ECG Flashcards by EJ Byrne

Rhythmic (60 BPM)

No p waves

F waves (saw shaped waves)

Qrs normal

LAD

No patho Q waves

No hypertrophy

Atrial Flutter

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Rhythmic (60 BPM)

P waves

LAD

Qrs wideà RBBB

Patho Q in 2, 3, AVFà ACUTE INFERIOR MI

RBBB
Pathological Q and ST elevation in II,III,aVF —> acute inferior MI
*if there was Extreme LAD —>no bifasicular block as the deviation is caused by the inf. MI

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Arrhythmic due to digitalis - Dali moustache - V1, V2

No p waves

F waves ATRIAL FIBRILLATION with ventricular INTERPOLATED BEAT

ATRIAL FIBRILLATION
LVH
polymorphic VPC

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Rhythmic (sinus origin)

P waves present

QRS normal

No patho Q

T: negative T in lead I and Biphasic T wave in V2-V5 ( sign of ischemia)à stable angina

Deep S in V2 V3

Axis 90 ( normal)

LVH? In a young guy this is less likely

THE KEY SAYS ACUTE ANTERIOR MI??

Sinus rhythm and Acute ANTERIOR MI –> Stable Angina

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Rhythmic (90 BPM)

P waves

PR normal

QRS normal

No patho Q

ST elevation in leads I, 2, AVL, AVF V1-6 à can be pericarditis

PQ DEPRESSION

pericarditis

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Arrhythmic (70 BPM)

No P waves

Qrs wide

Extreme LAD
no patho Q waves

Atrial Fibrillation
LVH
LAH

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Rhythmic 45 BPM

Not f wavesà noise

Sinus bradycardia

Decreased PR

delta waves

WPW

AVL have patho Q waves this is due to WPW

TYPE B because V1 is negative

Sinus bradycardia
WPW type B (negative in V1)

LVH

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Rhythmic 75 BPM

P waves

PR increased–> 1st degree AV block

QRS wide

RSR in V5 and V6à LBBB

1st degree AV block and LBBB

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Sinus bradycardia

P normal

PR normal

No patho Q

LVH ( >35mm)

ST elevations in V2-V3 and biphasic T wave–> hyperacute ANTERIOR MI

Sinus bradycardia
LVH
Wellens syndrome (negative T v2-v5)
hyperacute anterior MI

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ventricular tachycardia

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Rhythmic

P normal

Qrs wide

Extreme LAD

Sinus tachycardia

LBBB (notched R in 1, AVL, V5 or V6)

No q in V5 V6

Rs or QS in V1-V4

Prolonged ID time in V6

VPC

V1 RS

Deep S

Wide R in v5-6

I, AVL have a notched R wave

VPC
LBBB
cannot diagnose hypertrophy when there is a BBB

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Rhythmic ( 65 BPM)

p waves present

PR decreased with delta wave present

Wide QRS

TYPE A

ST depression ( ascending due to WPW changes)

PR short QRS Wideà WPW

Not tachycardia so not ortho/antidromic

TYPE A WPW syndrome

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Rhythmic (75 BPM)

P waves ( 2.5 mmà p. pulmonale)

PR: normal

QRS: normal (-30 )

Patho Q: in AVL

St: elevation V1-3 anteroseptal ischemia due to LVH

Sokoloff index:

Sv1+ R v6 >35 mm

Strain in ST depression

P. pulmonale, LVH with anteroseptal ischemia with VPC

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Rhythmic (75 BPM)

P wave followed by QRS

PR >0.2s same in each of the leads–> 1st degree AV block
QRS wide

Lead I RSR and in V1 and deep Sà RBBB

Negative T in V2-V5

Extreme RADà Left posterior hemiblock

No hypertrophy or patho Q waves

Fascicular block and primary AV blockà TRIFASCICULAR BLOCK

1st degree AV block+ RBBB+ LPHà trifascicular block
negative T waves V2-V5

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Rhythmic 80 BPM

P waves

PR normal

Axis normal 60 degrees

Patho Q in V1-V4

ST elevations in V1-V5, 1 and AVL

Extensive acute MI

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Rhythmic ( 100 BPM)à tachycardia

P waves present but after the QRS

Junctional Tachycardia

Axis: extreme LAD ( -40)à Left anterior Hemiblock

No patho Q waves

No hypertrophy

JUNCTIONAL tachycardia
Left anterior Hemiblock

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Sinus Bradycardia

WPW

Rhythmic (35 BPM)

P waves

PR normal

2:1 AV block

QRS normal

Axis normal (0)

No patho Q

Sinus bradycardia
2nd Degree AV blockà 2:1 block

Arrhythmic

Axis: LAD (-30) lead II equiphasic)

Allorhythmia – bigeminia

P waves

Qrs normal in the conducted beats with VPCà VENTICULAR BIGEMINIA

Every second beat is a VPC

P pulmonale

Ventricular Bigeminia
P. mitrale
LVH

Arrhythmic 120-150 BPM

P wavesà MAT/ ectopic

Qrs normal

RAD 120

RVH ( deep V6 and tall R wave in V1)

MAT, RVH

Rhythmic 75 BPM

P waves

Qrs wide

LAD

RBBB wide QRS

Inferior old subavute MI and RBBB is the cause of LAD not LAH

RBBB
inferior old/subacute MI and RBBBà LAD ( no anterior hemiblock)

Arrhythmic (50 BPM) bradycardia

Axis: 30 normal

Dropped Pà 2nd degree AV block Mobitz type I

(LAST BEAT LONGER THAN THE FIRST CONDUCTED BEAT)

Qrs wide due to necrosis in the MI and hypertrophy

Patho Q: II, III, AVF

sV1+ Rv5 > 35 mm (LVH)

