EKG Sample

ECG Interpretation
Interactive Case Studies

Sagar Kalahasti, M.D., F.A.C.C.
Staff Cardiologist, Heart and Vascular Institute
Cleveland Clinic
No relationships to disclose
What Should I Expect on the

Boards?
ECG tracings with one or two major findings
Clinical vignette with each tracing
Questions that are focused as much on the clinical scenario as
the ECG itself
No trickery
No coding of all of the abnormalities on the ECG
ECG Interpretation: A Case-Based Review
ECG
CG Fundamentals
u da e ta s
Rate:: Fast or slow?

Rate
Rhythm:: Sinus or not? Narrow complexes or wide?
Rhythm
Intervals:: PR and QT normal or prolonged?
Intervals
P wave:
wave: Normal sinus axis? Atrial enlargement?
g
QRS: Axis shift? Q waves? Ventricular hypertrophy? Bundle branch
QRS:
block?
The ST segment:
segment: Elevation or depression?
The T wave:
wave: Upright or inverted?
Best approach is to apply the same systematic

approach to each ECG
Heart Rate and Timing

One small box = 0.04 sec = 40 ms
One large box = 0.2 sec = 200 ms
Paper speed 1500 mm/min
One beat per 0.2 sec = 300 bpm
Heart Rate = 1500/RR (mm) OR 300/ # large boxes between two R waves
300 150 100 75
3 seconds between hash marks
ECG Complexes and Intervals
P wave: atrial depolarization (right

(right-left)
left)
QRS: ventricular depolarization (septum-LV-RV)
T wave: ventricular repolarization
PRinterval:efficiencyofatrialandAVnodalconduction
STsegment:quiettimebetweenventriculardepolarizationandrepolarization
QTinterval:efficiencyofventriculardepolarizationandrepolarization
Case 1
A 70 year
year--old man with a history of hypertension and
paroxysmal atrial fibrillation presents to the
emergency
g
y department
p
complaining
p
g of episodic
p
dizziness and palpitations. His medication list
includes a heart pill and a water pill.
Case 1
All of the following may account for this mans
presentation except
except
A Hypocalcemia
A.
B. Hypomagnesemia
C Hyperkalemia
C.
H
k l i
D. An inherited ion channel disorder
E An
E.
A adverse
d
d
drug iinteraction
t
ti
Case 1
All of the following may account for this mans
presentation except
except
A Hypocalcemia
A.
B. Hypomagnesemia
C Hyperkalemia
C.
H
k l i
D. An inherited ion channel disorder
E An
E.
A adverse
d
d
drug iinteraction
t
ti
Diagnoses
1 Normal sinus rhythm
1.
2. Polymorphic ventricular tachycardia (Torsades de Pointes)
3. Prolonged QT interval
ECG Interpretation: A CaseBased Review
The QT Interval
Normal QT is 0.35 0.43 seconds
QTc = QT/RR
QT/RR
in seconds
Prolonged QTc if 0.44 sec
Entire T wave should fall in first half of the RR interval
Prolonged
P l
d QT
Normal
N
l QT
Causes of QT Interval Prolongation

Medications
Class Ia (quinidine, procainamide) and III (sotalol, amiodarone) antiarrhythmics

Tricyclic antidepressants
Non--sedating antihistamines
Non
Ranolazine
Electrolyte
y Deficiencies
Hypomagnesemia
Hypomagnesemia
Hypo
Hypocalcemia
calcemia
Hypo
Hypokalemia
kalemia
Liquid Protein Diets

Intracranial hemorrhage
Inherited long QT syndromes
Metabolic Derangement
Myxedema
Hypothermia (look for shivering artifact)
Case 2
A 44 year
year--old woman with a murmur since childhood
presents with several months of progressive exertional
dyspnea. Her physical examination is remarkable for a
systolic ejection murmur along the left sternal border
border,
a split S2 that does not change with respiration and
pitting
p
g lower extremity
y edema.
Case 2
Her subsequent echocardiogram is most likely to
demonstrate which of the following?
A. Flow across the interatrial septum detected by color

