EKG Training, Practice and Quiz (2023)


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Atrial Flutter
EKG Training, Practice and Quiz (1)

The atrial heart rate is rapid (250-350 bpm), but ventricular rate is often slower. EKG rhythm will appear regular. P wave and PR interval are not observable, but saw-toothed flutter waves are present. The QRS complex will typically be normal (0.06-0.10 sec).

Bundle Branch Block
EKG Training, Practice and Quiz (2)

The EKG rhythm P wave features should appear normal and the PR interval is normal (0.12-0.20 sec). The QRS complex will typically be wide (>0.12 sec).

First Degree Heart Block
EKG Training, Practice and Quiz (3)

The P wave will be normal while the PR interval is prolonged (>0.20 sec). The QRS complex will typically be normal (0.06-0.10 sec). A first degree av block occurs when electrical impulses moving through the atrioventricular (AV) node are delayed (but not blocked). The adjective first degree indicates slowed conduction without missed beats.

Idioventricular Rhythm
EKG Training, Practice and Quiz (4)

The EKG rhythm will appear regular with a very slow heart rate(20-40 bpm). The P wave will be absent and the PR interval is not measurable. The QRS complex will typically be wide (>0.10 sec) and a bizarre appearance.

Junctional Escape Rhythm
EKG Training, Practice and Quiz (5)

The EKG rhythm will appear regular. Heart rate that is slow (40-60 bpm). The P wave will be present before, during (hidden) or after QRS, if visible it is inverted. The PR interval is not measurable. The QRS complex will typically be normal (0.06-0.10 sec).

Junctional Tachycardia
EKG Training, Practice and Quiz (6)

The EKG rhythm will appear regular with a fast heart rate (100-180 bpm). The P wave can appear before, during (hidden) or after QRS, if visible it is inverted. Observe that the PR interval is absent or short. The QRS complex will typically be normal (0.06-0.10 sec).

Multifocal Atrial Tachycardia
EKG Training, Practice and Quiz (7)

The EKG rhythm will appear irregular with a fast heart rate (> 100 bpm). The P wave features often change shape and size from beat to beat with at least three differing forms. Observe that the PR interval is variable. The QRS complex will typically be normal (0.06-0.10 sec). In addition, the T wave can be distorted.

Normal Sinus Rhythm
EKG Training, Practice and Quiz (8)

The EKG rhythm will appear regular with a normal (60-100 bpm) heart rate. The P wave appears normal and precedes each QRS. Observe that the PR interval is normal (0.12-0.20 sec). The QRS complex will typically be normal (0.06-0.10 sec).

Pacemaker Failure to Capture
EKG Training, Practice and Quiz (9)

The EKG rhythm will appear irregular with heart rate that is slow or normal. Observe that the pacemaker spikes are not followed by p waves or QRS complexes.

Pacemaker Failure to Pace
EKG Training, Practice and Quiz (10)

The EKG rhythm will appear irregular and pacemaker spikes do not appear.

Pacemaker Single Chamber Atrial
EKG Training, Practice and Quiz (11)

The EKG rhythm will appear regular with heart rate that is normal. The P wave and PR interval will both appear normal. The QRS complex is also normal. Pacemaker spikes will precede the P wave.

Premature Atrial Complex
EKG Training, Practice and Quiz (12)

The EKG rhythm will appear irregular with heart rate that is usually normal but depends on underlying rhythm. The P wave will appear premature, positive and a shape that is abnormal. Observe that the PR interval is normal or longer. The QRS complex will typically be 0.10 sec or less.

Premature Junctional Complex
EKG Training, Practice and Quiz (13)

The EKG rhythm will appear regular with premature beats with heart rate that is the underlying rate. The P wave is present before, during (hidden) or after QRS. If the P wave is visible, it is inverted. Observe that the PR interval is absent or short. The QRS complex will typically be normal (0.06-0.10 sec).

Premature Ventricular Complex
EKG Training, Practice and Quiz (14)

The EKG rhythm will appear irregular with heart rate that is the underlying rate. The P wave features absent. Observe that the PR interval is not measurable. The QRS complex will typically be wide (> 0.10 sec) with a bizarre appearance.

Premature Ventricular Complex Bigeminy
EKG Training, Practice and Quiz (15)

The EKG rhythm will appear irregular with an absent P wave and the PR interval is not measurable. The QRS complex will typically be wide (> 0.10 sec) with a bizarre appearance. The PVC appears on every second beat.

Premature Ventricular Complex Quadrigeminy
EKG Training, Practice and Quiz (16)

The EKG rhythm will appear irregular. The P wave is absent and the PR interval is not measurable. The QRS complex will typically be wide (> 0.10 sec) and bizarre in appearance. The PVC appears every fourth beat.

Premature Ventricular Complex Trigeminy
EKG Training, Practice and Quiz (17)

The EKG rhythm will appear irregular. The P wave is absent and the PR interval is not measurable. The QRS complex will typically be wide (> 0.10 sec) with a bizarre appearance. The PVC appears every third beat.

Second Degree Heart Block Type I
EKG Training, Practice and Quiz (18)

The EKG rhythm will appear irregular but with progressively longer pr interval lengthening. The P wave is normal. Observe that the PR interval becomes progressively longer until a QRS complex is missed, then cycle repeats. The QRS complex will typically be normal (0.06-0.10 sec).

