Health Education Assets Library (HEAL)
 
Filters: Format: "image/png" Collection: "ehsl_heal"
1 - 100 of 288
Number of results to display per page
TitleDescriptionSubjectCollection
1 Folate Pool - The Role of B Vitamins in One-Carbon MetabolismThis figure depicts the pathway for folate utilization and the role of vitamins B6 and B12 in the metabolism of methyl-tetrahydrofolate and homocysteine.Folate; FolicinHEAL Open Review Collection
2 LVH - best seen in the frontal plane leads!LVH - best seen in the frontal plane leads!Knowledge Weavers ECG
3 Isochronic ventricular rhythmAn isochronic ventricular rhythm is also called an accelerated ventricular rhythm because it represents an active ventricular focus. This arrhythmia is a common reperfusion arrhythmia in acute MI patients. It often begins and ends with fusion beats and there is AV dissociation. Treatment is usuall...Knowledge Weavers ECG
4 LVH: limb lead criteriaIn this example of LVH, the precordial leads don't meet the usual voltage criteria or exhibit significant ST segment abnormalities. The frontal plane leads, however, show voltage criteria for LVH and significant ST segment depression in leads with tall R waves. The voltage criteria include 1) R in...Knowledge Weavers ECG
5 ST segment depressionST segment depression is a nonspecific abnormality that must be evaluated in the clinical context in which it occurs. In a patient with angina pectoris ST depression usually means subendocardial ischemia and, unlike ST elevation, is not localizing to a particular coronary artery lesion.Knowledge Weavers ECG
6 Rate-dependent LBBBIn this rhythm strip of sinus arrhythmia, the faster rates have a LBBB morphology. In some patients with a diseased left bundle branch, the onset of LBBB usually occurs initially as a rate-dependent block; i.e., the left bundle fails to conduct at the faster rate because of prolonged refractoriness...Knowledge Weavers ECG
7 RV vs LV PVC's - marquetteRV vs LV PVC's - marquetteKnowledge Weavers ECG
8 RBBB: Precordial leadsRBBB: Precordial leadsKnowledge Weavers ECG
9 Inferior MI and RBBBInferior MI and RBBBKnowledge Weavers ECG
10 Atrial parasystoleParasystolic rhythms involve an independent ectopic pacemaker resulting in nonfixed coupled premature beats. Parasystole may occur in the atria, as seen in this example, in the AV junction, and in the ventricles. Note the common inter-ectopic interval separating the parasystolic PAC's.Knowledge Weavers ECG
11 Digitalis intoxication: junctional tachycardia with and without exit blockIn A the rhythm is junctional tachycardia with RBBB. In B there is 2nd degree exit block with a 3:2 conduction ratio; i.e., every 3rd junctional impulse fails to reach the ventricles... at least for the first two groupings on 1.4sec.Knowledge Weavers ECG
12 LVH and many PVCsThe combination of voltage criteria (SV2 + RV6>35mm) and ST-T abnormalities in V5-6 are definitive for LVH. There may also be LAE as evidenced by the prominent negative P terminal force in lead V1. Isolated PVCs and a PVC couplet are also present.Knowledge Weavers ECG
13 Frontal plane QRS axis = +150 degrees (RAD)This is an unusual right axis deviation (RAD). Lead I is negative, which usually means RAD. Lead II is the isoelectric lead, which almost always means -30 degrees; but in this example the axis is 180 degrees away from -30, or +150 degrees.Knowledge Weavers ECG
14 Pacemaker failure to capture - marquettePacemaker failure to capture - marquetteKnowledge Weavers ECG
15 WPW type preexcitation - marquetteWPW type preexcitation - marquetteKnowledge Weavers ECG
16 Sinus pause or arrest - marquetteSinus pause or arrest - marquetteKnowledge Weavers ECG
17 SA exit block - marquetteSA exit block - marquetteKnowledge Weavers ECG
18 An interpolated PACAlthough most PACs reset the sinus node producing an incomplete compensatory pause, this PAC, indicated by the black arrow, is interpolated, i.e., sandwiched between two sinus beats. Note that the subsequent sinus P wave conducts with prolonged PR interval due to the relative refractoriness of the...Knowledge Weavers ECG