Doppler
B. A calcified aortic valve with a high transvalvular pressure

gradient
C. A large pericardial effusion

D. Severe left ventricular hypertrophy with outflow tract
obstruction
b t ti iin mid
id systole
t l
E. Normal left and right ventricular size and function
Case 2
Her subsequent echocardiogram is most likely to
demonstrate which of the following?
A. Flow across the interatrial septum detected by color

Doppler
B. A calcified aortic valve with a high transvalvular pressure

gradient
C. A large pericardial effusion

D. Severe left ventricular hypertrophy with outflow tract
obstruction
b t ti iin mid
id systole
t l
E. Normal left and right ventricular size and function
Diagnoses
1.
2.
3.
4.
Sinus rhythm with first degree AV block

Right atrial enlargement
Right axis deviation
Right ventricular hypertrophy
Right
g Axis Deviation
QRS axis between 100
100 and 270
270
May be a normal variant in children and young adults
Causes
Pulmonary embolism
Obstructive pulmonary disease
Right ventricular hypertrophy left posterior fascicular block
Lateral wall myocardial infarction
Ostium secundum ASD
QRS Axis Determination

QRS (+)
( ) iin I and
d aVF?
VF?
QRS (+) in I and (-) in AVF?
R
Extreme Axis
Look at II
If (+) in II
+
If (-) in II
Lead I (0)
Normal Axis
QRS (-) in I and (+) in aVF?

QRS ((-)) in
i I and
d (-)
( ) in
i aVF?
VF?
Right Axis
Normal Axis
III
+
+
Lead II (60)
L d aVF
Lead
VF (90)
Right Atrial Enlargement

Causes of Right Atrial Enlargement
COPD
CO
Pulmonary Hypertension
Congenital Heart Disease
ASD
Pulmonic stenosis
Eisenmengers
Normal variant in thin patients
P Wave Morphology
Left Atrial Enlargement

P wave duration > 0.12 sec in II, III, aVF
P wave notched in II, III, aVF
V1 terminal
i lPd
deflection
fl i > 1
1mm
V1 terminal P deflection > 0.04 sec
Right Atrial Enlargement

P wave amplitude > 2.5 mm in II, III, aVF
P wave peaked in II, III, aVF
P wave axis
i 70
70
0
V1 initial P deflection > 1.5 mm
Right Ventricular Hypertrophy

Diagnostic Criteria
Right axis deviation
R/S ratio in V1 > 1 or R/S ratio in V5 or V6 1
R wave in V 1 7 mm
R wave iin V1 + S wave iin V5 or V6 10.5
10 5 mm
qR complex in V1
ST depression or T wave inversion in right precordial leads
Onset of intrinsicoid deflection in V1 < 00.05
05 sec
Common Causes
Pulmonary Hypertension
Pulmonic Stenosis
COPD
Case 3
An 83 yearyear-old man with paroxysmal atrial fibrillation,
di b t and
diabetes
d stage
t
II chronic
h i kidney
kid
di
disease presents
t
to your office complaining of lethargy for one week.
Two weeks ago he twisted his left ankle while walking
his dog
dog. He developed subsequent left ankle pain and
swelling that improved with an overover-the counter oral
analgesic.
Examination reveals a well appearing man in no
distress. Blood p
pressure is 110/65 mmHg.
g His
cardiovascular exam is remarkable for a regular
bradycardia and occasional prominent jugular venous
a waves.
Case 3
The most likely culprit for this mans presentation is which of
the following?
A. Advanced age.
B. Coronary artery disease.
C. Digoxin.
D. A tick bite.
E. Dental therapy without amoxicillin prophylaxis.
Case 3
The most likely culprit for this mans presentation is which of
the following?
A. Advanced age.
B. Coronary artery disease.
C. Digoxin.
D. A tick bite.
E. Dental therapy without amoxicillin prophylaxis.
P
R
P
R
P
R
P
R
Diagnoses
1. Sinus rhythm with third degree AV block
2. Accelerated junctional escape rhythm
3. ST and T wave abnormality, consider digitalis effect
Complete
p
((3rd degree)
g ) AV Block
Criteria
Atrial and ventricular impulses occur independent of each other
Atrial rate is usually faster than ventricular rate
PR interval varies
PP andd RR iinterval
t
l are constant
t t
Causes
Digitalis
g
toxicity
y
Myocardial infarction
Inferior better prognosis
Anterior usually requires permanent pacing
Degeneration of the conduction system
Endocarditis
Lyme Disease
AV Conduction Delays
y
Seco
Second
d Degree
eg ee AV Block
oc
Mobitz Type 1
Progressive PR prolongation until P does not conduct
RR containing the dropped P is < 2 x PP interval
Normal QRS duration (usually)
Consider myocardial infarction (inferior in particular)
Mobitz Type 2
Intermittent nonnon-conduction of P wave
PR interval constant
RR containing the dropped P is = 2 x PP interval
Widened QRS
2:1 AV Block
* Regular atrial rhythm with two P waves for each QRS
* Can be Mobitz I or Mobitz II
Favors Mobitz I
Narrow QRS
Block improves
p
with
atropine
Block worsens with vagal

