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Bigeminal PVCs and a couplet  

Sinus rhythm with a triplet and couplet of PVCs  

Identify the following rhythms. 1. 2. 3. 4. 5. Answers 1. Complete heart block The rhythm is regular with a ventricular rate of 38/min.   There are small upright P waves present but they are not associated with a QRS complex.   The QRS complexes are wide suggesting a ventricular origin.   No ectopic beats are seen.   PR:  ---,  QRS:  .16 sec,  QT:  .40 sec. Interpretation:  Complete heart block 2. Normal sinus rhythm The rhythm is regular.   The rate is 75/min.   There are upright P waves before each QRS complex. Lead II shows 3mm ST segment depression with an inverted T wave.   No ectopic beats are seen. PR:  .16 sec,  QRS:  .08 sec,  QT:  .36 sec.  Interpretation:  Normal sinus rhythm 3. Normal sinus rhythm with a multifocal couplet This strip shows an arterial blood pressure waveform in the 2nd lead. ...

Identify the following rhythms. 1. 2. 3. 4. 5. Answers 1. Complete heart block The rhythm is regular with a rate of 38/min.   The P waves are upright and uniform.   There is no association between the P waves and the QRS complexes.   A P wave is buried in the ST segment of the 2nd complex.  No ectopic beats are seen.   The QRS complex is wide suggesting an ventricular escape rhythm.   PR:  ---,  QRS:  .16 sec,  QT:  .52 sec. 2. Junctional rhythm changing to a sinus rhythm The rhythm is irregular with a rate of 70/min.   The initial 3 complexes have negative P waves and the remaining 4 complexes have upright P waves.  There is slight pause after the 3rd complex in which the rhythm transitions from a junctional rhythm to a sinus rhythm.   All the P waves have a corresponding QRS complex.  No ectopic bea...

Identify the following rhythms. 1. 2. 3. 4. 5. Answers 1. Sinus bradycardia with biphasic P waves The rhythm is regular and the rate is 57/min.   There are biphasic P waves present.  The first deflection is negative followed by a positive upstroke.  No ectopic beats are present.  There is some slurring of the R wave which almost gives it a delta-looking appearance.  PR:  .12 sec,  QRS:  .10 sec,  QT:  .44 sec. 2. Normal sinus rhythm with unifocal PVCs The rhythm is irregular due to the PVCs.   The rate is 90/min.   There are upright P waves that precede a QRS complex.  Two unifocal PVCs are present.  The PVCs are followed by a compensatory pause.  The PVCs have a buried P wave in the down slope of the S wave.  If you measure the P-P interval you will see that the P-P intervals on the blocked P wav...

Identify the following rhythms. 1. 2. 3. 4. 5. Answers 1. Bigeminy The rhythm is irregular due to the unifocal PVCs.   The rate is 90.  There are small upright P waves present.  There are PVCs occurring every 2nd beat.   PR:  .14 sec,  QRS:  .16 sec, QT:  .40 sec. 2. Biventricular paced with a multifocal couplet The rhythm is irregular due to the couplet.   The rate is 80/min.  The are flutter waves between the QRS complexes.  A multifocal couplet is present.  There are biventricular pacer spikes before the QRS complexes.  PR: ---,  QRS:  .12 sec,  QT:  .32 sec 3. Trigeminy The rhythm is irregular due to the unifocal PVCs.   The rate is 80/min.   The are small upright P waves present.  The PR interval is progressively lengthening.  Unifocal PVCs are present every 3r...

Identify the following rhythms. 1. 2. 3. 4. 5. Answers 1. 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. 2. 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. 3. ...