ECG Flashcards
Rhythmic (60 BPM)
No p waves
F waves (saw shaped waves)
Qrs normal
LAD
No patho Q waves
No hypertrophy
Atrial Flutter
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
Arrhythmic due to digitalis - Dali moustache - V1, V2
No p waves
F waves ATRIAL FIBRILLATION with ventricular INTERPOLATED BEAT
ATRIAL FIBRILLATION
LVH
polymorphic VPC
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
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
Arrhythmic (70 BPM)
No P waves
Qrs wide
Extreme LAD
no patho Q waves
Atrial Fibrillation
LVH
LAH
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
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
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
ventricular tachycardia
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
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
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
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
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
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
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