maneuvers
Inferior MI setting
Favors Mobitz 2
Widened QRS
Block worsens with
atropine
Block improves with vagal

maneuvers
Anterior MI setting
Digitalis and the ECG

Digitalis can cause practically any ECG abnormality
Digitalis Effect
PR prolongation and QT shortening
Sagging hockey stick ST segments
Flat, biphasic or inverted T waves
Digitalis Toxicity
Second or third degree AV block
Atrial
At i l fib
fibrillation
ill ti or atrial
t i l ttachycardia
h
di with
ith thi
third
dd
degree AV bl
block
k
Bidirectional ventricular tachycardia
Case 4
A 64 yearyear-old woman presents to an urgent care
center complaining of nausea, vomiting and
diaphoresis that began two hours ago. She was
previously well and does not see a doctor on a regular
basis. Her vital signs include a blood pressure of
110/70 mmHg and heart rate of 75 bpm. Examination
reveals a pale, diaphoretic woman who looks
uncomfortable and in mild respiratory distress.
Cardiopulmonary auscultation is unremarkable.
Case 4
Which of the following will not provide a long term
survival benefit for this patient?
A Aspirin
A.
B. Atorvastatin
C Isosorbide Dinitrate
C.
D. Ramipril
E Metoprolol
E.
Case 4
Which of the following will not provide a long term
survival benefit for this patient?
A Aspirin
A.
B. Atorvastatin
C Isosorbide Dinitrate
C.
D. Ramipril
E Metoprolol
E.
Diagnoses
1. Normal sinus rhythm
2. Inferior myocardial infarction, acute
3. ST and lateral T wave abnormality, consider myocardial ischemia
Coronary Disease and the ECG

Myocardial Ischemia
Horizontal or downsloping
p g ST segment
g
depression
p
Symmetric T wave inversion
Myocardial Infarction
ST elevation often preceded by increased T wave amplitude
Horizontal or upwardly convex ST segment elevation of 1 mm
in two contiguous limb leads
Horizontal or upwardly convex ST segment elevation of 2 mm
in two contiguous precordial leads

Associated ST depression in nonnon-infarct leads
Q waves, indicative of completed infarction
Q 0.03 sec and > 1 mm deep in I, II, avL, aVF, V4V4-6
Q of any size in V1V1-3
Infarct Localization
Left Anterior Descending (LAD)
Septum: V1 and V2
Anterior:
A t i
V3 and
d V4
Anterolateral (diagonal branches): 1, aVL, V3V3-6
Apical: V1
V1--4 and II, III, aVL
Circumflex
High Lateral: I, aVL
Lateral: V4
V4--6
Anterolateral: I, aVL, V3
V3--6
Right Coronary Artery (RCA)

Inferior: II, III, aVF
Posterior: tall R or ST depression in V1 and V2
RV: V4R V6R
Case 5
A 53 yearyear-old man with a history of hypertension,
COPD and remote myocardial infarction presents to
the emergency department complaining of intermittent
palpitations for the past few days. He denies any
recent chest pain, dizziness or syncope. He appears
well and is in no obvious distress. The intake nurse
measures his blood pressure with an automated cuff
and gets a reading of 116/65 mmHg but states that the
pulse reading cant be right. You come over to
investigate
g
and p
perform an ECG.
Case 5
The most appropriate next step would be to
A. Give adenosine 6 mg IV push.

