APEX EKG EXAMS SCRIPT UPDATED QUESTIONS AND
ANSWERS SURE A+
✔✔Ventricular Tachycardia (LETHAL) - ✔✔Regularity: usually regular
Rate: 140 to 250 beats per minute
P wave: Usually none seen, but dissociated from the QRS if present
PRI : none
QRS: > 0.12 seconds, wide and bizarre, tombstone like
QTI: unable to determine
T wave: absent, usually buried in the QRS
✔✔Torsades De Pointes (LETHAL) - ✔✔Big little big little, Twisting
✔✔Ventricular Fibrillation (LETHAL) - ✔✔Regularity: indeterminable
Rate: unable to measure, ventricles are beating in excess of 400 beats per minute
P wave: none
PRI : none
QRS: none
QTI: none
T wave: none
There are NO waveforms only an irregular wavy chaotic baseline
✔✔Idioventricular Rhythm (LETHAL) - ✔✔Regularity: usually regular
Rate: 20 to 40 beats per minute
P wave: absent
PRI : none
QRS: wide and bizarre
QTI: unable to determine
T wave: absent, or may slopes off in the opposite direction of the QRS
✔✔Agonal Rhythm (LETHAL) - ✔✔Regularity: irregular
Rate: less than 20 beats per minute
P wave: absent
PRI : none
QRS: wide and bizarre, > 0.12 sec
QTI: unable to determine
T wave: slopes off in the opposite direction of the QRS
✔✔Asystole (LETHAL) - ✔✔Regularity: none
Rate: zero
P wave: none
PRI : none
QRS: none
QTI: none
T wave: none
, ✔✔Heart Block 1st Degree AVB - ✔✔Regularity: atrial and ventricular rate are regular
Rate: varies depends on underlying rhythm
P wave: upright, smooth, round and uniform shape, one for every QRS complex
PRI : greater than 0.20 seconds, prolonged but constant
QRS: 0.06 to 0.10 seconds
QTI: 0.36 to 0.46 seconds
T wave: upright, smooth and round uniform shape, normal
✔✔Heart Block 2nd Degree AVB Type I - ✔✔Regularity: usually irregular, but can look
regular but interrupted, a classic sign of Wenckebach is a pattern of grouped beats, with
a pause
Rate: atrial rate usually 60-100; ventricular rate less than the atrial rate due to the
nonconducted beats
P wave: upright, smooth, round and uniform shape, BUT not all are followed by a QRS
complex
PRI : progressively gets longer until you have a P wave without a QRS complex (or a
"dropped beat")
QRS: 0.06 to 0.10 seconds
QTI: 0.36 to 0.46 seconds
T wave: upright, smooth and round uniform shape, normal
✔✔Heart Block 2nd Degree AVB Type II (LETHAL) - ✔✔Regularity: may be regular,
irregular or regular but interrupted
Rate: atrial rate usually 60-100; ventricular rate less than the atrial rate due to the
nonconducted beats, ventricular rate can be very slow
P wave: upright, smooth, round and uniform shape, BUT not all are followed by a QRS
complex
PRI : 0.12 to 0.20 seconds, and constant or "fixed"
QRS: 0.06 to 0.10 seconds, usually normal but can be widened
QTI: 0.36 to 0.46 seconds
T wave: upright, smooth and round uniform shape, normal
*Characterized by more P waves than QRS complexes-- this is a dangerous rhythm
because with no warning the AV nodes blocks a conduction with no resulting
contraction of the ventricles
✔✔3rd Degree AVB or Complete Heart Block (LETHAL) - ✔✔Regularity: atria and
ventricles are regular
Rate: atrial rate unusually 60-100; ventricular rate usually 20-40
P wave: upright, smooth, round and uniform shape, P waves may be hidden in QRS
complexes or T waves
PRI : none, because there is no association btw the P waves and QRS complexes
QRS: typically widened, but can be normal of < 0.12 seconds
T wave: usually abnormal, or within the QRS
*the ventricles and the atria are beating independent of one another