Second Degree Heart Block Type II
EKG Training, Practice and Quiz (19)

The EKG rhythm will appear regular (atrial) and irregular (ventricular) with heart rate that is characterized by atrial rate that is usually faster than ventricular rate (usually slow). The P wave has a normal form, but more P waves than QRS complexes. The PR interval is normal or prolonged. The QRS complex will typically be normal or wide.

Sinoatrial Block
EKG Training, Practice and Quiz (20)

The EKG rhythm will appear irregular when SA block occurs with a normal or slow heart rate. The P wave will be normal and the PR interval will be normal (0.12-0.20 sec). The QRS complex will typically be normal (0.06-0.10 sec). The pause time is an integer multiple of the p-p interval.

Sinus Arrest
EKG Training, Practice and Quiz (21)

The EKG rhythm will appear irregular due to a pause. Heart rate will be normal to slow. The P wave is normal. The PR interval is normal (0.12-0.20 sec). The QRS complex will typically be normal (0.06-0.10 sec). Pause time is not an integer multiple of the p-p interval.

Sinus Arrhythmia
EKG Training, Practice and Quiz (22)

The EKG rhythm will appear irregular, varying with respiration with heart rate that is normal (60-100 bpm) and rate may increase during inspiration. The P wave is normal and the PR interval is also normal (0.12-0.20 sec). The QRS complex will typically be normal (0.06-0.10 sec). Heart rate frequently increases with inspiration, decreasing with expiration.

Sinus Bradycardia
EKG Training, Practice and Quiz (23)

The EKG rhythm will appear regular with a slow heart rate (under 60 bpm). The P wave and the PR interval are normal. The QRS complex will typically be normal (0.06-0.10 sec).

Sinus Tachycardia
EKG Training, Practice and Quiz (24)

The EKG rhythm will appear regular with a fast heart rate (> 100 bpm). The P wave will be normal but may merge with T wave at very fast rates. Observe that the PR interval is>normal (0.12-0.20 sec). The QRS complex will typically be normal (0.06-0.10 sec). The QT interval shortens with increasing heart rate.

Supraventricular Tachycardia
EKG Training, Practice and Quiz (25)

The EKG rhythm will appear regular and heart rate that will be fast (150-250 bpm). The P wave will be merged with T wave. The PR interval is normal (0.12 sec) but can be difficult to measure. The QRS complex will typically be normal (.10 sec).

Third Degree Heart Block
EKG Training, Practice and Quiz (26)

The EKG rhythm will appear regular, but atrial and ventricular rhythms are independent. Heart rate is characterized by atrial rate usually normal but faster than the ventricular rate. The P wave will have normal shape and size but may appear within QRS complexes. The PR interval is absent: the atria and ventricles beat independently. The QRS complex will typically be normal, but wide if junctional escape focus.

Ventricular Fibrillation
EKG Training, Practice and Quiz (27)

The EKG rhythm will appear highly irregular with an unmeasurable heart rate. The P wave is absent, the PR interval is not measurable and no QRS complex. The EKG tracings is a wavy line.

Ventricular Tachycardia
EKG Training, Practice and Quiz (28)

The EKG rhythm will appear regular with heart rate that is fast (100-250 bpm). The P wave is absent and the PR interval is not measurable. The QRS complex will typically be wide (>0.10 sec) with a bizarre appearance.

Ventricular Tachycardia Monomorphic
EKG Training, Practice and Quiz (29)

The EKG rhythm will appear regular with a fast (100-250 bpm) heart rate. The P wave is absent and the PR interval is not measurable. The QRS complex will typically be wide (>0.10 sec) and bizarre looking.

Ventricular Tachycardia Polymorphic
EKG Training, Practice and Quiz (30)

The EKG rhythm will appear regular or irregular with heart rate that is fast (100-300 bpm). The P wave is absent and the PR interval is not measurable. The QRS complex will typically be normal or wide (>0.10 sec) with a bizarre shape.

Ventricular Tachycardia Torsade de Pointes
EKG Training, Practice and Quiz (31)

The EKG rhythm will appear irregular with heart rate that is fast (200-250 bpm). The P wave is absent and the PR interval is not measurable. The QRS complex will typically be wide (>0.10 sec). Its shape is characterized by a gradual change in the EKG amplitude and a twisting of the QRS complexes around a line.

Wandering Atrial Pacemaker
EKG Training, Practice and Quiz (32)

The EKG rhythm will appear to be irregular with a normal heart rate. The P wave can be observed changing shape and size from beat to beat (at least three different forms). The PR interval is variable in duration. The QRS complex will typically be normal (0.06-0.10 sec) and the T wave normal. If heart rate exceeds 100 bpm, then rhythm may be multifocal atrial tachycardia (MAT).

Wolff-Parkinson-White Syndrome
EKG Training, Practice and Quiz (33)

The EKG rhythm will appear regular unless atrial fibrillation present. Heart rate is normal (60-100 bpm). The P wave is normal. Observe that the PR interval is can be short (less than 0.12 sec). The QRS complex will typically be wide (over 0.12 sec). A delta wave (positive or negative) distorts the early part of the QRS complex.

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