B Give
B.
Gi dilti
diltiazem 20 mg IV b
bolus
l ffollowed
ll
db
by a d
drip
i att 5
mg/hour.
C. Give digoxin 0.5 mg IV push.

D. Deliver a 360 Joule unsynchronized shock immediately.
E. Give amiodarone 150 mg IV bolus followed by a drip at 1.0
mg/min.
/ i
Case 5
The most appropriate next step would be to
A. Give adenosine 6 mg IV push.

B Give
B.
Gi diltiazem
dilti
20 mg IV b
bolus
l ffollowed
ll
db
by a d
drip
i att 5
mg/hour.
C. Give digoxin 0.5 mg IV push.

D. Deliver a 360 Joule unsynchronized shock immediately.
E. Give amiodarone 150 mg IV bolus followed by a drip at 1.0
mg/min.
/ i
Diagnosis
Ventricular tachycardia
Wide Complex Tachycardia

Favors VT
AV dissociation
Fusion
F sion beats
Very wide QRS (>0.14 s)
Precordial concordance
Extreme or left axis
Absence of RS complex in
allll precordial
di l lleads
d
Any precordial RS interval

> 0.1 sec
Favors Aberrant SVT
No AV dissociation
N ffusion
No
i b
beats
QRS < 0.14 s
Precordial discordance
Relatively normal axis
Any precordial RS complex
All precordial RS intervals <
0.1 sec
Case 6
A 23 yearyear-old woman with no significant medical history
presents to your office complaining of chest pain for the past
three days preceded by malaise and a cough productive of
yellow sputum. The chest pain has been constant since
onset but waxes and wanes in intensity. She denies any
dyspnea, palpitations or syncope. Vital signs include a
pulse of 100 bpm, BP 138/80 mmHg and a temperature of
38.1 C. Exam reveals an uncomfortable young woman in
38.1
no distress. Conjunctival injection is present but her
p for regular
g
cardiovascular exam is unremarkable except
tachycardia. Her lungs are clear.
Case 6
All of the following are appropriate therapeutic agents
for this patient except
except
A Indomethacin
A.
B. Colchicine
C Aspirin
C.
A ii
D. Clopidogrel
E Ibuprofen
E.
Ib
f
Case 6
All of the following are appropriate therapeutic agents
for this patient except
except
A Indomethacin
A.
B. Colchicine
C Aspirin
C.
A ii
D. Clopidogrel
E Ibuprofen
E.
Ib
f
Diagnoses
2. Pericarditis
Acute Pericarditis
Stages
1: concave up ST elevation in all leads (except aVR)
2: ST point normalizes, T wave amplitude increases
3: T wave inversion
4: Normalization
Other Clues
Sinus tachycardia
PR depression
p
Low voltage or electrical alternans (if effusion)
Symptoms are important
Differential diagnosis
Myocardial Infarction usually focal, look for reciprocal changes
Early repolarization normal variant, young, asymptomatic patients
Case 7
A 58 yearyear-old woman comes to you for preoperative risk
assessment prior to an elective abdominal hysterectomy.
Her medical history is significant only for bleeding uterine
fibroids. She denies any concerning symptoms and
exercises regularly without limitations or symptoms. Her
physical examination is completely within normal limits and
her ECG is shown.
Case 7
Which of the following statements regarding this patient
is false?
A. She will likely remain asymptomatic.

