essentials of ecg & dysrhythmia monitoring

1Practice Strips

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ESSENTIALS OF ECG & DYSRHYTHMIA MONITORING

Practice StripsAnalyze each strip and check your interpretation with the answer key at the end.

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Answer Key

1

1) Regular; 2) atrial and ventricular rate 54 bpm (division or sequence); 3) there are P waves after each QRS, inverted in lead II; 4) no PR interval; 5) QRS 0.04 sec; 6) QT 0.40 sec; 7) abnormalities are a rate of 54 bpm and P waves after each QRS which are inverted in lead II; 8) junctional rhythm

21) Regular; 2) atrial and ventricular rates 63 bpm (division or sequence); 3) there are P waves before each QRS; 4) PR 0.20 sec; 5) QRS 0.16 sec; 6) QT 0.44 sec; 7) abnormality is a QRS duration 0.16 sec; 8) sinus rhythm with bundle branch block

3

1) Atrial rhythm is regular and ventricular irregular; 2) atrial rate 65 (division) or 66 (sequence) and ventricular rate 50 bpm (6 second); 3) there are P waves before each QRS and two P waves without a QRS; 4) PR 0.20 sec; 5) QRS 0.14 sec; 6) QT 0.44 sec; 7) abnormalities are an atrial rate faster than ventricular rate, two P waves which do not conduct QRSs, resulting in an irregular ventricular rhythm with a rate of 50 bpm; 8) second-degree AV block type II

41) Regular; 2) ventricular rates 31 bpm (division); 3) there are no P waves; 4) no PR interval; 5) QRS 0.12 sec; 6) QT 0.44 sec; 7) abnormalities are no P waves, a ventricular rate of 31 bpm and QRS 0.12 sec; 8) idioventricular rhythm

5 1) No rhythm; 2) no atrial or ventricular rates; 3) no P waves; 4) no PR interval; 5) no QRS; 6) no QT; 7) abnormalities are no P QRS or T waves and a nearly flat baseline; 8) asystole

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1) Irregular; 2) atrial rate 50 bpm (6 second) and ventricular rate 100 bpm (6 second); 3) there are P waves before each narrow QRS; 4) PR 0.20 sec; 5) narrow QRS 0.06 sec, wide QRS 0.08-0.16 sec; 6) QT 0.32 sec for narrow beats, 0.52 for wide beats; 7) abnormalities are an irregular rhythm due to early wide QRSs with a duration of 0.08-0.16 sec; 8) sinus beats with premature ventricular contractions (PVCs); the PVCs occur in a bigeminal pattern and are multifocal

71) Regular; 2) atrial and ventricular rate 136 bpm (division) or 130 bpm (sequence); 3) there are P waves before each QRS, Ps are inverted but that is normal in V1; 4) PR interval 0.12 sec; 5) QRS 0.04 sec; 6) QT 0.20 sec; 7) abnormality is a rate of 136 bpm; 8) sinus tachycardia

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1) Regular; 2) atrial and ventricular rate 41 bpm (division or sequence); 3) there are P waves after each QRS, Ps are inverted in lead II; 4) PR can’t be measured; 5) QRS 0.08 sec; 6) QT 0.48 sec; 7) abnormalities are a rate of 41 bpm and inverted P waves after each QRS; 8) junctional rhythm

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1) Irregular; 2) ventricular rate 200 bpm (6 second); 3) there are no P waves; 4) no PR interval; 5) QRS varies 0.12-0.16 sec; 6) QT can’t be measured; 7) abnormalities are an irregular rhythm with no P waves, a ventricular rate of 200 bpm with QRS that varies in shape with duration 0.12-0.16 sec; 8) ventricular tachycardia (polymorphic ventricular tachycardia)

101) Regular; 2) ventricular rate 58 bpm (division or sequence); 3) there are no P waves; 4) no PR interval; 5) QRS 0.12 sec; 6) QT 0.52 sec; 7) abnormalities are a ventricular rate of 58 bpm, no P waves, and QRS of 0.12 sec; 8) accelerated idioventricular rhythm