19 Incomplete AV dissociation due To 2nd degree AV block2nd degree AV block is evident from the nonconducted P waves. Junctional escapes, labled J, terminate the long pauses because that's the purpose of escape pacemakers....to protect us from too slow heart rates. All QRSs with shorter RR intervals are capture beats, labeled c. Atypical RBBB with a q...Knowledge Weavers ECG
20 Frontal plane QRS axis = +50 degrees1) lead aVL is the smallest QRS and closest to being the isoelectric lead; 2) perpendiculars to aVL are +60 and -120 degrees; 3) lead I is positive; 4) therefore, the axis is closest to being +60 degrees. Because aVL is actually slightly positive, the axis is only about +50 degrees (i.e., slightly ...Knowledge Weavers ECG
21 Atypical LBBB with primary T wave abnormalitiesPrimary T wave abnormalities in LBBB refer to T waves in the same direction as the major deflection of the QRS. These are seen in leads I, III, aVL, V2-4. Most likely diagnosis is myocardial infarction.Knowledge Weavers ECG
22 Mobitz II 2nd degree AV block with LBBBThe QRS morphology in lead V1 shows LBBB. The arrows point to two consecutive nonconducted P waves, most likely hung up in the diseased right bundle branch. This is classic Mobitz II 2nd degree AV block.Knowledge Weavers ECG
23 RBBB with primary ST-T abnormalities: Precordial leadsRBBB with primary ST-T abnormalities: Precordial leadsKnowledge Weavers ECG
24 Bifascicular block: RBBB + LAFBBifascicular block: RBBB + LAFBKnowledge Weavers ECG
25 PVC with R-on-T - marquettePVC with R-on-T - marquetteKnowledge Weavers ECG
26 PVCs - marquettePVCs - marquetteKnowledge Weavers ECG
27 Right Ventricular Hypertrophy (RVH) & Right Atrial Enlargement (RAE)In this case of severe pulmonary hypertension, RVH is recognized by the prominent anterior forces (tall R waves in V1-2), right axis deviation (+110 degrees), and P pulmonale (i.e., right atrial enlargement). RAE is best seen in the frontal plane leads; the P waves in lead II are >2.5mm in amplitud...Knowledge Weavers ECG
28 ECG intervals and wavesThe P wave represents atrial activation; the PR interval is the time from onset of atrial activation to onset of ventricular activation. The QRS complex represents ventricular activation; the QRS duration is the duration of ventricular activation. The ST-T wave represents ventricular repolarizatio...Knowledge Weavers ECG
29 Atrial flutter with 2:1 AV conductionFlutter waves are best seen in lead V1; one immediately follows the QRS and the other precedes the next QRS. The regular ventricular rate of 150 bpm should always prompt us to condider this diagnosis.Knowledge Weavers ECG
30 Left axis deviation: QRS axis = -45 degreesThere is no isoelectric, but leads aVR and II are the closest to being isoelectric, placing the axis between -30 and -60 degrees. The axis, therefore, is about -45 degrees.Knowledge Weavers ECG
31 Long QT: an ECG marker for sudden cardiac deathLong QT: an ECG marker for sudden cardiac deathKnowledge Weavers ECG
32 Frontal plane QRS axis = 0 degreesFrontal plane QRS axis = 0 degreesKnowledge Weavers ECG
33 Isolated PAC - marquetteIsolated PAC - marquetteKnowledge Weavers ECG
34 Inferolateral ST segment elevationST Segment elevation with a straight or convex upwards configuration usually means transmural ischemia (or injury) and is seen in the setting of acute myocardial infarction. This ECG finding may also be seen transiently during coronary artery spasm. Unlike ST depression, ST elevation is often loca...Knowledge Weavers ECG
35 A PAC initiates paroxysmal atrial fibrillationThe arrow indicates slight alteration of the ST-T wave by a PAC. The PAC, in turn, falls during the vulnerable period of atrial repolarization and initiates atrial fibrillation. Similar but more catastrophic events happen in the ventricles when PVC's occur during the vulnerable period, i.e. R-on-T...Knowledge Weavers ECG
