Hello and welcome to the rhythm challenge. In this video I'm going to quickly go through about 45 several arrhythmias. They're all different and be ready to click your pause button because I'm going to go through them really quickly and I don't want you to get the answer before you had a chance to you know give a your own best attempt at interpreting the arrhythmia. So let's go ahead and get started.
Here's your first arrhythmia. Go ahead and... Look at the atrial activity, the ventricular activity, the width of the QRS complexes, and hit the pause button and try to give your best interpretation. I'm going to click to the answer now. This first arrhythmia is atrial fibrillation.
You may have been thinking atrial flutter. That's not a horrible guess, but this is not a flutter wave pattern or a sawtooth pattern. This is all a fibrillatory wave. And it is an irregularly irregular arrhythmia. If you look at these R to R intervals, they are definitely not consistent.
With a fibrillatory wave, you're unable to identify any clear P waves. This is atrial fibrillation. Take a look at the next one. All right, take a good look and hit pause when you're ready to interpret.
This is a sinus rhythm with a first degree AV block. You have a consistent prolonged PR interval. Here's the next one. Hit pause and interpret this rhythm.
This is a third degree AV block. Okay, it might be difficult to identify the P waves, but you could definitely see a P wave here and you see one here. So just try to march those out. with that same P to P interval, and you will be able to see that some of them are hidden within the T waves and QRS complexes. And the P to P's are regular, the R to R's are regular, there's no drop beats, you just have AV disassociation.
That's a third degree AV block. Here's your next arrhythmia. Make sure you hit pause and try to interpret it.
This is an accelerated idioventricular rhythm. Those are retrograde P waves, which can occur with ventricular rhythm. This fits the rate of about 60 beats per minute, which is an accelerated idioventricular rhythm. Very wide QRS complexes. Here's your next one.
As soon as it comes up, there you go. Make sure you hit pause and try to interpret this. This is a monomorphic ventricular tachycardia. You can see it's very fast, much faster than 100. Wide QRS complexes. Your QRS complex starts about there and ends right about there.
That's a wide QRS complex. It's ventricular tachycardia. Here's your next one. Take a good look at it.
This rhythm is... Mobitz 1 or second degree type 1 or WinkyBach. You see you have a PR interval that is prolonging.
So you have a going, going, going, and then you have a P wave without a QRS complex. So going, going, going, gone. That is Mobitz 1 or second degree type 1. Here is your next arrhythmia. Make sure you give it a chance to interpret it.
This is a Mobitz 2, a second degree type 2, a consistent PR interval with dropped beats. Mobitz 2, consistent PR interval with dropped beats. Here's your next arrhythmia.
Make sure you hit pause and try to give a good interpretation. This is a junctional tachycardia, no obvious atrial activity. or no P waves before the QRS complex.
They have a narrow QRS complex. It is a very regular rhythm, junctional tachycardia, greater than 100 beats per minute. Here's your next one. And this rhythm is a two to one AV block, two to one AV block or untypable AV block, because you can't decipher this between a Mobitz one and a Mobitz two. So we just call it a two.
to one AV block or untypable. Here's your next arrhythmia. This one should look vaguely familiar.
Moving on. It is atrial flutter with a variable conduction. Variable conduction because your R to R interval here is much different from this one, right?
So this is an atrial flutter with variable conduction. That is a sawtooth pattern for the atrial activity. Moving along.
Starting to get a little bit harder here. Let's take a look at the answer. This is a sinus rhythm with ventricular bigemini.
So your underlying rhythm is obviously sinus, right? You have an underlying sinus rhythm there. And then every other beat is a big PVC. So it is monomorphic or unifocal ventricular bigemini. Take a look at the next one.
This one's a little bit more difficult. Let's take a look at the answer. Ectopic atrial tachycardia with a block. You have a three to one ATAC.
A lot of times this is due to a DIG toxicity, medication induced. Let's take a look at another arrhythmia here. Okay, let's look at the answer. This is a supraventricular tachycardia.
More specifically, this is avian nodal reentry tachycardia. You can't see any obvious atrial activity. Very narrow QRS complexes and very fast.
Very, very regular. All of those fit SVT. Here's your next one. And this is a third degree AV block.
Shouldn't be that difficult to identify these P waves throughout without any association with the QRS complexes. Third degree AV block. Here's your next one and this one is another SVT. It's another avian nodal reentry tachycardia. No obvious atrial depolarization but you do have very narrow very regular QRS complexes and it's very very fast.
That is AVNRT and just to simplify it we'll call it SVT. Here's your next arrhythmia. Okay, the answer is an ectopic atrial rhythm. If you said it was a junctional rhythm, I wouldn't take any points off. You do have inverted P waves.
I guess the PR interval just isn't short enough to really call it a junctional rhythm. However, it's neither here nor there. It's going to pretty much require the same type of treatment, which isn't a whole lot pre-hospitally.
Moving on to the next rhythm. Okay, and the answer for this one is polymorphic VTAC. Polymorphic VTAC.
If you said torsades de pointe or torsades to points, I wouldn't count you off any points for that either. It does look like it has a bowtie effect. In fact, this looks a lot like early V-fib might look. A lot of people confuse early ventricular fibrillation for torsades. If you see it, how it ends here, looking like it's going into a coarse V-fib.
Torsades. is almost always caused by a prolonged QT interval, so that is much more of a specific type of polymorphic V-tach. Here's another arrhythmia.
These often confuse people, but this is a 2-to-1 atrial flutter. A 2-to-1 atrial flutter. If you could just continue these sawtooth patterns right through the QRS complexes, or you cover the QRS complexes, It becomes very, very easy to see that sawtooth pattern.
