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Arrhythmia Recognition & Classification Flashcards

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  1. An accelerated idioventricular rhythm (AIVR) is defined as a ventricular rhythm with a rate of:

    Answer: 40–100 bpm

    AIVR occurs when the ventricular escape pacemaker rate accelerates to 40–100 bpm, exceeding the inherent escape rate but not meeting the threshold for ventricular tachycardia.

  2. On an ECG, a junctional escape rhythm would most commonly display:

    Answer: Narrow QRS at 40–60 bpm with absent, retrograde, or buried P waves

    A junctional escape rhythm originates in the AV node or His bundle, producing narrow QRS complexes at 40–60 bpm; P waves may be retrograde (inverted in II, III, aVF) or hidden in the QRS.

  3. Which lead is considered BEST for identifying P-wave morphology and diagnosing atrial arrhythmias?

    Answer: Lead II

    Lead II is oriented parallel to the normal P-wave axis (0–75°), making atrial depolarization waves most visible and well-defined for rhythm analysis.

  4. Ashman's phenomenon occurs in atrial fibrillation when a beat following a long R-R interval is conducted aberrantly. This is because:

    Answer: A longer preceding cycle prolongs refractoriness of the bundle branches

    A long R-R interval extends the refractory period; a subsequent short R-R cycle finds the bundle branch (typically RBBB pattern) still refractory, causing aberrant conduction.

  5. Sinus node dysfunction (sick sinus syndrome) can manifest on the ECG as all of the following EXCEPT:

    Answer: Prolonged QTc interval

    Sick sinus syndrome encompasses sinus pauses, SA exit block, and tachycardia-bradycardia syndrome; prolonged QTc reflects ventricular repolarization and is not a feature of sinus node dysfunction.

  6. A 'bigeminy' pattern on an ECG is defined as:

    Answer: Every other beat is a premature complex

    Bigeminy describes a pattern where every other beat is an ectopic (premature) complex — atrial, junctional, or ventricular — alternating with normal sinus beats.

  7. Which finding on an ECG differentiates sinus bradycardia from a junctional escape rhythm?

    Answer: Presence of upright P waves in lead II before each QRS in sinus bradycardia

    Sinus bradycardia retains normal P-wave morphology with upright P waves in lead II preceding each QRS, distinguishing it from junctional rhythm where P waves are absent, retrograde, or buried.