ANSWERS SURE A+
✔✔Ventricular Tachycardia (LETHAL) - ✔✔Regularity: usually regular
Rate: 140 to 250 beats per minute
P wave: Usually none seen, but dissociated from the QRS if present
PRI : none
QRS: > 0.12 seconds, wide and bizarre, tombstone like
QTI: unable to determine
T wave: absent, usually buried in the QRS
✔✔Torsades De Pointes (LETHAL) - ✔✔Big little big little, Twisting
✔✔Ventricular Fibrillation (LETHAL) - ✔✔Regularity: indeterminable
Rate: unable to measure, ventricles are beating in excess of 400 beats per minute
P wave: none
PRI : none
QRS: none
QTI: none
T wave: none
There are NO waveforms only an irregular wavy chaotic baseline
✔✔Idioventricular Rhythm (LETHAL) - ✔✔Regularity: usually regular
Rate: 20 to 40 beats per minute
P wave: absent
PRI : none
QRS: wide and bizarre
QTI: unable to determine
T wave: absent, or may slopes off in the opposite direction of the QRS
✔✔Agonal Rhythm (LETHAL) - ✔✔Regularity: irregular
Rate: less than 20 beats per minute
P wave: absent
PRI : none
QRS: wide and bizarre, > 0.12 sec
QTI: unable to determine
T wave: slopes off in the opposite direction of the QRS
✔✔Asystole (LETHAL) - ✔✔Regularity: none
Rate: zero
P wave: none
PRI : none
QRS: none
QTI: none
T wave: none
, ✔✔Heart Block 1st Degree AVB - ✔✔Regularity: atrial and ventricular rate are regular
Rate: varies depends on underlying rhythm
P wave: upright, smooth, round and uniform shape, one for every QRS complex
PRI : greater than 0.20 seconds, prolonged but constant
QRS: 0.06 to 0.10 seconds
QTI: 0.36 to 0.46 seconds
T wave: upright, smooth and round uniform shape, normal
✔✔Heart Block 2nd Degree AVB Type I - ✔✔Regularity: usually irregular, but can look
regular but interrupted, a classic sign of Wenckebach is a pattern of grouped beats, with
a pause
Rate: atrial rate usually 60-100; ventricular rate less than the atrial rate due to the
nonconducted beats
P wave: upright, smooth, round and uniform shape, BUT not all are followed by a QRS
complex
PRI : progressively gets longer until you have a P wave without a QRS complex (or a
"dropped beat")
QRS: 0.06 to 0.10 seconds
QTI: 0.36 to 0.46 seconds
T wave: upright, smooth and round uniform shape, normal
✔✔Heart Block 2nd Degree AVB Type II (LETHAL) - ✔✔Regularity: may be regular,
irregular or regular but interrupted
Rate: atrial rate usually 60-100; ventricular rate less than the atrial rate due to the
nonconducted beats, ventricular rate can be very slow
P wave: upright, smooth, round and uniform shape, BUT not all are followed by a QRS
complex
PRI : 0.12 to 0.20 seconds, and constant or "fixed"
QRS: 0.06 to 0.10 seconds, usually normal but can be widened
QTI: 0.36 to 0.46 seconds
T wave: upright, smooth and round uniform shape, normal
*Characterized by more P waves than QRS complexes-- this is a dangerous rhythm
because with no warning the AV nodes blocks a conduction with no resulting
contraction of the ventricles
✔✔3rd Degree AVB or Complete Heart Block (LETHAL) - ✔✔Regularity: atria and
ventricles are regular
Rate: atrial rate unusually 60-100; ventricular rate usually 20-40
P wave: upright, smooth, round and uniform shape, P waves may be hidden in QRS
complexes or T waves
PRI : none, because there is no association btw the P waves and QRS complexes
QRS: typically widened, but can be normal of < 0.12 seconds
T wave: usually abnormal, or within the QRS
*the ventricles and the atria are beating independent of one another
