Exclusive: 3 Practice Questions to Hone Your EKG Skills
It is especially important that you can accurately correlate subjective information with objective findings in EKG interpretation. For a little practice we’ve provided 3 exercises from Maureen Knechtel’s, EKGs for the Nurse Practitioner and Physician Assistant.
Below, you are presented with a patient’s basic history and a corresponding EKG. Remember to follow a system, so you will not leave anything out.
Calculate the rate in beats per minute (bpm). Evaluate if the rhythm is regular or irregular. Is the axis normal, left, or right? Look for the presence or absence of heart block. This includes sinus block; first-, second-, or third-degree atrioventricular (AV) block; bundle branch block; and QT prolongation. Look for signs of ischemia and infarction and strain patterns such as those seen in ventricular hypertrophy and consider atrial enlargement. After careful examination, document your final interpretation.
Question 1:
A 60-year-old female presents to the clinic for a routine 6-month follow-up. She is maintained on flecainide for a history of paroxysmal atrial fibrillation. Her EKG is seen here.
Rate: _________________________________________________________________________
Rhythm: ______________________________________________________________________
Axis: _________________________________________________________________________
Block: ________________________________________________________________________
Infarction: _____________________________________________________________________
Interpretation: __________________________________________________________________
Question 2:
A 25-year-old female presents for evaluation of tachycardia and states that her heart feels like it is racing away. She has a medical history significant for generalized anxiety and feels like she may be having a panic attack. Her EKG is seen here.
Rate: _________________________________________________________________________
Rhythm: ______________________________________________________________________
Axis: _________________________________________________________________________
Block: ________________________________________________________________________
Infarction: _____________________________________________________________________
Interpretation: __________________________________________________________________
Question 3:
A 20-year-old female presents for a college sports physical and offers no complaints. An EKG is requested by her school prior to sports participation. Her EKG is seen here.
Rate: _________________________________________________________________________
Rhythm: ______________________________________________________________________
Axis: _________________________________________________________________________
Block: ________________________________________________________________________
Infarction: _____________________________________________________________________
Interpretation: __________________________________________________________________
The answers are below! Take your time and try to fill it out before looking!!
Answers!
Question 1:
Rate: 72 beats per minute (bpm).
Rhythm: Regular, sinus.
Axis: Normal +30 degrees.
Block: First-degree atrioventricular (AV) block with PRi approximately 280 ms.
Infarction: None.
Interpretation: Normal sinus rhythm with first-degree AV block.
Teaching point: The PR interval is greater than one large box, which is consistent with a first-degree AV block. This is not uncommon in the setting of antiarrhythmic therapy with Flecainide, given its mechanism of action
Question 2:
Rate: 156 bpm.
Rhythm: Regular, sinus.
Axis: Normal +30 degrees.
Block: None.
Infarction: None.
Interpretation: Sinus tachycardia.
Teaching point: The QRS complexes are narrow and fast, but there are P waves visible in most leads. These findings, in addition to the clinical information of anxiety, are consistent with sinus tachycardia.
Question 3:
Rate: 60 bpm.
Rhythm: Regular, sinus.
Axis: Normal +60 degrees.
Block: None.
Infarction: None.
Interpretation: Sinus rhythm with mild sinus arrhythmia.
Teaching point: There are normal-appearing P waves prior to each QRS complex. The rate is approximately 60 bpm. Mild sinus arrhythmia with a normal to slow resting heart rate is common in a young, healthy, physically active patient.
There are 65 more practice examples in this chapter, buy it here or shop our selection of clinical resources for new nurse practitioners!