Strip Answers Number

17Practice Strips


Answer Key

111) Regular; 2) atrial and ventricular rates 94 bpm (division) or 95 bpm (sequence); 3) there are P waves before each QRS; 4) PR 0.24 sec; 5) QRS 0.08 sec; 6) QT 0.32 sec; 7) abnormality is PR 0.24 sec; 8) sinus rhythm with first-degree AV block

12

1) Irregular due to two early beats; 2) atrial and ventricular rates 70 bpm (6 second); 3) there are P waves before each QRS but the P before the third QRS is inverted in lead II; 4) PR 0.16 sec and 0.06 sec for the inverted P; 5) QRS 0.06 sec; 6) QT 0.36 sec; 7) abnormalities are an irregular rhythm due to two early beats and an inverted P wave in lead II with a short PR interval before the third QRS; 8) sinus rhythm with a premature junctional contraction (PJC, the third beat) and a premature atrial contraction (PAC, the last beat)

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1) Regular; 2) atrial rate 58 bpm (division and sequence) and ventricular rate 29 bpm (division); 3) there are P waves before each QRS but every other P wave fails to conduct a QRS; 4) PR 0.20 sec; 5) QRS 0.14 sec; 6) QT 0.56 sec; 7) abnormalities are an atrial rate of 58 and a ventricular rate of 29 bpm, only every other P wave conducts a QRS; 8) 2:1 second-degree AV block

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1) Irregular due three early P-QRS-Ts; 2) atrial and ventricular rates 80 bpm (6 second); 3) there are P waves in front of every QRS but the one in front of the early beats look different; 4) PR 0.20 sec; 5) QRS 0.06 sec; 6) QT 0.32 sec; 7) abnormalities are an irregular rhythm due to three early P-QRS-Ts; 8) sinus rhythm with premature atrial contractions (PACs)

15

1) Irregular due to a missing beat resulting in a noncompensatory pause; 2) atrial and ventricular rates 50 bpm (6 second); 3) there are P waves before each QRS; 4) PR 0.24 sec; 5) QRS 0.08 sec; 6) QT 0.40 sec; 7) abnormalities are an irregular rhythm and rate of 50 bpm due to a missing beat resulting in a noncompensatory pause, and a PR 0.24 sec; 8) sinus bradycardia with first-degree AV block and a sinus pause

161) Irregular; 2) ventricular rate 60 bpm (6 second); 3) there are no P waves but a coarse baseline; 4) no PR interval; 5) QRS 0.06 sec; 6) QT 0.48 sec; 7) abnormalities are an irregular rhythm, no P waves with a coarse baseline; 8) atrial fibrillation

171) Regular; 2) ventricular rate 60 bpm (division and sequence); 3) there are no P waves; 4) no PR interval; 5) QRS 0.12 sec; 6) QT 0.48 sec; 7) abnormalities are no P waves and a QRS 0.12 sec; 8) accelerated idioventricular rhythm

181) Regular; 2) atrial and ventricular rates 65 bpm (division) or 66 bpm (sequence); 3) there are P waves before each QRS but they are inverted in lead II; 4) PR 0.12 sec; 5) QRS 0.08 sec; 6) QT 0.52 sec; 7) abnormality is P waves that are inverted in lead II; 8) accelerated junctional rhythm

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1) Regular 2) atrial and ventricular rates 250 bpm (division) pr 270 bpm (sequence); 3) there appear tobe P waves before each QRS but thery are burried in the T waves; 4) PR interval can not be measured; 5) QRS 0.08 sec; 6) QT 0.24 sec; 7) abnormalities Atrial and ventircular rates of 250 bpm resulting in P waves burried in the T waves and unmeasurable PR; 8) supraventricular tachycardia (SVT)

201) Irregular; 2) atrial and ventricular rates 50 bpm (6 second); 3) there are P waves before each QRS; 4) PR 0.16 sec; 5) QRS 0.06 sec; 6) QT 0.44 sec; 7) abnormalities are an irregular rhythm that changes slowly and a rate of 50 bpm; 8) sinus arrhythmia


18 Practice Strips


Answer Key

21

1) Regular; 2) atrial rate 97 bpm (division) or 95 bpm (sequence) and ventricular rate 34 bpm (division); 3) there are P waves; 4) PR intervals vary with no pattern; 5) QRS 0.20 sec; 6) QT 0.44 sec; 7) abnormalities are an atrial rate faster than ventricular rate of 34 bpm, PR intervals that vary with no pattern and QRS 0.20 sec; 8) third-degree AV block

