Health Education Assets Library (HEAL)
 
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TitleDescriptionSubjectCollection
51 Complete AV block, junctional escape rhythm, and ventriculophasic sinus arrhythmiaComplete AV block is seen as evidenced by the AV dissociation. A junctional escape rhythm sets the ventricular rate at 45 bpm. The PP intervals vary because of ventriculophasic sinus arrhythmia; this is defined when the PP interval that includes a QRS is shorter than a PP interval that excludes a ...Knowledge Weavers ECG
52 Junctional parasystole and pseudo-AV blockThis complicated rhythm strip shows normal sinus rhythm and a competing junctional parasystolic focus. Solid circles indicate junctional premature beats from the parasystolic focus. Open circles indicate non-conducted junctional prematures; the first open circle is a nonconducted junctional prematur...Knowledge Weavers ECG
53 Premature junctional complexes with retrograde P wavesThe ladder diagram illustrates the PJC with retrograde atrial captureKnowledge Weavers ECG
54 Left Atrial Abnormality & 1st Degree AV Block: Leads II and V1Left Atrial Abnormality & 1st Degree AV Block: Leads II and V1Knowledge Weavers ECG
55 Right Axis Deviation & RAE (P pulmonale): Leads I, II, IIIRight Axis Deviation & RAE (P pulmonale): Leads I, II, IIIKnowledge Weavers ECG
56 Ventricular bigeminy - marquetteVentricular bigeminy - marquetteKnowledge Weavers ECG
57 LBBB and 2nd degree AV block, mobitz type IMobitz II 2nd degree AV block is usually a sign of bilateral bundle branch disease. One of the two bundle branches should be completely blocked; in this example the left bundle is blocked. The nonconducted sinus P waves are most likely blocked in the right bundle which exhibits 2nd degree block. ...Knowledge Weavers ECG
58 Infero-posterior MI&RBBBDeep Q waves in II, III, aVF plus tall R waves in V1-2 are evidence for this infero-posterior MI. The wide QRS (>0.12s) and RR' complex in V1 are evidence for RBBB. Any time RBBB has an initial R in V1 equal to or greater than the R', true posterior MI must be considered. Q waves in V5-6 suggest a...Knowledge Weavers ECG
59 Extensive anterior/anterolateral MI: recentSignificant pathologic Q-waves (V2-6, I, aVL) plus marked ST segment elevation are evidence for this large anterior/anterolateral MI. The exact age of the infarction cannot be determined without clinical correlation and previous ECGs, but this is likely a recent MI.Knowledge Weavers ECG
60 Nonconducted PAC's slowing the heart rateConsecutive nonconducted PAC's, indicated by arrows, can significantly slow the heart rate. Note the distortion of the ST-T waves caused by the PAC. A hint in recognizing nonconducted PAC's is to find conducted PAC's in the same rhythm strip.Knowledge Weavers ECG
61 three fates of PAC's: 1. normal conduction; 2. aberrant conduction; 3. non-conductionthree fates of PAC's: 1. normal conduction; 2. aberrant conduction; 3. non-conductionKnowledge Weavers ECG
62 QRS axis = 0 degreesLead aVF is isoelectric; lead I is positive; therefore, the QRS axis is 0 degrees.Knowledge Weavers ECG
63 Ventricular fusion beat - marquetteVentricular fusion beat - marquetteKnowledge Weavers ECG
64 60 cycle artifact - marquette60 cycle artifact - marquetteKnowledge Weavers ECG
65 LBBB: precordial leadsLBBB: precordial leadsKnowledge Weavers ECG
66 Not all sore thumbs are ventricular in originPACs have three fates: normal conduction into ventricles, aberrant conduction in ventricles due to bundle branch or fascicular block, and non-conduction due to block in AV junction. In this example PAC 1 is normally conducted and PAC 2 is conducted with RBBB aberration. The longer preceding cycle ...Knowledge Weavers ECG
67 Acute infero-postero-lateral MIHyperacute ST segment elevation is seen in leads II, III, aVF (inferior location) and in leads V4-6 (apical lateral wall location). Hyperacute ST depression is seen in leads V1-2 (an expression of posterior wall injury). in addition there are reciprocal ST segment depression changes in leads I an...Knowledge Weavers ECG
68 Ventricular Pacemaker Rhythm: V1-3Note the small pacemaker spikes before the QRS complexes. In addition, the QRS complex in V1-3 exhibits ventricular ectopic morphology; i.e., there is a slur or notch at the beginning of the S wave, and >60ms delay from onset to QRS to nadir of S wave. This rules against a supraventricular rhythm wi...Knowledge Weavers ECG
69 Inferior MI: fully evolvedSignificant pathologic Q-waves are seen in leads II, III, aVF along with resolving ST segment elevation and symmetrical T wave inversion. This is a classic inferior MI.Knowledge Weavers ECG
70 Complete AV block (3rd degree) with junctional rhythmComplete AV block (3rd degree) with junctional rhythmKnowledge Weavers ECG
71 QRS axis = +90 degreesLead I is isoelectric; II and III are positive; the axis is +90 degrees.Knowledge Weavers ECG
72 Left bundle branch block - marquetteLeft bundle branch block - marquetteKnowledge Weavers ECG
73 Junctional escape rhythmJunctional escape rhythmKnowledge Weavers ECG
74 Diagram: AV nodal reentrant tachycardiaThe AV node often has dual pathways; in this diagram the alpha pathway is fast, but has a long refractory period; the beta pathway is conducts more slowly, but recovers faster.In sinus rhythm the faster alpha pathway is used and accounts for the normal PR interval. When a PAC occurs, however, the i...Knowledge Weavers ECG
75 Atrial parasystoleIn atrial parasystole non-fixed coupled PACs, shown by arrows, occur at a common inter-ectopic interval or at multiples of this interval. Atrial fusions, not shown here, may also occur when the PAC occurs in close temporal proximity to the sinus impulse.Knowledge Weavers ECG
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