IDENTIFY each one of the rhythms using the process of rhythm identification. I a
ID: 3476701 • 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
The name of the given ecg is wandering arterial pacemaker. Because the heart in the ecg varies from 50 to 100 beats per minutes. The rhytm is also irregular. Its PR interval is also variable. Allmost all the features are met in the lead.