SKILLS OSCE Rhythm Identification Flashcards
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What is this?
SINUS TACHYCARDIA
—SA node discharge > 100 bpm
—normal P waves and QRS complexes
Results from:
—increased sympathetic activity and is an APPROPRIATE physiologic response to exercise or pathologic conditions.
Treatment
—🔺treat the underlying cause including: hyperthyroidism, fever/sepsis, hypoxia, anemia, pain, and hypovolemia.
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What is this rhythm?
Atrial flutter with 3:1 block
saw tooth pattern
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Which rhythm is this?
AFIB
No P waves
Variable ventricular rate
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What rhythm is this?
What could you treat it with?
AFIB
No P waves
Variable ventricular rate
BB, CCB, Digoxin
Amiodarone
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What rhythm is this?
Afib with aberrant beat
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What is this?
Ectopic rhythm
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What is this?
Treatment?
AVNRT — Adenosine
Little tiny p-wave RIGHT after the QRS
Slow-Fast AVNRT (Common AVNRT)
—Accounts for 80-90% of AVNRT
—Associated with Slow AV nodal pathway for anterograde conduction and Fast AV nodal pathway for retrograde conduction.
—The retrograde P wave is obscured in the corresponding QRS or occurs at the end of the QRS complex as pseudo r’ or S waves
ECG:
—P waves are often hidden – being embedded in the QRS complexes.
—Pseudo r’ wave may be seen in V1
—Pseudo S waves may be seen in leads II, III or aVF.
In most cases this results in a ‘typical’ SVT appearance with absent P waves and tachycardia
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What is this?
Treat with?
AVNRT — adenosine
Narrow complex QRS
Hard to see P waves because they are embedded in QRS, or inverted
OR superimposed at the end of a QRS, making them look like an R wave in V1 (pseudo R’ wave)
140-280 beats
Regular rhythm
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What is this?
[know]
WPW
Memorise
Treatment: procainamide
Tachycardia
Accessory pathway, or bundle of Kent
Patch of conducive tissue
Bypassing AV node
Allows impulses to arrive soon
Pre-excitement
Shortened PR interval
Ventricular depolarisation happens slower, hence slurring, delta wave
WPW > develops into tachycardia, and is AVRT, can be orthodromic or antidromic
Watch video on slide 88
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What is this?
Atrial tachycardia
Narrow complex QRS
P wave hidden in T wave
But looks different than first 2
Single foci
When they break, there’s a little pause and sinus resumes
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What is this?
MAT
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What is this?
Trigeminy
PVC
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What is this
Ventricular tachycardia
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What is this?
What do you treat it with?
Torsades
IV magnesium
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What is this
Treatment?
Vfib ➡️ defibrillate
Pass out
Low blood pressure
Cardiac arrest
Ventricles not squeezing any blood out
Code blue
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What is this?
Delta waves
The characteristic ECG findings in Wolff-Parkinson-White syndrome are:
—Short PR interval (< 120ms)
—Broad QRS (> 100ms)
—A slurred upstroke to the QRS complex (the delta wave)
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What is this?
PVC pairs (couplets)
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What is this?
Non-sustained VT
Runs of PVCs
4 in this example and then 3
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What is this?
Ventricular quadrigeminy
PVC every 4th beat
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What is this?
Multi-focal PVCs
PVCs often occur in repeating patterns:
Bigeminy — every other beat is a PVC
Trigeminy — every third beat is a PVC
Quadrigeminy — every fourth beat is a PVC
Couplet — two consecutive PVCs
NSVT — between three and thirty consecutive PVCs (see below)
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What is this?
Acute Tx?
Stable Tx?
Ventricular tachycardia
Acute = cardiovert
Stable = amiodarone
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What is this?
First degree heart block
PR > 200ms (5 small squares)
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What is this?
2nd degree Mobitz type I (wenckebach)
Progressive prolongation of the PR interval culminating in a non-conducted P wave:
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What is this?
2nd degree Mobitz Type II
A form of 2nd degree AV block in which there is intermittent non-conducted P waves without progressive prolongation of the PR interval
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What is this?
Complete heart block
Complete heart block: There is AV dissociation, with the atrial rate (~100 bpm) independent of the ventricular rate (~40 bpm) (strip above)
Attached EKG
Complete Heart Block:
Atrial rate is ~ 60 bpm
Ventricular rate is ~ 27 bpm
None of the atrial impulses appear to be conducted to the ventricles
There is a slow ventricular escape rhythm
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What is this?
Isolated RBBB.
Typical RSR’ pattern in V1-2
Widened S waves again demonstrated in lateral leads, especially V4-6
Appropriate discordance in leads V1-2
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What are all these depicting?
LBBB
