Practice EKG Rhythm Strips 230
Identify the following rhythms.
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Answers
1.
The rhythm is irregular. The heart rate is 120/min. The P waves are readily identified. There appears to be some fibrillatory activity between the QRS complexes. There are some multifocal PVCs seen every third beat in a trigeminal pattern. PR: ---, QRS: .08 sec, QT: .36 sec. Interpretation: Atrial fibrillation with trigeminal PVCs.
2.
The rhythm is irregular. There are some upright P waves present but the morphology of the P waves begin to change after the 3rd complex. The P wave of the 4th - 6th complex fuses with the QRS complex. The progressive shortening of the PR interval and the fusion of the P wave with the QRS complex represent some kind of AV dissociation. The initial rhythm begins as sinus bradycardia and then changes to dissociated rhythm. The QRS complex is narrow throughout the rhythm so the rhythm is supraventricular in nature. The P waves of the 3rd-6th complexes are probably not conducting and a thus a junctional escape rhythm begins to emerge. PR: .12 sec, QRS: .08 sec, QT: .40 sec. Interpretation: Sinus bradycardia with competing junctional escape rhythm. See ACLS 2013 Arrhythmias by Ken Gauer, MD for an excellent explanation regarding AV dissociation
3.
The rhythm is irregular. The rate is 50/min. The P waves show some splitting but they are uniform and upright. The QRS complex is narrow. No ectopic beats are noted. PR: .16 sec, QRS: .08 sec, QT: .44 sec. Interpretation: Sinus bradycardia with sinus arrhythmia
4.
The rhythm is regular with a heart rate of 188/min. The P waves are not seen. The QRS complex is narrow which suggests a supraventricular origin for the rhythm. No ectopic beats are seen. PR: ---, QRS: .08 sec. QT: .28 sec. Interpretation: Supraventricular tachycardia
5.
The rhythm is irregular. The ventricular rate is at leas 300/min or higher. No P waves are seen. The QRS complex is very irregular and varies in morphology. Interpretation: Ventricular fibrillation
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Answers
1.
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| Atrial fibrillation with trigeminal PVCs |
The rhythm is irregular. The heart rate is 120/min. The P waves are readily identified. There appears to be some fibrillatory activity between the QRS complexes. There are some multifocal PVCs seen every third beat in a trigeminal pattern. PR: ---, QRS: .08 sec, QT: .36 sec. Interpretation: Atrial fibrillation with trigeminal PVCs.
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| Sinus bradycardia with competing junctional escape rhythm |
The rhythm is irregular. There are some upright P waves present but the morphology of the P waves begin to change after the 3rd complex. The P wave of the 4th - 6th complex fuses with the QRS complex. The progressive shortening of the PR interval and the fusion of the P wave with the QRS complex represent some kind of AV dissociation. The initial rhythm begins as sinus bradycardia and then changes to dissociated rhythm. The QRS complex is narrow throughout the rhythm so the rhythm is supraventricular in nature. The P waves of the 3rd-6th complexes are probably not conducting and a thus a junctional escape rhythm begins to emerge. PR: .12 sec, QRS: .08 sec, QT: .40 sec. Interpretation: Sinus bradycardia with competing junctional escape rhythm. See ACLS 2013 Arrhythmias by Ken Gauer, MD for an excellent explanation regarding AV dissociation
3.
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| Sinus bradycardia with sinus arrhythmia |
The rhythm is irregular. The rate is 50/min. The P waves show some splitting but they are uniform and upright. The QRS complex is narrow. No ectopic beats are noted. PR: .16 sec, QRS: .08 sec, QT: .44 sec. Interpretation: Sinus bradycardia with sinus arrhythmia
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| Supraventricular tachycardia |
The rhythm is regular with a heart rate of 188/min. The P waves are not seen. The QRS complex is narrow which suggests a supraventricular origin for the rhythm. No ectopic beats are seen. PR: ---, QRS: .08 sec. QT: .28 sec. Interpretation: Supraventricular tachycardia
5.
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| Ventricular fibrillation |
The rhythm is irregular. The ventricular rate is at leas 300/min or higher. No P waves are seen. The QRS complex is very irregular and varies in morphology. Interpretation: Ventricular fibrillation
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