EKG strip help

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  1. This is a discussion on EKG strip help in Cardiac Nursing, part of Nursing Specialties ... I have an EKG strip and I am unable to figure out what rhythm it is. I understand how to calculate...

    by Mar 7, '12
    I have an EKG strip and I am unable to figure out what rhythm it is. I understand how to calculate the intervals and times but I do not know if there are P-waves in this strip or if they are T-waves and what the rhythm would be classified as. Can anyone help me?



    Are there P-waves? What would this rhythm be called? (Ex. Sinus Tach, A. Fib, Atrial Flutter, ect).Thank you so much!!
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    by Breanna13 Mar 7, '12 11:39 pm
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  3. 10 Comments so far...

  4. Mar 8, '12 by
    Looks like SR with a 1st degree block to me. There are inverted T waves. You need blood work.
  5. Mar 8, '12 by
    Sinus Rhythm with a 1º Heart Block, possibly an IVCD(if QRS ≥ .12, I can't tell from my laptop screen), depressed ST segment, and going into PSVT.

    I feel like I'm right, but correct me if I'm not!
  6. Mar 8, '12 by
    SR with 1st degree heart block and maybe a bundle branch block? QRS looks slurred. At the end the strip goes into SVT.
  7. Mar 11, '12 by
    i would guess ths owner of this heart rhythm has history of af. does this person have a history of afib? you have a sinus with 1st degree av block and a bundle branch block then a burst of afib. you can have 'discordant' T waves in bundle (and left bundle) without it being the inverted t wave of ischemia. more info is needed but thats the best i got with the little strip thats provided
    Last edit by surferbettycrocker on Mar 11, '12
  8. Asst. Admin
    Mar 12, '12 by
    Quote from Breanna 13
    I have an EKG strip and I am unable to figure out what rhythm it is. I understand how to calculate the intervals and times but I do not know if there are P-waves in this strip or if they are T-waves and what the rhythm would be classified as. Can anyone help me?



    Are there P-waves? What would this rhythm be called? (Ex. Sinus Tach, A. Fib, Atrial Flutter, ecg).Thank you so much!!
    The basic rhythm is regular. R-R interval is regular with the exception where it comes in early. There is a P wave for every QRS, even on the early beat it is in the T wave. The early beat is followed by a similar beat where there is a P wave for the QRS, there are two of them making it a couplet. The QRS on the couplet matches the QRS of the other beats and has a P Wave making it a premature atrial contraction (premature atrial contractions pictures - Google Search

    The PR interval is very long.....approx .28. What do you know about the PR interval? If it is long what would it be called?


    It also appears that the QRS is prolonged as well and is approx .11. What do you know about the QRS being prolonged?

    and....the heart rate is approximately 80. The last part of the strip shows the onset of a narrow complex tachycardia rate of approx 150. What is a narrow complex tachycardia with HR grester than 150 called?

    CV Physiology: Determining Heart Rate from the Electrocardiogram
    ECG Primer: Calculations
    PSTC Paramedic Student Electrocardiography

    What would the rhythm be......1st degree AV block with a bundle branch block with premature atrial contractions/couplet with onset of PSVT
  9. Mar 12, '12 by
    Quote from Esme12
    What would the rhythm be......1st degree AV block with a bundle branch block with premature atrial contractions/couplet with onset of PSVT
    Esme12, I am going to kindly disagree with some of your interpretation.

    First, in order to interpret a bundle branch block, you really need a 12 lead. The strip shown is not adequate.

    Second, there is not enough of the strip to adequately say that there is a sustained onset of PSVT. The last three beats are a run of PACs, and it suggests that the rhythm goes back to baseline rate.

    Yes on the first degree AV Block.

    It would really help to know which leads that you are looking at. I can only assume that you are looking at leads 1 and 2.

    My interpretation: 1st degree AV Block with a wide complex aberrancy. Run of PACs.
  10. Asst. Admin
    Mar 12, '12 by
    Quote from ambgirl2nurse
    Esme12, I am going to kindly disagree with some of your interpretation.

    First, in order to interpret a bundle branch block, you really need a 12 lead. The strip shown is not adequate.

    Second, there is not enough of the strip to adequately say that there is a sustained onset of PSVT. The last three beats are a run of PACs, and it suggests that the rhythm goes back to baseline rate.

    Yes on the first degree AV Block.

    It would really help to know which leads that you are looking at. I can only assume that you are looking at leads 1 and 2.

    My interpretation: 1st degree AV Block with a wide complex aberrancy. Run of PACs.
    We will have to agree to disagree. Because I strongly disagree.

    If you look at the strip the leads are most likely Lead II and MCL1 or V1 as there are the recommended monitoring leads and the leads used on every test I have seen over 33 years of nursing in critical care/open heart/cath lab/trauma flight/EMT-P and emergency medicine. MCL1/V1 best used when monitoring as MCL1 will help discern VT versus SVT with aberrancy. A 12 lead may be necessary to discern L R or L BBB block or bifascicular and hemi blocks but is not necessary on a regular strip for a QRS greater than .10.

    A QRS that measures greater than .10 is a BBB for strip reading. The last four beats has a different narrow QRS morphology that is above the ventricles that is above 150 which qualifies it as a supra (above the ventricle) ventricular tachycardia. It is paroxysmal as we see it begin and possibly see it begin top end but you cannot assume what the strip was going to turn into. The PAC possible couplet/run is the 6th beat in. with the same QRS morphology and the tachycardia is 12 beats in preceded by a PAC.
    ICUFAC"S index


    Peace
    Last edit by Esme12 on Mar 12, '12
    nursej22 and brainkandy87 like this.
  11. Mar 13, '12 by
    Quote from Esme12
    A 12 lead may be necessary to discern L R or L BBB block or bifascicular and hemi blocks but is not necessary on a regular strip for a QRS greater than .10.
    You can tell if a patient has a BBB on a standard strip...the 12-lead just confirms it and tells what kind of BBB it is.

    Quote from Esme12
    A QRS that measures greater than .10 is a BBB for strip reading. The last four beats has a different narrow QRS morphology that is above the ventricles that is above 150 which qualifies it as a supra (above the ventricle) ventricular tachycardia. It is paroxysmal as we see it begin and possibly see it begin top end but you cannot assume what the strip was going to turn into. The PAC possible couplet/run is the 6th beat in. with the same QRS morphology and the tachycardia is 12 beats in preceded by a PAC.
    ICUFAC"S index


    Peace
    Well said.
    Creamsoda and Esme12 like this.
  12. Mar 20, '12 by
    Agree with Esme.

    Hopefully you don't get THAT strip on a test...