IDENTIFY each one of the rhythms using the process of rhythm identification. I a
ID: 3476666 • Letter: I
Question
IDENTIFY each one of the rhythms using the process of rhythm identification. I am looking for what the name of the rhythm is.
NOTES: TO help identify rhythms using the process
Atrial Fibrillation:
Rate: Atrial usually 400-600 bpm, ventricular rate determined by AV blockade
Rhythm: Ventricular rhythm is irregularly irregular
P waves: No identifiable P waves
PR interval: Not measurable
QRS duration: .11 unless intraventricular conduction delay exists
Atrial Flutter:
Ectopic rhythm in which irritable focus fires regularly at a very rapid rate
Rate: Atrial rate 250-350; ventricular rate determined by AV junction
Rhythm: Atrial is regular, ventricular is regular or irregular depending on Av conduction/blockade
P waves: No identifiable P wave, saw-toothed flutter waves
QRS: .11 but may be wide if flutter waves are buried in QRS or intraventricular conduction delay exists
Wolff-Parkinson-White syndrome is common in patients with AVRT
Rate: Usually 60-100 if underlying rhythm is sinus
Rhythm: Regular unless associated with Afib
P waves: Normal unless associated with Afib
PR interval: If P waves are observed, .12
QRS: Wide, usually .12, slurred upstroke of QRS (delta wave) seen in more than one lead
AVNRT:
Rate: 150-250 (usually 180 – 200)
Rhythm: Ventricular rhythm is regular
P waves: Often hidden in QRS, negative P wave can be present, P wave can occur after QRS
PR interval: Not measurable because P waves are not seen before QRS
QRS duration: .11 unless intraventricular conduction delay exists
Atrial Tachycardia:
Rate: 100-250
Rhythm: Regular
P waves: Positive P precedes each QRS, P wave differ in shape from sinus P wave. Rapid rate makes it difficult to distinguish P waves from T waves
PR interval: May be shorter or longer than normal
QRS duration: .10 unless intraventricular conduction delay
Wandering Atrial Pacemaker:
Rate: Usually 60-100 bpm, >100 it is called multifocal atrial tachycardia
Rhythm: May be irregular
P waves: Size, shape, and direction may change from beat to beat. At least 3 different P wave configurations
PR interval: Variable
QRS duration: .11 unless intraventricular conduction delay exists
Premature atrial complex : PAC
Beat is premature (early)
Rhythm is usually regular with premature beats
Rate depends on underlying rhythm
P wave is premature, positive in lead II, one before each QRS unless not conducted, often differs in shape from sinus P wave
PR interval may be normal or prolonged
QRS usually .10 or less but may be wide if aberrantly conducted, may be absent in non-conducted P wave
Explanation / Answer
6) In the given ECG, there is no identifiable P waves. The rhythm is irregular. PR interval is not measurable. So, the given ECG pattern represents atrial fibrillation.
7) In the given ECG, saw toothed wave patterns were observed. P waves not identifiable. So, the given ECG pattern represents atrial flutter.