ECG

Question 1

PJC

Premature Junctional Contractions

Answer 1

Regularity: R - R Irregular
Rate: depends on the underlying rhythm
P wave: If visible the P wave will be inverted
PRI: less than .12 seconds
QRS: less than .12 seconds

Question 2

First Degree Heart Block

Answer 2

Regularity: depends on the underlying rhythm
Rate: depends on the underlying rhythm
P wave: upright and uniform, each followed by the QRS
PRI: greater than .20 seconds
QRS: less than .12 seconds

Question 3

Second Degree Type 1 Heart Block

Answer 3

Wenckebach
Regularity: R-R interval irregular in a pattern of grouped beating with the R-R interval getting progressively longer until one drops off.
Rate: Ventricular rate is usually slower than <100, atrial rate is 60-80.
P wave: upright and uniform, some not followed by QRS
PRI: gets progressively longer until one P wave is not followed by a QRS complex. After the blocked beat the cycle starts again
QRS: less than .12 seconds

Question 4

Complete Heart Block

Answer 4

Regularity: P-P intervals are regular, R-R intervals are regular
Rate: Atrial rate is usually normal range (60-100), the ventricular rate will be slower.
P wave: upright and uniform, more P waves than QRS
PRI: no PRI, the P waves have no relationship to the QRS
QRS: if the focus is ventricular the QRS will be .12 or greater, if the focus is junctional, the QRS will be .12 or less.

Question 5

Second Degree Type 2 Heart Block

Answer 5

Regularity: R-R interval is constant - regular
R-R interval may vary if the conduction rate varies
Rate: Atrial rate is normal, the ventricular rate is usually in the bradycardia range.
P wave: upright and uniform, always more p waves than QRS
PRI: will be constant on conducted beats but may be slightly wider than normal
QRS: less than .12

Question 6

Sinus Arrhythmia

Answer 6

Regularity: R-R intervals vary and change with pt respirations
Rate: atrial and ventricle rates are equal, HR is in the normal range but can be slower
P wave: uniform and P wave in front of every QRS complex.
PRI: measures between .12 and .20 and consistent across the strip
QRS: less than .12

Question 7

Wandering Pacemaker

Answer 7

Regularity: R-R intervals vary, rhythm can be slightly irregular
Rate: the atrial and ventricle rates are equal, heart rate is usually within a normal range but can be slower
P wave: morphology of the P wave changes but there is one in front of every QRS although some may be tough to spot
PRI: varies slightly but should be less than .20 and some will be less than .12
QRS: less than .12

Question 8

Atrial Fibrillation

Answer 8

Regularity: irregularly irregular. Ventricular rhythm is grossly irregular.
Rate: less than a hundred - controlled
more than a hundred - rapid ventricular response
P wave: no p waves
PRI: no p wave, no PRI
QRS: less than .12

Question 9

Atrial Flutter

Answer 9

Regularity: Irregularly Irregular
Rate: Atrial rate is between 250 and 350, the ventricular rate depends on the conduction
P Wave: saw tooth appearance
PRI: can't be measured
QRS: less than .12

Question 10

Ventricular Vibrillation

Answer 10

Regularity: The baseline it totally chaotic
Rate: cannot be determined
P wave: no discernible p wave
PRI: no PRI
QRS: no discernible QRS

Question 11

Accelerated Junctional Rhythm

Answer 11

Regularity: The R-R intervals are constant, the rhythm is regular
Rate: Atrial and ventricular rates are equal, faster than the inherent rate but not yet into a true tachycardia range. Usually 60-100
P wave: can come before or after the QRS complex or it can be lost entirely. If visible, it will be inverted
PRI: If the p wave precedes the QRS it will be less than .12 but it may fall within the QRS so it won’t be visible
QRS: less than .12