Strain sign seen in leads

SUBACUTE inferior MI
LVH
2nd degree AV block Mobitz I

HR – 4 boxes = 75 bpm
Axis: Lead I is positive and aVF is positive = axis is normal
Lead II p wave is tall and wide – greater than 2.5 mV – P. pulmonale
aVR – has a pathological Q wave – error or old infarct
R progesssion starts late
No sign of hypertrophy – L- no Sokolow index
R – no tall R in V1-V3 or deep S in V5-V6

P. pulmonale

Rhythmic ( 140 BPM)

Wide QRS and notched

Interpolated Premature beats

No patho Q
poor R progression

QS in V2 and V3à SEPTAL MI

ST elevated a little–> old MI

Low atrial ( junctional acceleration)
interpolated ventricular beat
old septa MI (patho Q in V1-2)

Arrythmic P waves PP interval constant 2nd degree AV block mobitz type I Qrs wide due to a LBBB with ventricular Premature beats No patho Q Axis: extreme LAD **2nd degree AV block Mobitz I LBBB ventricular Premature beats extreme LAD**

Patient has a pacemaker Arrhythmic (90 BPM) P waves normal PR interval completely changing and we see the pacemaker spikes ( ventricular pacemaker)à AV junction problem pacemaker needed if Mobitz II, high degree AV block, 3rd degree AV block, 2:1 block) Look in lead 2: negative ( left to the right= LV pacemaker) Pacemaker can be dangerous here: R on T phenomenonà flutter No patho q waves V1: R/S \>1 = RVH **RVH with pacemaker in the left ventricle (2 degree mobitz 2, high av block, 3rd degree block or 2:1 block)**

Rhythmic 150 BPM No p waves (they are T waves) QRS: narrowà indicates we have a supraventricular tachycardia but we have no P wavesà reentry phenomenon AVNRT No difference between ANRT and AVNRTà Patient does not have WPW (AVRT) \*\* not junctional acceleration as the AV can only fire up to 100 BPM\*\* **AVNRT- supraventricular tachycardia use carotid massage**

Rhythmic 120 BPM P waves present PR normal Axis: normal (80) No patho Q ST elevated in 2, 3, AVF ST depression in AVL, V2 and V3à posterior TROPONIN T and I will be elevated Check myoglobin ( positive within 1 hour) \*\* Troponin lasts 1 week so we cannot tell if it is a new MI)\*\* Check the myocardium specific marker **Hyperacute posterior inferior MI**

Hypotension due to low CO Rhythmic (HR \<40 BPM) bradycardia P waves present Measure PP interval: (sinus tachycardia, about 100 BPMà some P waves are inside the QRS) 3rd degree AV block with junctional escape rhythm With of the QRS= normal Axis normal Patho Q in V1(only 1 lead) ST elevation in 2,3, AVF ST depression in AVL, V2, V3, V4 T’en dome HYPERACUTE posterior inferior MI **3rd degree AV block with Junctional escape rhythm; posterior-inferior hyperacute MI**

Rhythmic 65 BPM Normal axis P waves QRS normal PR normal V1 negative T V2-3 little Rà POOR R PROGRESSION with a negative T waveà ISCHEMIA P mitrale

Arrhythmic (72 BPM) P waves Qrs wide DDD pacemaker and ventricular PC

Arrthymic (200 BPM) No p waves ATRIAL FIBRILLATION Qrs narrow Extreme LAD Patho Q in V1-3à ANTEROSEPTAL SUBACUTE/ OLD MI MAT RVH R/S \<1 in V6

Arrhythmic ( 70 BPM) normal HR why arrhythmic? Look at PP intervals: PP rhythmic but we have P unconductedà 2 degree mobitz I ( last conducted beat is longer than the first beat) P waves (normal) PR normal QRS: normal Axis: -30 because lead 2 equiphasic Patho q: none No hypertrophy signs No ST changes **2nd degree Mobitz I**

Arrhythmic 60 BPM ( borderline bradycardia) Sinus bradycardia Every 3rd beat is a VPC Patho q in 2, 3, AVFà subacute inferior MI ST unchanged Negative T Sinus bradycardia ventricular Trigeminia subacute inferior MI

Rhythmic 60 BPM Normal axis P waves PR normal QRS: wide in I, III, AVL, V1-3 Negative T wave in lead III AVF no p waves RBBB Wide QRS Deep RSR in VI Broad S in V6 **RBBB**

Rhythmic 160 BPM P waveà atrial tachycardia Different PR intervals Mild multifocal reentry atrial phenomenon **ATRIAL TACHYCARDIA 2:1 Block LVH**

Rhythmic P waves not from the sinus--\> atrial QRS narrow--\> AVRT (supraventricular rhythm) Atrial rhythm WPWà orthodromic tachycardia Atrial rhythm WPWà orthodromic tachycardia

Rhythmic (75 BPM) P present PR long ( borderline) QRS normal Axis: RAD (AVR equiphasicà 120) No patho Q R/S \>1 VIà RVH R/S \<1 V6 **RVH with 1st degree AV block**

Rhythmic ( 50 BPM) tachycardia Axis: extreme RAD P waves PR: \>0,2sà 1st degree AV block qRS wide Negative Coronary T in V2àV5 Patho q: AVR NO ST elevationà strain sign in lead II Right ventricular hypertrophy R/S \>1 in VI and R/S \<1 in V6 Strain Chest pain due to ischemia ( RBBB) ? **Sinus bradycardia 1st degree AV block and LPH and RBBB= TRIFASCICULAR BLOCK RVH ( abnormal V1 and V6) NSTEMI MI**

Rhythmic (95 BPM) P waves EXTREME LAD qrs normal Patho Q in 2,3, AVF ST depression in V2,3,4 **Extreme LAD Acute inferoposterior MI**