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1) Irregular overall with a burst of regular tachycardia; 2) atrial rate difficult to determine as Ps are only seen before and after the wide complex tachycardia, ventricular rate 150 bpm (6 second) overall, but during the burst of regular wide tachycardia rate is 167 bpm (division) or 180 bpm (sequence); 3) there are P waves before each narrow QRS; 4) PR 0.24 sec for the narrow beats; 5) QRS 0.06 sec for narrow beats and 0.16 sec for wide beats; 6) QT is distorted (by P waves for narrow QRSs and by next QRS for wide beats); 7) abnormalities are an overall irregular rhythm due to a burst of wide complex tachycardia with rate of 167 bpm and QRS 0.16 sec, and a PR interval 0.24 sec for the narrow QRSs; 8) sinus tachycardia with first-degree AV block and a burst of ventricular tachycardia

231) Irregular; 2) ventricular rate 110 bpm (6 second); 3) there are no P waves, baseline is wavy; 4) no PR interval; 5) QRS 0.08 sec; 6) QT 0.28 sec; 7) abnormalities are an irregular rhythm, rate of 110 bpm and no P waves with a wavy baseline; 8) atrial fibrillation

241) Regular; 2) atrial and ventricular rates 38 bpm (division) or 37 bpm (sequence); 3) there are P waves in front of every QRS; 4) PR 0.20 sec; 5) QRS 0.08 sec; 6) QT 0.60 sec; 7) abnormality is a rate of 38 bpm; 8) sinus bradycardia

251) Irregular; 2) no atrial or ventricular rates; 3) there are no P waves; 4) no PR interval; 5) no QRS; 6) no QT; 7) abnormalities are an irregular rhythm of coarse waves with no P, QRS, or T waves; 8) ventricular fibrillation

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1) Irregular due to a missed beat; 2) atrial rate 100 bpm (6 sec) and ventricular rate 90 bpm (6 second); 3) there are P waves before each QRS and one early P wave with no QRS; 4) PR 0.12 sec; 5) QRS 0.08 sec; 6) QT 0.32 sec; 7) abnormality is an irregular rhythm due to an early P with no QRS and a noncompensatory pause; 8) sinus rhythm with nonconducted premature atrial contraction (PAC)

271) Regular; 2) ventricular rate 75 bpm (division and sequence); 3) there are no P waves; 4) no PR interval; 5) QRS 0.20 sec; 6) QT 0.56 sec; 7) abnormalities are no P waves and a QRS 0.20 sec; 8) accelerated idioventricular rhythm

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1) Regular; 2) atrial rate 300 bpm (division and sequence) and ventricular rate 68 bpm (division) or 69 bpm (sequence); 3) there are no P waves, there are flutter waves; 4) no PR intervals; 5) QRS 0.08 sec; 6) QT distorted by flutter waves; 7) abnormality is no P waves but instead flutter waves at 300 bpm; 8) atrial flutter

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1) Regular atrial and irregular ventricular rhythm; 2) atrial rate 65 bpm (division) or 66 bpm (sequence) and ventricular rate 40 bpm (6 second); 3) there are P waves before each QRS and two P waves that do not conduct QRSs; 4) PR interval varies, gradually getting longer until a QRS is dropped; 5) QRS 0.10 sec; 6) QT 0.48 sec; 7) abnormalities are an atrial rate faster than ventricular rate and PR that gradually gets longer until a QRS is dropped; 8) second-degree AV block type I (Wenckebach)


19Practice Strips


Answer Key

30

1) Irregular due to two early beats; 2) ventricular rate 80 (6 second); 3) there are no P waves; 4) no PR interval; 5) QRS 0.08 sec for narrow beats, 0.16 sec for the two early beats; 6) QT 0.44 sec for narrow beats, 0.40 sec for wide beats; 7) abnormalities are no P waves and two early QRSs with duration of 0.16 sec; 8) accelerated junctional rhythm with two premature ventricular contractions (PVCs)


essentials of ecg & dysrhythmia monitoring

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