ECG ECG Troubleshooting 3

Question 1

An ECG shows a rate of 150 bpm with narrow QRS complexes and no visible P waves. Which arrhythmia should be considered first?

Accepted Answer

Atrial flutter with 2:1 conduction

Answer

Atrial flutter at a typical atrial rate of 300 bpm with 2:1 AV conduction produces a ventricular rate of approximately 150 bpm; flutter waves may be hidden in the QRS or T wave.

Question 2

When a patient's ECG shows motion artifact making interpretation difficult, what is the FIRST action the ECG technician should take?

Accepted Answer

Ask the patient to relax and lie still, then repeat the recording

Answer

Patient movement is the most common cause of artifact, and instructing the patient to remain still and relaxed should be the first step before any equipment adjustments.

Question 3

Which finding on a 12-lead ECG is most suggestive of left ventricular hypertrophy (LVH)?

Accepted Answer

S wave in V1 plus R wave in V5 or V6 exceeding 35 mm

Answer

The Sokolow-Lyon criterion (SV1 + RV5 or RV6 ≥ 35 mm) is a widely used ECG voltage criterion for diagnosing LVH.

Question 4

A 60-year-old male presents with chest pain. The ECG shows ST depression in leads V1-V3. Which condition should be ruled out first?

Accepted Answer

Posterior MI (reciprocal changes)

Answer

ST depression in V1-V3 may represent reciprocal changes of a posterior MI; posterior leads (V7-V9) should be obtained to look for ST elevation confirming posterior STEMI.

Question 5

An ECG shows a short PR interval of 100 ms, a delta wave, and a wide QRS. What is the diagnosis?

Accepted Answer

Wolff-Parkinson-White (WPW) syndrome

Answer

WPW syndrome is characterized by a short PR interval, slurred upstroke (delta wave) of the QRS, and widened QRS due to ventricular pre-excitation via an accessory pathway.

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ECG ECG Troubleshooting 3