Practice EKG Strips 432

Identify the following rhythms.

1.

a. Complete heart block
b. Second degree heart block type I
c. First degree block
d. 2nd degree heart block type II

2.

a. Failure to capture
b. Failure to sense
c. Demand atrial pacing
d. Complete heart block

3.

a. Third degree heart block
b. A type I block changing to a type II block
c. Sinus arrhythmia
d. Sinus bradycardia with sinus arrest


4.

a. Atrial paced
b. AV paced
c. Biventricular paced
d. Ventricular paced

5.

a. Sinus rhythm with multifocal PVCs
b. Atrial fibrillation with unifocal PVCs
c. Sinus rhythm with bigeminal PVCs
d. Sinus arrest with multiform PVCs



Answers
1. a. Complete heart block.  In this strip the P waves are not associated with a QRS complex and this is evidenced by a PR interval that varies from beat to beat.

2. a. Failure to capture. Everything is going well until after the 6th beat then the pacemaker fails to capture. There are pacemaker spikes but no associated ventricular activity. The pacing resumes with the last two beats

3. b. A type I block changing to a type II block. Nice run of Wenckebach. then it changes to a type two block with consistent PR intervals.  It appears that the dropped P wave is fused with the T wave of the 2nd complex.  Notice the change in the morphology of that P wave.  After the pause, a 2nd degree block begins with 2:1 conduction.  The PR interval is fixed on complexes 3 - 5.

4. b. AV paced. 100% paced. Pacer spikes are seen before both the P wave and the QRS complexes. The rate is 60/min.

5. c. Sinus rhythm with bigeminal PVCs. The rhythm is irregular. Upright P waves are paired with QRS complexes. The P waves are wide, left atrial enlargement. The sinus QRS complexes are narrow. A unifocal PVC is seen every other beat. A compensatory pause follows each PVC. PR: .16 sec, QRS: .08 sec, QT: .36 sec.