Or if you just flipped it upside down in your head and you just saw the sawtooth pattern going across the bottom, it might make it easy. It's a two-to-one atrial flutter. Next one. This is a more difficult arrhythmia to identify.
This one is another atrial flutter. Another two-to-one atrial flutter. It looks much different than that last one. This one has P wave just before the QRS complex and just after, all the way throughout.
In fact, it's called an F wave, flutter wave. All right, the next one. And this one is a Mobitz 1. It's another second-degree type 1 AV block or sometimes called WinkyBock phenomenon. You have that prolonging of the PR interval. until you have a P wave, which is probably right about there, with no QRS complex.
Prolonging P wave, no QRS complex. This is a Mobitz 1. Next. This one looks a little bit more straightforward. This is a atrial flutter. This is a 5 to 1, much easier to identify than those 2 to 1s.
All right, take a look at the next one. Take a good look at the rhythm and this one is multifocal atrial tachycardia. Multifocal atrial tachycardia. Note the different morphologies of the P waves. That's your dead giveaway.
When you have multiple P wave morphologies, you got to start thinking either wandering atrial pacemaker or if it's greater than 100 beats per minute, it would be MAT, multifocal atrial tachycardia. Next one. This is an easy one.
Let's just move along. That is V-fib, ventricular fibrillation. All right, next one.
You only get one break with the V-fib. All right, take a good look at it. This is another SVT, supraventricular tachycardia.
This is atrioventricular tachycardia, atrioventricular tachycardia. Very regular, very fast, no clearly identifiable P waves. SVT.
Let's move along. Obviously you have two different types of rhythms here. You have a sinus rhythm that goes into Torsades de poing.
It's the best French I can do. A very clear bowtie effect and it did happen because of an R on T phenomenon. Torsades.
Next one. And feel free to hit pause and walk away for a little bit. This rhythm is an accelerated idioventricular.
You got a wide, fast rhythm. These are probably actually retrograde P waves on top of the T waves. You don't see that very often, but it's wide, it's regular, it fits the accelerated idioventricular rate. That's what you got there.
Next one. All right, you might note this one looks very fast. This is another SVT. This is avinodal re-entry tachycardia. This probably requires synchronized cardioversion.
That is a fast rhythm right there. Your patient is not going to be appreciating it very much. All right, let's move on to the next one. Remember how to treat those SVTs.
All right, this one, I lied before. You get two breaks. That's another V-fib. Ventricular fibrillation.
Ventricular fibrillation. Next one. Take a good look at this rhythm. You might notice something's missing. That's because this is a junctional escape rhythm.
It's slow, narrow, and very regular junctional escape. No atrial activity. All right, moving on to the next one.
This one's a trick. I threw sinus tach right there in the end of it. Close to the end at least. This is sinus tachycardia.
Remember sinus tachycardia doesn't really require treatment. Just give them fluids and treat the underlying cause. Going on to the next one. All right take a good look at the atrial activity here. This is an atrial flutter with variable conduction again.
Atrial flutter with variable conduction. Your R to R intervals are irregular. Alright, next one. This is atrial fibrillation. I'm going to start moving a little quicker.
Get ready to hit that pause. Here's your next one. Now you have atrial flutter with three to one conduction.
Flutter waves continue throughout. There's one really hidden in that QRS complex, three to one conduction. Next one. This is an atrial tachycardia. Atrial tachycardia.
Okay, you do have P waves. They're hidden in that T wave. It looks like it has a little bit of a bump. That's not.
T waves never have bumps like that. It's always caused by something like a P wave hidden in there. Next one. As soon as that atrial tachycardia comes off the screen, you'll see the new one.
Alright, take a good look at this one. This one is an accelerated junctional rhythm. Accelerated junctional rhythm.
You do have inverted P waves here with a narrow QRS complex, and then those go away for a couple beats there. Next one. This is just a sinus rhythm with 60 cycle artifacts.
Look at that thick bass line. Next one. Okay, this one's easy.
Asystole. Start CPR, right? Asystole or your EKG monitor isn't on.
Next one. Okay, this one is a sinus rhythm with a first degree AV block. Just have a little bit of a prolonged PR interval there.
Next one. This one is a wandering atrial pacemaker. Note the morphologies of the P waves.
Since it's slower than 100 beats per minute with several different morphologies, it's called the WAP, wandering atrial pacemaker. Alright, next EKG. This one is Emobitz 2, secondary type 2. You have consistent PR interval with dropped beats. Next one. As soon as it comes up here...
Take a good look at it. You may have never seen this before. It's a ventricular asystole or ventricular standstill.
You have P waves with no QRS complexes. Next arrhythmia. This is a Mobitz 1, a second degree AV block type 1. You have that going going gone pattern.
Next this is A monomorphic ventricular tachycardia. Monomorphic ventricular tachycardia. They're all the same shape, very fast, very wide.
You should be able to identify that instantly. Here's your next one. This is a third degree AV block.
Third degree AV block. Complete AV disassociation. Also sometimes called the complete heart block. Here's your next one. Very simple.
This is simply a sinus rhythm with unifocal ventricular trigeminy. Here's your next one. There's no more. That's the end of it. We went through about 45 arrhythmias there.
I hope I didn't go too quick. I did warn you though, click that pause button. Well, all right, that was a very long ECG course. If you want to go back and watch it again, you can start with chapter one if you haven't done the ECG course yet and you just wanted to do the arrhythmia challenge.
Well then I strongly suggest if you weren't getting a whole lot of those that you go click the left image there and start with the entire ECG course on chapter one. If you're ready to start learning the coveted 12 leads, click on the image to the right and get started with the 12 lead comprehensive course. All right, as always, subscribe to the channel and you'll see videos as they become available.