Junctional Rhythm, Heart Block, and Pacemakers Worksheets

Home » MEDCLIN530 » EKG » 12-Lead EKG Confidence » III. Common Clinical Arrhythmias » 9. Junctional Rhythm, Heart Block, and Pacemakers » Junctional Rhythm, Heart Block, and Pacemakers Worksheets
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These worksheets are for self-study only. Answers will not be evaluated.

Instructions for Chapter 9 Worksheets

Inconsistent with other chapters. No instructions, sample worksheet, EKG, or Clinical associations given, okay? Delete this for Chapter 9?

 

 

 

Worksheet 9.1

For each arrhythmia, examine the whole strip. Determine an atrial and ventricular rate.

Atrial rate Ventricular rate Diagnosis

Second degree AV block (2° AVB) Type I, Wenckebach, with four to three conduction. The PR interval gradually increases until a QRS is dropped. There are four P waves to three QRS complexes, thus a four to three ratio.

Worksheet 9.2

For each arrhythmia, examine the whole strip. Determine an atrial and ventricular rate.

Atrial rate Ventricular rate Diagnosis

Atrial pacing. A discrete vertical spike of a pacing artifact is present 0.28 seconds before the QRS.

Worksheet 9.3

For each arrhythmia, examine the whole strip. Diagnose the abnormality of the top strip to diagnose and explain the arrhythmia on the second strip.

Atrial rate Ventricular rate Diagnosis
  • The top strip shows ventricular pacing and a long QTc.
  • The bottom strip taken later shows torsade.

Worksheet 9.4

For each arrhythmia, examine the whole strip. Diagnose the abnormality of the top strip to diagnose and explain the arrhythmia on the second strip.

Atrial rate Ventricular rate Diagnosis

Sinus rhythm with first degree AV block.

Worksheet 9.5

For each arrhythmia, examine the whole strip. Diagnose the abnormality of the top strip to diagnose and explain the arrhythmia on the second strip.

Atrial rate Ventricular rate Diagnosis

Atrial pacing.

Worksheet 9.6

For each arrhythmia, examine the whole strip. Diagnose the abnormality of the top strip to diagnose and explain the arrhythmia on the second strip.

Atrial rate Ventricular rate Diagnosis

Atrial pacing followed by atrial and ventricular pacing. Note the tiny vertical pacemaker artifacts at the onset of the QRS in the last two QRS complexes.

Worksheet 9.7

For each arrhythmia, examine the whole strip. Diagnose the abnormality of the top strip to diagnose and explain the arrhythmia on the second strip.

Atrial rate Ventricular rate Diagnosis

Atrial fibrillation with 4 second pause. The patient needs a pacemaker to control the pauses, and medications to control the tachycardia.

Worksheet 9.8

For each arrhythmia, examine the whole strip. Diagnose the abnormality of the top strip to diagnose and explain the arrhythmia on the second strip.

Atrial rate Ventricular rate Diagnosis

Sinus bradycardia with a very long first degree AV block. The QRS is wide suggesting bundle branch block as well. Also, there is an upward deflection hidden in the ST segment, that may represent a nonconducted P wave, which would make this second degree AV block.

Worksheet 9.9

For each arrhythmia, examine the whole strip. Diagnose the abnormality of the top strip to diagnose and explain the arrhythmia on the second strip.

Atrial rate Ventricular rate Diagnosis

Second degree AV block, since there are P waves without QRS complexes. However there are sequential non-conducted P waves making this Type II second degree AV block, called Mobitz II, with 3:1 conduction. This requires immediate attention.

Worksheet 9.10

For each arrhythmia, examine the whole strip. Diagnose the abnormality of the top strip to diagnose and explain the arrhythmia on the second strip.

Atrial rate Ventricular rate Diagnosis

Complete heart block with ventricular escape. The second QRS complex does not come from the preceding P wave. It is a ventricular escape beat. (Compare this to Worksheet EKG 9.9, where the QRS after the pause has a normal PR interval.)

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