B Radiofrequency ablation is appropriate therapy if she
B.
develops palpitations.
C. Procainamide is appropriate therapy if she develops

rapid
id atrial
t i l fib
fibrillation.
ill ti
D. Verapamil is appropriate therapy if she develops rapid

atrial fibrillation.
E. Cardioversion is appropriate therapy if she develops

rapid atrial fibrillation
Case 7
Which of the following statements regarding this patient
is false?
A. She will likely remain asymptomatic.

B Radiofrequency ablation is appropriate therapy if she
B.
develops palpitations.
C. Procainamide is appropriate therapy if she develops

rapid
id atrial
t i l fib
fibrillation.
ill ti
D. Verapamil is appropriate therapy if she develops rapid

atrial fibrillation.
E. Cardioversion is appropriate therapy if she develops

rapid atrial fibrillation
Delta waves
Diagnoses
2. PrePre-excitation (Wolff
(Wolff--Parkinson
Parkinson--White Pattern)
Wolff--Parkinson White ((WPW))

Wolff
Criteria
PR interval < 0.12 seconds
QRS widening with ventricular prepre-excitation delta wave
Presentation
Narrow complex tachycardia
Wide complex tachycardia
Atrial fibrillation
AVOID AV nodal blocking drugs
Management
g
Antiarrhythmic therapy
Cardioversion
Radiofrequency Ablation
Case 8
A 62 yearyear-old man with a history of diabetes and
hypertension presents to the emergency department with
two days of lethargy and malaise. He was seen in the
emergency department four days ago for left flank pain and
hematuria. A contrast enhanced CT scan was negative for
kidney stones or other abdominal or pelvic pathology. His
pain resolved with IV morphine and toradol and he was sent
home with oral percocet and instructions to strain his urine.
His flank pain and hematuria have since resolved. His
physical
p
y
examination is unremarkable.
Case 8
All of the following interventions are appropriate at
this time except
A. intravenous calcium chloride
B. intravenous glucose and regular insulin

C. nebulized albuterol
D. oral polystyrene sulfonate
E. intravenous magnesium sulfate
Case 8
All of the following interventions are appropriate at
this time except
A. intravenous calcium chloride
B. intravenous glucose and regular insulin

C. nebulized albuterol
D. oral polystyrene sulfonate
E. intravenous magnesium sulfate
Creatinine 4.0 mg/dL, Potassium 7.1 mEq/L

Diagnoses
1. Normal sinus rhythm with first degree AV block
2. Non
Non--specific interventricular conduction delay
3 Increased T wave amplitude
3.
amplitude, consider hyperkalemia
Potassium and the ECG

Hyperkalemia
Mild (K 5.55.5-6.5 mEq/L)
Peaked T waves
> 10 mm in precordial leads
> 6 mm in limb leads
Shortened QT
Moderate (K 6.6
6.6--7.5 mEq/L)
First degree AV block
Wide P with low amplitude
QRS prolongation
Hypokalemia
Prominent U waves
ST depression, flattened T
waves (K usually < 2.5 mEq/L)
Increased P amplitude
Prolonged QT
All degrees of AVB
Ventricular arrhythmias
Severe (K > 7.5 mEq/L)
Sinus arrest
Left or right bundle branch pattern
Marked QRS widening (sine wave)
ST elevation
Ventricular arrhythmia
y
and asystole
y
Case 9
A 19 year-old male college student with no known
medical history presents to the university student
health clinic complaining of episodic dizzy spells for the
past two weeks. He describes episodes of
lightheadedness and palpitations that occur for a few
minutes and then spontaneously resolve. He
attributed these to finals week jitters but he is now on
summer break and the symptoms have continued. He
tells you Im feeling dizzy right now.
Case 9
All of the following statements regarding this patient are
true except
A. Carotid sinus massage

g may
y terminate this rhythm
y
B. Intravenous adenosine may terminate this rhythm
C. This rhythm may be amenable to cure with radiofrequency
ablation
D. This rhythm may not be amenable to cure with

radiofrequency ablation
E. This patient will require anticoagulation to prevent stroke.
Case 9
All of the following statements regarding this patient are
true except
A. Carotid sinus massage

