EKGs Flashcards
PAC
The ectopics on the rhythm strip are PACs. Abnormal P wave morphology sompared to underlying rhythm. The P prime wave is conducted to the QRS (ventricula complex).
Sinus Rhythm with PVC
The correct answer is sinus rhythm with PVCs. The P waves have normal morphology and precede QRS complexes, until wide, premature complexes appear. The ST segment goes in opposite direction of the QRS complex. These are characteristic of PVCs.
Sinus Tachycardia
The rhythm strip reveals sinus tachycardia. P wave morphology appears normal; this is followed by a ventricular complex (QRS)
Describe the appearance of the EKG
Saw tooth and flutter waves
Atrial flutter waves are identified, best seen in inferior leads (II, III, AVF) and V1 and V2. Flutter waves reflect “saw tooth” pattern.
MAT
The rhythm is Multifocal Atrial Tachycardia (MAT). The criteria are 3 or more morpholigically different P waves and a tachycardia. Usually the rhythm is associated with patients who have lung disease (ex. COPD).
AFib and LVH with strain
The rhythm is atrial fibrillation. The atria are beating >350 times/min. with an irregular ventricular response. The QRS voltage is increased in several leads and the ST-T wave suggest a “ST-T strain pattern compatible with LVH and strain pattern
SVT
SVT is the correct answer. The QRS complexes are narrow, no discernible P waves detected and the heart rate is fast.
Ventricular Tachycardia
The rhythm strip reveals features of ventricular tachycardia (VT). The rhythm does not show well defined P waves before each QRS complex; the QRS complexes are conducted at a fast rate, are wide in morphology and predominately regular. Secondary ST-T changes are seen.
VFib
Unresponsive, unable to feel pulses and a rhythm strip showing diffuse, chaotic irregular morphology is compatible with ventricular fibrillation (VF).
Normal sinus rhythm, 1st degree AV block
The rhythm is sinus as evident by a normal P wave which precedes each QRS complex; the P-R interval is prolonged (> .2 sec.) meeting criteria for 1st degree AV block.
2nd degree AV block, Wenckebach
The tracing reveals a progressive increase in the P-R interval, followed by a P wave that is non conducted to the dropped QRS complex; this causes a pause in the rhythm as well as grouped beating. This is a 2nd degree AV block, Wenckebach.
3rd degree complete AV block
3rd degree (complete) AV block is the answer. The atria are beating independently of the ventricles (AV dissociation); there is total block of conduction to the ventricle.
RBBB
Right Bundle Branch Block (RBBB) is the correct answer. The characteristic morphology of a RBBB demonstrates a wide QRS complex (> .12 sec.), rsR1 or M shaped QRS in V1 and wide S wave in lead I and V6.
LBBB
The ECG reveals features of a LBBB. These salient features include absence of a septal Q wave in leads I, V5 and V6 , a wide QRS complex ( > .12 sec. duration), monophasic R wave in lead I, and V6 and a QS or rS in V1.
Left ventricular hypertrophy with strain
The ECG meets the criteria of LVH with strain pattern. The voltage of the S wave in V1 plus R wave in V5 or V6 is equal or greater than 35 mm. The ST and T wave changes are in opposite direction of the QRS complex and are depressed below the baseline.
Acute anterior wall STEMI
Acute anterior wall STEMI is the correct interpretation of the ECG. There is ST segment elevation in several precordial chest leads.
ECG changes are characteristic of hypokalemia
The ECG reveals flat T waves and a U wave compatible with a low potassium (hypokalemia).
ECG reveals characteristic changes of pericarditis
The ECG reveals diffuse ST elevation with upward concavity in multiple leads compatible with pericarditis.
Torsades de Pointes
Rapid ventricular rate with twisting of QRS complexes (some upward pointing and downward pointing - “like a party streamer”).
AFib
The rhythm is irregular with an undulating baseline, associated with an irregular ventricular response. The atria are fibrillating (fine “f” waves) at a rapid rate, 300-400/min. or faster; absence of P waves.
