2 EKG strip questions

Nurses General Nursing

Published

Can you PLEASE help me to identify these 2 rhythm strips?

I think the first one is Sinus Rhythm with 3 PAC's OR 2nd degree AV block Type 2.

I think the second is Paroxysmal Atrial Tachycardia.

(Click image to enlarge).

^^**cant be

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Thanks everyone for your help.

The first strip is SINUS RHYTHM WITH 3 PAC's.

It looked like a heart block to me until you go towards the middle of the strip and then it's a beat by itself. It LOOKED like the PR interval was getting longer and longer and the QRS was dropped. But the offbeat in the middle doesn't show that to be true. The early beats are PAC's.

The second strip is PAROXYSMAL ATRIAL TACHYCARDIA.

That's whenever a rhythm is really fast and then converts back to NSR or vice versa.

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Specializes in Dialysis.

I diasagree. The PR interval in QRS #1 is 0.12. QRS #2 is 0.16. The next wave is either a T wave or a P wave. If it's a P wave the there is a block, if it is a T wave then there is something else going on. The QRS in the middle also has either a P wave without a QRS or a T wave. How do you explain the varying PR intervals?

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Specializes in RETIRED Cath Lab/Cardiology/Radiology.

Strip one looks like a second degree heart block (Wenckebach).

PR interval is normal for first beat, longer for second and blocks at third beat (there is no QRS after third P wave); the cycle repeats.

Agree with others re: strip two: SVT converting to NSR.

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My guess is:

1) 2nd degree AV block.

2) SVT converting back to NSR.

3) This makes me miss cardiac ICU....

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Specializes in Emergency.

I think many are making the error of thinking that the T waves are P waves which is causing confusion re: the pr interval. There is no P wave without a QRS on this strip and there is no lengthening pr interval.... Those are the T waves of the previous QRS complex.

Thanks OP for returning to give us the answers.

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I am seeing Bigeminal PJC's, possibly PAC's, for the first strip, and SVT to NSR for the second.

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Specializes in Dialysis.
... there is no lengthening pr interval....

Not trying to engage in a urination contest but what is your measurement of the PR interval in the first and second QRS complex on strip # 1?

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Specializes in NICU.
It can be sinus rhythym because the r to r on the underlying rhythym is irregular. Its def a sinus arrythmia.

The R to R is irregular ONLY because of the early beats. if you look at the strip where there are no early beats, the rhythm is regular.

sinus arrhythmia is a slight variance in rhythm where P, QRS, and T are consistent. You barely notice a sinus arrhythmia, and it can a normal finding. The OPs rhythm strip has a significant irregularity, and since the P, QRS, and T waves are consistent everywhere except in the early beats, there is obviously more going on here than a sinus arrhythmia.

PACs: http://cardiac.northbayhealthcarenursing.com/premature-atrial-conctractions.html

Sinus Arrhythmia: http://cardiac.northbayhealthcarenursing.com/sinus-dysrhytmia-arrhytmia.html

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Specializes in NICU.
Not trying to engage in a urination contest but what is your measurement of the PR interval in the first and second QRS complex on strip # 1?

In the 1st beat, the PRI is about .14 secs. kinda hard to measure on a computer screen. :) if you measure the PRI in the heartbeats that are not early, they are all about the same, .14 secs. You cannot measure a PRI in the 2nd beat because there is not one. It is a premature contraction. The P wave is probably buried in the T wave.

Here is a neat little reference.

PACs: Premature Atrial Conctractions - Cardiac Rhythm Interpretation Review

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Specializes in Emergency.

In the 1st beat, the PRI is about .14 secs. kinda hard to measure on a computer screen. :) if you measure the PRI in the heartbeats that are not early, they are all about the same, .14 secs. You cannot measure a PRI in the 2nd beat because there is not one. It is a premature contraction. The P wave is probably buried in the T wave.

Here is a neat little reference.

PACs: Premature Atrial Conctractions - Cardiac Rhythm Interpretation Review

Couldn't have said it better.

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Specializes in Dialysis.

FTA discussing P waves : " If it is in the preceding T wave it will distort the appearance of the T wave .' I'm obviously not seeing the distortion in the T wave because it looks exactly like the P waves. The T waves on the strip that are undisturbed by a P wave buried in them look exactly like the T waves where there is a buried P wave. The T wave and the P waves appear to have the same morphology so where is the distortion one would expect by a buried P wave?

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