Advent Health EKG |Questions With Verified
Answers |(Latest 2023/ 2024 Update)
1. Afib
- ANSWER: The impulse originates in the Atria
• The Atrial rate is > 300 and unable to measure [N/A]
• No discernable P waves - PRI & Atrial rhythm cannot be
measured [N/A]
• The Ventricular rhythm is irregular
• QRS within normal limits
• If the Ventricular rate is <100 the rhythm is controlled A-fib;
• if the Ventricular rate is > 100 the rhythm is uncontrolled A-fib
• This is a chronic rhythm for some patients
• Treatment: controlled patients: anticoagulants and
antiarrhythmics; uncontrolled but stable patients: Beta blockers,
calcium channel blockers, or digoxin; Unstable patients:
cardioversion
2. Junctional Rhythm
- ANSWER: Impulse starts in the AV junction
• P waves are absent, short, inverted or retrograde
• Ventricular Rhythm: Regular
• Ventricular Rate: 40-60 bpm
• QRS is usually within normal limits
3. Accelerated Junctional Rhythm
- ANSWER: Accelerated Junctional
• Same criteria as Junctional Rhythm, except the Ventricular rate is
60-100
• For stable patients: IV access, vagal maneuvers, adenosine, O2,
Beta blockers, calcium channel blockers
4. Idioventricular Rhythm (IVR)
- ANSWER: Impulse originates in the ventricles
• ▪ Rhythm: Ventricular is usually regular
• ▪ Rate: Ventricular between 20-40
• ▪ QRS: ≥ 0.12
• ▪ Atrial rate, rhythm, and PRI: N/A
- Treatment: assess pt, check for DNR in chart, transcutaneous pacing,
atropine. NEVER GIVE ANTI-ARRYTHMICS MEDICATIONS
5. Accelerated Idioventricular Rhythm
- ANSWER: Follows the same criteria as IVR, except Ventricular rate is
40-100.
• If no intervention happens, the patient will deteriorate.
, Advent Health EKG |Questions With Verified
Answers |(Latest 2023/ 2024 Update)
- Treatment: assess pt, atropine, transcutaneous pacing. NEVER GIVE
ANTI-ARRHYTHMIC MEDICATIONS
6. Ventricular Pacing
- ANSWER: • The pacemaker lead is placed in to right ventricle.
• The pacemaker generator fires an impulse Initiating ventricular
activity.
• The right ventricle will contract first followed by the left ventricle.
This results in a wide QRS
• Atrial activity is typically absent. Therefore, Atrial rhythm, rate,
and PRI are non- measurable
• Rhythm: Ventricular regular
• Rate: Ventricular within set pacer limits. Measured from pacer
spike to pacer spike
• QRS: Wide; Pacer spike seen before each QRS. Measured from
pacer spike to end
• of QRS
7. Atrial-ventricular Pacing
- ANSWER: One pacemaker lead is placed into the right atria and
another is placed into the right
• ventricle.
• The pacemaker generator fires an impulse to the atria and then to
the ventricle sequentially
• causing atrial then ventricular contraction.
• Rhythm: Atrial and Ventricular regular
• Rate: Atrial and Ventricular same & within set limits
• P waves: Pacer spike seen at beginning of atrial activity P waves
may or may not be seen
• (lead type dependent)
• PRI: WNL - Measured from atrial spike to ventricular spike
• QRS: Wide - Measured from ventricular spike to end of QRS
8. Failure to capture
- ANSWER: A pacer spike note followed by the appropriate atrial or
ventricular response
• Can be a potentially lethal situation!
9. Failure to pace
- ANSWER: Absence of pacer activity (spikes) when the pacemaker
generator should have fired an impulse.
• Typically seen when the patient's intrinsic heart rate falls less than
the pacemaker's low HR limit and
• the pacer fails to fire.
Answers |(Latest 2023/ 2024 Update)
1. Afib
- ANSWER: The impulse originates in the Atria
• The Atrial rate is > 300 and unable to measure [N/A]
• No discernable P waves - PRI & Atrial rhythm cannot be
measured [N/A]
• The Ventricular rhythm is irregular
• QRS within normal limits
• If the Ventricular rate is <100 the rhythm is controlled A-fib;
• if the Ventricular rate is > 100 the rhythm is uncontrolled A-fib
• This is a chronic rhythm for some patients
• Treatment: controlled patients: anticoagulants and
antiarrhythmics; uncontrolled but stable patients: Beta blockers,
calcium channel blockers, or digoxin; Unstable patients:
cardioversion
2. Junctional Rhythm
- ANSWER: Impulse starts in the AV junction
• P waves are absent, short, inverted or retrograde
• Ventricular Rhythm: Regular
• Ventricular Rate: 40-60 bpm
• QRS is usually within normal limits
3. Accelerated Junctional Rhythm
- ANSWER: Accelerated Junctional
• Same criteria as Junctional Rhythm, except the Ventricular rate is
60-100
• For stable patients: IV access, vagal maneuvers, adenosine, O2,
Beta blockers, calcium channel blockers
4. Idioventricular Rhythm (IVR)
- ANSWER: Impulse originates in the ventricles
• ▪ Rhythm: Ventricular is usually regular
• ▪ Rate: Ventricular between 20-40
• ▪ QRS: ≥ 0.12
• ▪ Atrial rate, rhythm, and PRI: N/A
- Treatment: assess pt, check for DNR in chart, transcutaneous pacing,
atropine. NEVER GIVE ANTI-ARRYTHMICS MEDICATIONS
5. Accelerated Idioventricular Rhythm
- ANSWER: Follows the same criteria as IVR, except Ventricular rate is
40-100.
• If no intervention happens, the patient will deteriorate.
, Advent Health EKG |Questions With Verified
Answers |(Latest 2023/ 2024 Update)
- Treatment: assess pt, atropine, transcutaneous pacing. NEVER GIVE
ANTI-ARRHYTHMIC MEDICATIONS
6. Ventricular Pacing
- ANSWER: • The pacemaker lead is placed in to right ventricle.
• The pacemaker generator fires an impulse Initiating ventricular
activity.
• The right ventricle will contract first followed by the left ventricle.
This results in a wide QRS
• Atrial activity is typically absent. Therefore, Atrial rhythm, rate,
and PRI are non- measurable
• Rhythm: Ventricular regular
• Rate: Ventricular within set pacer limits. Measured from pacer
spike to pacer spike
• QRS: Wide; Pacer spike seen before each QRS. Measured from
pacer spike to end
• of QRS
7. Atrial-ventricular Pacing
- ANSWER: One pacemaker lead is placed into the right atria and
another is placed into the right
• ventricle.
• The pacemaker generator fires an impulse to the atria and then to
the ventricle sequentially
• causing atrial then ventricular contraction.
• Rhythm: Atrial and Ventricular regular
• Rate: Atrial and Ventricular same & within set limits
• P waves: Pacer spike seen at beginning of atrial activity P waves
may or may not be seen
• (lead type dependent)
• PRI: WNL - Measured from atrial spike to ventricular spike
• QRS: Wide - Measured from ventricular spike to end of QRS
8. Failure to capture
- ANSWER: A pacer spike note followed by the appropriate atrial or
ventricular response
• Can be a potentially lethal situation!
9. Failure to pace
- ANSWER: Absence of pacer activity (spikes) when the pacemaker
generator should have fired an impulse.
• Typically seen when the patient's intrinsic heart rate falls less than
the pacemaker's low HR limit and
• the pacer fails to fire.
