Practice Set: Wide-Complex and Block Tracings
Drill cards for the 6-step rhythm checklist and the mixed wide-complex and AV block cases in this practice set.
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Questions Covered in This Set
11 cards to master
List the 6 steps of the rhythm analysis drill.
1) Rate, 2) Regularity, 3) P waves, 4) PR interval, 5) QRS width, 6) Name it and decide sick vs. not sick.
Mental fork: wide + fast + no P waves = ?
Assume ventricular tachycardia until proven otherwise.
Mental fork: more P waves than QRS complexes = ?
Some flavor of AV block.
Rate 38, regular; P waves at 88/min marching through independently; PR varies randomly; QRS 0.16 s.
Third-degree (complete) heart block with a ventricular escape rhythm — AV dissociation. Transcutaneous pacing and call cardiology.
How do you avoid mistaking complete heart block for Mobitz II?
In complete block the PR interval never repeats a stable value; Mobitz II has a fixed PR on conducted beats.
Sinus rhythm at 76 with an early, wide, bizarre beat every third complex.
Sinus rhythm with ventricular trigeminy (every other beat would be bigeminy). Check K+, Mg2+, ischemia, stimulants.
Rate 190, regular, QRS 0.15 s, no P waves, identical complexes, BP 78/40, prior MI.
Monomorphic ventricular tachycardia; unstable → synchronized cardioversion. Prior MI + age >35 strongly favors VT.
Rate 68, PR fixed at 0.28 s with every P conducting, QRS 0.14 s with RSR′ in V1 and slurred S in I and V6.
First-degree AV block PLUS right bundle branch block — record both findings.
V1 rule for bundle branch blocks
Terminal positive deflection (RSR′, rabbit ears) = RBBB; broad monophasic notched R = LBBB.
Self-test answers A–E
A: Mobitz I (Wenckebach) second-degree block. B: Ventricular fibrillation. C: Torsades de pointes (long QT). D: Mobitz II second-degree block. E: Agonal/ventricular escape rhythm (dying heart).
Normal PR interval and QRS width values
PR 120–200 ms (3–5 small boxes); QRS narrow if <120 ms (≤3 small boxes), wide if ≥120 ms.
