EKG Practice Test 1 - Learn & Master ACLS/PALS
Learn & Master ACLS/PALS

Learn and Master ACLS/PALS

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EKG Practice Test 1

This EKG practice test is designed to help you learn to recoginze all of the EKG rhythms that you will encounter during emergencies and during the AHA ACLS provider course.  Use these EKG practice tests to help you become proficient in your rapid rhythm identification.  

Comments

  1. Marty says

    Fine ventricular fibrillation is not a thing, if you believe it is… please specifically define it for me. 🙂

    Reply

    • ACLS says

      Fine ventricular fibrillation is ventricular fibrillation in which the fibrillatory ECG waveforms are of low amplitude, with most waves measuring less than 3 mm in height, reflecting late or deteriorating VF that can resemble asystole on low-gain settings.[1][2]

      Core Definition

      • Ventricular fibrillation can be subcategorized by waveform amplitude on ECG into coarse and fine VF.[1]
      • Fine VF is characterized by fibrillatory waves that are predominantly less than 3 mm in amplitude.[1]
      • As VF persists, coarse VF with larger waveforms tends to deteriorate into fine VF with smaller, shallower waveforms.[3]
      • Fine VF may mimic asystole, especially if the monitor or defibrillator gain is set too low, so careful assessment in more than one lead and with appropriate gain is recommended.[2]

      Relation to AHA/ACLS Guidance

      • Current ACLS guidance acknowledges the coarse versus fine distinction but does not alter treatment strategy based on it; both are treated as shockable VF rhythms with the standard defibrillation-based VF/pulseless VT algorithm.[1][4]
      • Coarse VF is generally considered more responsive to defibrillation than fine VF, but this observation has not led to different AHA-recommended interventions.[1]

      Sources

      1. Ventricular Fibrillation — StatPearls — NCBI Bookshelf — NIH. https://www.ncbi.nlm.nih.gov/books/NBK537120/
      2. Ventricular fibrillation — Wikipedia. https://en.wikipedia.org/wiki/Ventricular_fibrillation
      3. Ventricular Fibrillation (VF) — ECG Library Diagnosis — LITFL. https://litfl.com/ventricular-fibrillation-vf-ecg-library/
      4. Part 6: Advanced Cardiovascular Life Support — Circulation. https://www.ahajournals.org/doi/10.1161/circ.102.suppl_1.i-136
      Reply

  3. patricia sites says

    Q #13 has a rate of 170 so it would be considered SVT and you are saying that is V-tach? Not sure why when anything over 150 classifies as SVT (which is a fancy way of saying v-tach). Not sure why its wrong at SVT?

    Reply

    • MOHAMMAD NASIM says

      Side-by-side summary
      Atrial Flutter SVT Atrial Fibrillation
      Rhythm Regular Regular Irregularly irregular
      Rate ~150 (2:1) 160–250 Variable
      P waves Sawtooth Hidden/retrograde None
      Baseline No flat line Flat Chaotic

      The most likely diagnosis is Atrial flutter with 2:1 AV conduction.

      Reply

  5. Ann says

    Please show the name of the ECG strip with the name and explanation, buy strip side ! It would be easier to learn!

    Thank you
    Ann

    Reply

    • ACLS says

      This would be considered sinus rhythm with a first-degree heart block.
      This is first-degree heart block. For first-degree heart block, the rhythm is regular. The PR interval will be prolonged at > 0.2. The QRS complex will usually be normal. First-degree heart block indicates slowed but not blocked conduction through the AV node.
      Kind regards,
      Jeff

      Reply

  8. Justin says

    The strip in question 11 has an irregular R-to-R interval, yet it is labeled as third degree heart block. Assuming this is a six-second strip, the ventricular rate is also higher than I would expect from an impulse that originates in the ventricle(s). Could someone please explain?

    Reply

  9. Loubna Boukli L.B says

    Question 8 doesn’t make sense. Even Chagpt think there is a problem. This rhythm is sinus bradycardia. would please explain more.

    Reply

    • ACLS says

      Q8 is second-degree heart block type II. For second-degree heart block type II, the ventricular rhythm will be irregular due to intermittent dropped QRS complexes. The atrial rhythm will be regular. The P-waves will look normal, and there will be more P-waves than QRS complexes. The PR interval will be normal or prolonged when a P-wave is followed by a QRS complex. The QRS complex will usually be normal or wide. Kind regards, Jeff

      Reply

    • April Nordeen says

      I dont see the chaos between the R waves. Absent p-waves could also be junctional rhythm and in this case junctional tachycardia.

      Reply

      • Shana says

        I’m not positive, but I believe that the difference is that junctional tachycardia is (albeit usually, not always) a regular rate, atrial fibrillation is an irregular rate. But yes for sure, absent P-waves are also indicative of junctional tachycardia.

  13. Rick S says

    Also for #9, while I do see how this could be mobitz type II, to ensure this was an accurate identification, a longer strip would be needed. Although the PR interval does increase, one could easily argue this was complete/3rd degree as well. While the first and second QRS complex do have an increase in PR interval, it could easily be argued that the P-P interval without accompanying QRS complexes are consistent, the P wave may be buried in the 3rd QRS complex. I am not saying that this is not an example of mobitz type II, don’t get me wrong. However, every ACLS course I have ever attended has the classical demonstration of longer longer longer drop, where this is ~ regular PR to VERY increased PR then a “drop” followed by a QRS without a discernible P wave. So nit picking, and I do appreciate the practice quiz for free. But I do believe a better example could be provided, as again without a longer lead this is debatable.

    Reply

  14. Rick S says

    For # 12, while agreed it should be treated as v-fib, in the ten sessions of ACLS I have experienced, this question would typically not be “Identify the rhythm” without context, more like how would you treat this. If it were to say with a pulse, or without a pulse, this would be different, although the examples of PEA given in ACLS typically look as though they are NSR without a pulse, this (in my opinion) would be a better substitute.

    Reply

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