CCT Rhythm Analysis: Atrial/Junctional 2

Question 1

What ECG characteristics are used to identify atrial flutter with 2:1 conduction?

Accepted Answer

Sawtooth flutter waves at approximately 300 bpm with a regular ventricular rate of approximately 150 bpm

Answer

Atrial flutter typically has an atrial rate of 250-350 bpm (classic: ~300 bpm) producing sawtooth flutter waves. With 2:1 conduction, every other flutter wave conducts to the ventricles, giving a ventricular rate of approximately 150 bpm.

Question 2

Which ECG finding is pathognomonic for Wolff-Parkinson-White (WPW) syndrome during sinus rhythm?

Accepted Answer

Short PR interval (< 0.12 sec) plus a delta wave (slurred QRS onset) plus wide QRS

Answer

The ECG triad of WPW syndrome during sinus rhythm is: short PR interval (<0.12 sec), delta wave (slurred initial QRS deflection from pre-excitation), and widened QRS complex — all resulting from early ventricular activation through the accessory pathway.

Question 3

Multifocal atrial tachycardia (MAT) is most commonly associated with which underlying condition?

Accepted Answer

Chronic obstructive pulmonary disease (COPD) and other severe pulmonary conditions

Answer

MAT is strongly associated with severe pulmonary disease — particularly COPD — and is also seen in critically ill patients with hypoxia, hypercapnia, and theophylline toxicity.

Question 4

On the ECG, a junctional escape rhythm typically presents with which rate and P wave pattern?

Accepted Answer

Rate 40-60 bpm; P waves absent, inverted (retrograde) before or after QRS, or hidden within the QRS, with narrow QRS morphology

Answer

The AV junction (His bundle area) has an intrinsic escape rate of 40-60 bpm. Junctional beats conduct to the ventricles normally via the His-Purkinje system (narrow QRS), but P waves are absent or retrograde (inverted in II, III, aVF).

Question 5

What is the key ECG difference between a premature atrial contraction (PAC) with aberrant conduction and a premature ventricular contraction (PVC)?

Accepted Answer

A PAC with aberrancy has a preceding (often abnormal) P wave and typically shows RBBB morphology; a PVC has no preceding P wave and has a different QRS morphology with a full compensatory pause

Answer

The presence of an abnormal P wave before the wide QRS (or a 'no P wave' for PVCs) and the morphology pattern (PAC with aberrancy is usually RBBB; PVCs vary) are the key distinguishing features.

CCT - Certified Cardiographic Technician Exam Practice Test

CCT - Certified Cardiographic Technician Exam Practice Test

CCT Rhythm Analysis: Atrial/Junctional 2