Identify the following ECG reading denoted in image?

NORCET 2 -2021 (Shift-2)

Medical Surgical Nursing

Medium

Appeared in: NORCET 2 -2021 (Shift-2)

Explanation

The ECG shows a rapid heart rate, well over 100 beats per minute.
The rhythm is regular, as evidenced by the consistent spacing between the QRS complexes.
The key identifying feature is the presence of wide QRS complexes (duration greater than 0.12 seconds) that all have the same shape (monomorphic).
P waves are not discernible because the rapid ventricular impulses dominate the heart's electrical activity.
This combination of a regular, wide-complex tachycardia is the classic presentation of Ventricular Tachycardia.

Option A: Atrial Fibrillation is characterized by an 'irregularly irregular' rhythm and typically narrow QRS complexes. The ECG in the image shows a regular rhythm with wide QRS complexes.
Option C: Ventricular Fibrillation is a chaotic, disorganized rhythm with no identifiable QRS complexes, P waves, or T waves. The ECG in the image shows organized, repeating wide QRS complexes.
Option D: Atrial Tachycardia is a supraventricular rhythm and thus typically presents with narrow QRS complexes (less than 0.12s). The ECG shows wide QRS complexes, indicating a ventricular origin.

Visual 1: Infographic: A side-by-side comparison of ECG strips for Atrial Fibrillation, Ventricular Tachycardia, Ventricular Fibrillation, and Atrial Tachycardia, highlighting the key differences in rhythm, rate, and QRS width.
Visual 2: Diagram: Illustrating the electrical pathway of the heart during normal sinus rhythm versus the ectopic focus in the ventricle causing Ventricular Tachycardia.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain ECG Interpretation: Ventricular Arrhythmias as background academic context rather than a clinical decision trigger.
Ventricular Tachycardia is a medical emergency because it can severely compromise cardiac output and may degenerate into pulseless VT or Ventricular Fibrillation, leading to cardiac arrest.
The first and most critical nursing action for a patient with this rhythm on a monitor is to immediately assess the patient for responsiveness and a pulse. The treatment pathway depends entirely on whether the patient is stable (has a pulse and is conscious) or unstable (pulseless or hypotensive).
What if? If the patient with this rhythm was found to be unresponsive and pulseless, the nurse's priority would be to immediately call for help (activate the code team), start high-quality CPR, and prepare for immediate defibrillation according to ACLS protocols.

How to Approach the Question

First, analyze the ECG systematically. Start with the rate. The complexes are close together, indicating a fast rate (tachycardia).
Next, assess the rhythm by checking the R-R intervals. In the image, the distance between each complex is consistent, indicating a regular rhythm.
Then, examine the QRS complex width. Is it narrow (less than 3 small squares) or wide (3 or more small squares)? The complexes are clearly wide, which points towards a ventricular origin.
Look for P waves. Are they present and associated with each QRS? Here, P waves are not discernible.
Synthesize the findings: A regular, wide-complex tachycardia is most commonly Ventricular Tachycardia. This allows you to confidently select the correct option.

Concept Tested & Keywords

Qcm8cdsFyFrV7NSqYAcML-