g may
y terminate this rhythm
y
B. Intravenous adenosine may terminate this rhythm
C. This rhythm may be amenable to cure with radiofrequency
ablation
D. This rhythm may not be amenable to cure with

radiofrequency ablation
E. This patient will require anticoagulation to prevent stroke.
Diagnosis
1. Supraventricular tachycardia, consider AV nodal reentrant
tachycardia
Supraventricular Tachycardias
Criteria
Regular rhythm
Narrow QRS complexes (unless pre-existing bundle
branch block or aberrancyy is p
present))
Rate > 100 bpm

Atrial waveform absent or appears retrograde
Differential Diagnosis
AV nodal reentry (most common by far)
Atypical AV nodal reentry
AV reentry
A-V Reentry
Case 10
A 42 year-old man with no medical history presents to an
g
care center with several hours of p
palpitations
p
and a
urgent
rapid heart rate. He tells you that hes experienced two
similar episodes over the past year but they always went
away
y before I could g
get to a doctor. He denies any
y other
symptoms and his current vital signs are BP 120/80 mmHg,
HR 150 bpm, RR 14. He looks well and his exam is
remarkable only for tachycardia. Last month the patient
established care with a new primary care physician who, in
view of his history of palpitations, arranged for a 48 hour
Holter monitor and a surface echocardiogram
echocardiogram. Both were
completely normal.
Case 10
Which of the following statements regarding this patient is
true?
A. He requires long-term coumadin therapy to prevent stroke.

B. He requires hospitalization for intravenous heparin and
TEE-guided cardioversion.
C. Catheter-based treatment of his arrhythmia

y
has a high
g
success rate.
D. The antiarrhythmic drug of choice for this patient is

amiodarone.
amiodarone
E. His arrhythmia is not likely to reoccur following

cardioversion.
Case 10
Which of the following statements regarding this patient is
true?
A. He requires long-term coumadin therapy to prevent stroke.

B. He requires hospitalization for intravenous heparin and
TEE-guided cardioversion.
C. Catheter-based treatment of his arrhythmia

y
has a high
g
success rate.
D. The antiarrhythmic drug of choice for this patient is

amiodarone.
amiodarone
E. His arrhythmia is not likely to reoccur following

cardioversion.
Diagnosis
1. Atrial flutter with 2:1 AV conduction.
Atrial Tachyarrhythmias
Atrial Flutter
Sawtooth F waves,, typically
yp
y at 240-340 bpm
p
Typical flutter has negative F waves in inferior leads
F waves lack an isoelectric baseline
Atrial
At i l Fib
Fibrillation
ill ti
Absent P waves or coarse, variable atrial wavelets
Irregularly irregular QRS pattern
Multifocal Atrial Tachycardia

Atrial rate > 100 bpm
Atrial waveforms with 3 morphologies
Variable PP and PR intervals
Seen often in patients with pulmonary disease
Case 11
A 65 year-old woman with type 2 diabetes,
hypertension and hypothyroidism recently moved to
your town and is seeing you today to establish care
with a new internist. She presently voices no
complaints and states that her blood pressures and
blood sugars have been well controlled with HCTZ,
lisinopril and metformin. She maintains an active
lifestyle that includes walking, biking and swimming
almost daily. Her ECG is shown.
Case 11
All of the following are true about this patient except
A. Her ECG may represent a variant of normal.

B. Her ECG may represent a prior myocardial infarction.
C. Her ECG may represent age-related degeneration of the
conduction system.
system
D. Her ECG may represent structural heart disease.

E Her ECG may make the future diagnosis of myocardial
E.
infarction difficult.
Case 11
All of the following are true about this patient except
A. Her ECG may represent a variant of normal.

B. Her ECG may represent a prior myocardial infarction.
C. Her ECG may represent age-related degeneration of the
conduction system.
system
D. Her ECG may represent structural heart disease.