36 Left Atrial Abnormality & 1st Degree AV BlockThe P-wave is notched, wider than 0.12s, and has a prominent negative (posterior) component in V1 - all criteria for left atrial abnormality or enlargement (LAE). The PR interval >0.20s. Minor ST-T wave abnormalities are also present.Knowledge Weavers ECG
37 3rd degree AV block rx'ed with a ventricular pacemakerIn A the ECG shows complete or 3rd degree AV block with a left ventricular escape rhythm, as evidenced by the upright QRS morphology. In B the artificial right ventricular pacemaker rhythm is shown.Knowledge Weavers ECG
38 Lead Error: V1 & V3 are TransposedIn this normal 12-lead ECG the V1 and V3 chest electrodes are interchanged. Experienced ECG interpreters should be able to spot this lead placement error.Knowledge Weavers ECG
39 PAC and PVC: complete vs. incomplete pausePAC and PVC: complete vs. incomplete pauseKnowledge Weavers ECG
40 Electronic atrial pacing - marquetteElectronic atrial pacing - marquetteKnowledge Weavers ECG
41 Normal sinus rhythm - marquetteNormal sinus rhythm - marquetteKnowledge Weavers ECG
42 Left ventricular PVC'sIn lead V1, these PVC's are positive or anterior in direction indicating probable LV origin with late activation of the right ventricle. The arrow points to the notch on the downstroke of the PVC making its morphology highly unlikely to be an aberrantly conducted supraventricular beat.Knowledge Weavers ECG
43 Junctional tachycardia with exit block: a manifestation of digitalis intoxicationTheladder diagramsays it all: the atria are fibrillating; there is complete heart block in the AV junction; a junctional tachycardia focus is firing at about 130 bpm, but not all junctional impulses reach the ventricles due to 2nd degree exit block.Knowledge Weavers ECG
44 Frontal plane QRS axis = +90 degrees1) Lead I is isoelectric; 2) perpendiculars to lead I are +90 and -90 degrees; 3) leads II, III, aVF are positive; 4) therefore, the axis must be +90 degrees.Knowledge Weavers ECG
45 Electrical and mechanical events diagram - marquetteElectrical and mechanical events diagram - marquetteKnowledge Weavers ECG
46 Anteroseptal MI, fully evolved: precordial leadsAnteroseptal MI, fully evolved: precordial leadsKnowledge Weavers ECG
47 Left atrial enlargement: leads II and V1Left atrial enlargement: leads II and V1Knowledge Weavers ECG
48 Fully evolved inferior MI: frontal planeFully evolved inferior MI: frontal planeKnowledge Weavers ECG
49 Frontal plane QRS axis = -75 degreesFrontal plane QRS axis = -75 degreesKnowledge Weavers ECG
50 Supernormal conduction: 2nd degree AV block with rare captures; accelerated ventricular rhythmThis complicated rhythm strip illustrates 'supernormal' conduction... a situation where conduction is better than expected. The ladder diagram shows that the accelerated ventricular rhythm prevents most of the sinus impulses from reaching the ventricles. Only appropriately timed sinus impulses rea...Knowledge Weavers ECG
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
76 Atrial flutter with 2:1 conduction: leads II, III, V1Atrial flutter with 2:1 conduction: leads II, III, V1Knowledge Weavers ECG
77 Pacemaker lead wire placement diagram - marquettePacemaker lead wire placement diagram - marquetteKnowledge Weavers ECG
78 Frontal and horizontal plane lead diagramFrontal and horizontal plane lead diagramKnowledge Weavers ECG
79 ST segment diagram - marquetteST segment diagram - marquetteKnowledge Weavers ECG
80 Atrial bigeminy - marquetteAtrial bigeminy - marquetteKnowledge Weavers ECG
81 Right Bundle Branch BlockRight Bundle Branch BlockKnowledge Weavers ECG
