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Ventricular paced with a run of VT:  Complexes 1-5 are ventricular paced.  These are followed by an 8 beat run of VT.  A pause follows the run of VT and an fusion beat is seen.  The last two complexes are native or intrinsic beats.  

On this page the pacemaker is either attempting to override the fast heart rate or accelerating to keep up with the patient's physical demands.  Any thoughts?

Identify the following rhythms. 1. 2. 3. 4. 5. Answers 1. Accelerated idioventricular rhythm The rhythm is regular with a rate of 48/min.   No P waves are seen.  The QRS is wide, suggesting a ventricular origin for the rhythm.  There are no ectopic beats.  PR:  ---,  QRS:  .12 sec,  QT:  .38 sec.   Interpretation:  Accelerated idioventricular rhythm 2.  Normal sinus rhythm with unifocal PVCs The rhythm is irregular.  The rate is 90/min.  There are upright P waves associated with a QRS complex.   The are two unifocal PVCs present.   PR:  .16 sec,  QRS:  .08 sec,  QT:  .38 sec.   Interpretation:   Normal sinus rhythm with unifocal PVCs 3.  P wave asystole The rhythm is regular with a rate of 57/min.   P waves are present but there are not corresponding QRS complexes, the...

Identify the following rhythms. 1. 2. 3. 4. 5. Answers 1. Atrial fibrillation with a PVC The rhythm is irregular with a rate of 60/min.   No P waves are present.   Fibrillation and flutter waves are present between the QRS complexes.  The 5th complex is a PVC.  There is some ST depression in  lead II.  PR:  ---,  QRS:  .08 sec,  QT:  .36 sec.   Interpretation:  Atrial fibrillation with a PVC 2. The rhythm is regular.   The heart rate is 48/min.  No P waves are seen.  The QRS complex is wide suggesting a ventricular origin for this rhythm.  No ectopic beats are noted.  PR:  ---,  QRS:  .12 sec,  QT:  .36 sec.  Interpretation:  Accelerated idioventricular rhythm. 3. NSR with a PVC triplet The rhythm is irregular due to the PVCs.   The rate is 90/min.  There are uprig...

Identify the following rhythms. 1. 2. 3. 4. 5. Answers 1. Sinus bradycardia with a PJC The rhythm is irregular with a heart rate of 50/min.   The P waves are upright, except for the 2nd complex.   The P wave of the PJC is negative.   PR:  .16 sec,  QRS:  .08 sec, QT:  .40 sec. 2. Ventricular paced with unifocal PVCs The rhythm is irregular due to the PVCs.   The ventricular rate is 60/min.   No P waves are seen. There are two unifocal PVCs present, the 1st and 4th complexes.   There are ventricular pacer spikes before the remaining QRS complexes.  PR:  ---,  QRS:  .16 sec,  QT:  .44 sec. 3. Junctional tachycardia The rhythm is regular with a rate of 125/min.   The P waves are absent.  No ectopic beats are noted.  The QRS complex is narrow.   PR:  ---,  QRS:  .08 sec,  QT...

Identify the following rhythms. 1. 2. 3. 4. 5. Answers 1. 3rd degree heart block The rhythm is irregular with a ventricular rate of 30 and an atrial rate of 88/min.   The P waves and the QRS complexes are not associated.  The wide QRS complex suggests an underlying ventricular escape rhythm.  No ectopic beats are present.  PR:  ---,  QRS;  .12 sec,  QT:  ..60 sec. 2. Accelerated idioventricular rhythm The rhythm is regular with a rate of 68.   No P waves are noted.  The QRS complex is very wide and the T waves are tall.  No PVCs, PJCs, or PACs are present.   PR:  ---,  QRS:  .22 sec.  QT:  .56 sec.  This patient was actually profoundly hyperkalemic.   With severe hyperkalemia there is loss or flattening of the P wave,  a nodal rhythm,  bizarre and widened QRS complex that may have a sine wave appearan...

Identify the following rhythms. 1. 2. 3. 4. 5. Answers 1. Complete heart block The rhythm is regular with a ventricular rate of 35/min and an atrial rate of 100/min.   The P waves and the QRS complexes are not associated.   The wide QRS complexes with a slow rate is indicative of  a ventricular escape rhythm.   PR:  ---,  QRS:  .16 sec,  QT:  .40 sec. 2. NSR with a multifocal couplet The rhythm is is irregular due to the PVCs.   The heart rate is 90/min.   The P waves are upright and appear before the QRS complexes.  A multifocal couplet is present.  The rSR pattern in the V1 lead suggests a RBBB.   There is 1mm ST depression in lead II.  PR:  .16 sec,  QRS:  .12 sec,  QT:  .36 sec. 3. NSR with trigeminal PACs The rhythm is irregular with frequent PACs.   The rate is 100/min.  ...