QT: .44 sec.
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Answers
1.
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| 1st degree block changing to a type I AV block |
The rhythm is irregular. The rate is 70/min. The P wave are upright and precede the QRS complexes. The PR interval is prolonged. Beginning at the 5th complex the rhythm transitions into a type I block with progressive lengthening of the PR interval and ending with a dropped beat after the 8th complex. The ST segment is down slopping. No ecoptic beats are seen. PR: .24 sec then progressively lengthening, QRS: .08 sec, QT: .44 sec.
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| Atrial fibrillation |
This rhythm is irregular and the rate is 110/min. No P waves are present but there are some fibrillatory/flutter waves present. Uncommonly it is called "flutteration." No ectopy is present. PR: ---, QRS: .08 sec, QT: .24 sec.
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| Atrial flutter with a variable block |
The rhythm is irregular with a rate of 100/min. Flutter waves are seen between some of the QRS complexes. There is a variable block of 2:1, 3:1, 4:1. The variably is seen best in the V1 lead. No ectopy is noted. PR: ---, QRS: .08 sec, QT: .32 sec.
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| Loose lead artifact |
There is a loose lead in lead II that looks like a polymorphic VT and atrial fibrillation in lead III.
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| Normal sinus rhythm with a multifocal couplet |
The rhythm is irregular. The rate is 70/min. The P waves are upright and are associated with QRS complexes. A multifocal couplet follows the 2nd complex. This is followed by a pause and sinus rhythm resumes. PR: .20 sec, QRS: .08 sec, QT: .44 sec.
I liked the atrial flutter with variable block cause it is the most challenging one , thx
ReplyDeleteThank you Salem Omar. The cardiologist that I work with told me that if the rhythm is irregular and has some atrial fibrillation present, then he was more apt to call it atrial fibrillation as opposed to atrial flutter with a variable block. I don't know if that is his personal preference or whether it is a standard among cardiologist.
ReplyDeleteThank you Mike, yes of course if the rhythm is irregular irregular this is AF however rhythm #3 is having grouped beating so it is regularly irregular in a sense that the beats inside the grouped beating are regular, my teacher told me to think about wenkebach whenever i see it but rhythm #3 is more like atrial flutter with variable block.
ReplyDeletesometimes i feel EKG interpretation is more like it is in the eye of the beholder ....
"The eye of the beholder" Yes! How very true. The heart does not play by our well defined rules and definitions.
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