82 2nd degree AV block, type I, with accelerated junctional escapes and a ladder diagramThe ladder diagram illustrates a Wenckebach type AV block by the increasing PR intervals before the blocked P wave. After the blocked P wave, however, a rev-ed up junctional pacemaker terminates the pause. Note that the junctional beats have a slightly different QRS morphology from the sinus beats...Knowledge Weavers ECG
83 Atrial tachycardia with exit block and AV blockThe ectopic P waves, easily seen in this example,occur in groups, separated by short pauses. This is likely due to an exit block just distal to the atrial pacemaker. Because not all of the P waves make it to the ventricles, there is also 2nd degree AV block. Therefore, two levels of block are pre...Knowledge Weavers ECG
84 LVHIn this example of LVH, the precordial leads don't meet the usual voltage criteria or exhibit significant ST segment abnormalities. The frontal plane leads, however, show voltage criteria for LVH and significant ST segment depression in leads with tall R waves. The voltage criteria include 1) R in a...Knowledge Weavers ECG
85 A nonconducted PAC causes an unexpected pauseUnexpected pauses in rhythm have several causes, the most frequent being a nonconducted PAC. In this example the nonconducted PAC is seen in the ST segment of the pause. Note the change in the ST-T compared to the other ST-T waves.Knowledge Weavers ECG
86 Giant TU fusion wavesTU fusion waves are often seen in long QT syndromes. The differential diagnosis of this ECG abnormality includes electrolyte abnormalities -hypokalemia, CNS disease, e.g., subarachnoid hemorrhage; hereditary long QT syndromes, and drugs such as quinidine.Knowledge Weavers ECG
87 Left anterior fascicular block (LAFB)LAFB is the most common of the intraventricular conduction defects. It is recognized by 1) left axis deviation; 2) rS complexes in II, III, aVF; and 3) small q in I and/or aVL.Knowledge Weavers ECG
88 Atrial flutter with 2:1 AV conduction: lead V1The arrows point to two flutter waves for each QRS complex. Atrial rate = 280; ventricular rate = 140.Knowledge Weavers ECG
89 Long QT Interval and Giant Negative T WavesLong QT Interval and Giant Negative T WavesKnowledge Weavers ECG
90 Frontal plane QRS axis = -15 degreesFrontal plane QRS axis = -15 degreesKnowledge Weavers ECG
91 Ventricular pacemaker rhythmNote the small pacemaker spikes before the QRS complexes in many of the leads. In addition, the QRS complex in V1 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 suprav...Knowledge Weavers ECG
92 Diffuse anterolateral T wave abnormalitiesDiffuse anterolateral T wave abnormalitiesT Wave AbnormalitiesKnowledge Weavers ECG
93 Frontal plane QRS axis = -45 degreesFrontal plane QRS axis = -45 degreesKnowledge Weavers ECG
94 Marked sinus arrhythmia - marquetteMarked sinus arrhythmia - marquetteKnowledge Weavers ECG
95 Muscle tremor artifact - marquetteMuscle tremor artifact - marquetteKnowledge Weavers ECG
96 RBBB + LAFB: bifascicular blockRBBB + LAFB: bifascicular blockKnowledge Weavers ECG
97 ECG of the century: A most unusual 1st degree AV blockOn Day 1, at a heart rate of 103 bpm the P waves are not clearly defined suggesting an accelerated junctional rhythm. However, on Day 2, at a slightly slower heart rate the sinus P wave suddenly appears immediately after the QRS complex. In retrospect, the sinus P wave in Day 1 was found burried i...Knowledge Weavers ECG
98 RBBB plus mobitz II 2nd degree AV blockThe classic rSR' in V1 is RBBB. Mobitz II 2nd degree AV block is present because the PR intervals are constant. Statistically speaking, the location of the 2nd degree AV block is in the left bundle branch rather than in the AV junction. The last QRS in the top strip is a junctional escape, since...Knowledge Weavers ECG
99 Left axis deviation: QRS axis = -60 degreesLead aVR is isoelectric; leads II and III are mostly negative. The QRS axis, therefore, is -60 degrees.Knowledge Weavers ECG
100 QRS axis = +30 degreesLead III is isoelectric; leads I and II are positive. The QRS axis, therefore, is +30 degrees.Knowledge Weavers ECG
1 - 100 of 288