E Her ECG may make the future diagnosis of myocardial
E.
infarction difficult.
Left Bundle Branch Block

Criteria
QRS dduration
ti 0.12
0 12 seconds
d
Broad, monophasic R waves in I, V5 and V6
rS or QS in V1
QRS-peak
QRS peak R wave
a ed
duration
ration >0
>0.05
05 seconds
Seen in
LVH
Myocardial infarction
Structural heart disease
Conduction system degeneration
Congenital
C
heart disease
Almost never occurs in normals
Right Bundle Branch Block
Criteria
- QRS 0.12 seconds
- rsR or rSR in V1 and/or V2
QRS-peak
peak R duration > 0
0.05
05 seconds in V1 and V2
- QRS
- Wide, slurred S waves in I, V5 and V6
Seen in normals, hypertension, rheumatic heart disease, cor
pulmonale,
l
l d
degenerative
ti conduction
d ti di
disease, Eb
Ebsteins
t i anomaly.
l
What Should I Focus On?

ECG manifestations of systemic and nonnon-cardiac illnesses
Thyroid disease
Pulmonary Disease
ECG manifestations of electrolyte

y disturbances
Potassium
Calcium
Relationship
R l ti
hi b
between
t
th
the surface
f
ECG and
d coronary artery
t
distribution
ECG manifestations of structural heart diseases and their

corresponding physical exam findings
Secundum ASD
Mitral Stenosis
Good Luck!
Acknowledgement
Dr. Michael Faulx, MD,FACC

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ECG Interpretation

Interactive Case Studies

What Should I Expect on the

ECG Interpretation: A Case-Based Review

Rate:: Fast or slow?

Best approach is to apply the same systematic

ECG Interpretation: A Case-Based Review

Heart Rate and Timing

300 150 100 75

3 seconds between hash marks

ECG Interpretation: A Case-Based Review

ECG Complexes and Intervals

P wave: atrial depolarization (right

ECG Interpretation: A Case-Based Review

ECG Interpretation: A Case-Based Review

ECG Interpretation: A Case-Based Review

ECG Interpretation: A Case-Based Review

ECG Interpretation: A Case-Based Review

ECG Interpretation: A CaseBased Review

ECG Interpretation: A Case-Based Review

Causes of QT Interval Prolongation

Class Ia (quinidine, procainamide) and III (sotalol, amiodarone) antiarrhythmics

Liquid Protein Diets

ECG Interpretation: A Case-Based Review

ECG Interpretation: A Case-Based Review

A. Flow across the interatrial septum detected by color

B. A calcified aortic valve with a high transvalvular pressure

C. A large pericardial effusion

E. Normal left and right ventricular size and function

ECG Interpretation: A Case-Based Review

A. Flow across the interatrial septum detected by color

B. A calcified aortic valve with a high transvalvular pressure

C. A large pericardial effusion

E. Normal left and right ventricular size and function

ECG Interpretation: A Case-Based Review

Sinus rhythm with first degree AV block

ECG Interpretation: A CaseBased Review

ECG Interpretation: A Case-Based Review

QRS Axis Determination

QRS (-) in I and (+) in aVF?

Right Atrial Enlargement

ECG Interpretation: A Case-Based Review

Left Atrial Enlargement

Right Atrial Enlargement

ECG Interpretation: A Case-Based Review

Right Ventricular Hypertrophy

ECG Interpretation: A Case-Based Review

ECG Interpretation: A Case-Based Review

ECG Interpretation: A Case-Based Review

ECG Interpretation: A Case-Based Review

ECG Interpretation: A CaseBased Review

Block worsens with vagal

Block improves with vagal

ECG Interpretation: A Case-Based Review

Digitalis and the ECG

ECG Interpretation: A Case-Based Review

ECG Interpretation: A Case-Based Review

ECG Interpretation: A Case-Based Review

ECG Interpretation: A Case-Based Review

ECG Interpretation: A Case-Based Review

ECG Interpretation: A CaseBased Review

Coronary Disease and the ECG

Horizontal or upwardly convex ST segment elevation of 2 mm

in two contiguous precordial leads