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1 Sino-atrial exit block, type I or wenckebachThis example illustrates 2nd degree sino-atrial exit block. In type 1 S-A block the conduction time between sinus firing and atrial capture progressively prolong, but this cannot be seen on the ECG tracing; type I exit block is inferred if the P-P intervals gradually shorten before the pause and if...Wenckebach AV Block; Ladder DiagramKnowledge Weavers ECG
2 Inferior & Anteroseptal MI + RBBBPathologic Q waves are seen in leads II, III, aVF (inferior MI) and in leads V1-3 (anteroseptal MI). RBBB is recognized by the wide QRS (>0.12s) and the anterior/rightwards orientation of terminal QRS forces. When an anteroseptal MI complicates RBBB (or visa versa) the rSR' complex in V1 (typical ...Knowledge Weavers ECG
3 Atrial flutter with 3:2 conduction ratio: frontal plane leadsNote the subtle bigeminy in the RR intervals. The best way to identify the flutter waves in this example is to imagine what lead III would look like if the QRS complexs disappeared; what remains is a reasonable saw-tooth pattern characteristic of atrial flutter with a flutter rate of about 300 bpm...Knowledge Weavers ECG
4 Accelerated ventricular rhythm with retrograde atrial capture and echo beatsRetrograde atrial captures from an accelerated ventricular focus are occurring with increasing R-P intervals, When the longer R-P occurs, the impulse traversing the AV junction finds a route back to the ventricles, and the result is a ventricular echo.Knowledge Weavers ECG
5 ECG components diagram - marquetteECG components diagram - marquetteKnowledge Weavers ECG
6 Postero-lateral MI: Precordial LeadsPostero-lateral MI: Precordial LeadsKnowledge Weavers ECG
7 Indeterminate frontal plane QRS axisIndeterminate frontal plane QRS axisKnowledge Weavers ECG
8 PAC couplet - marquettePAC couplet - marquetteKnowledge Weavers ECG
9 Normal variant: Early repolarizationEarly repolarization, a misnomer, describes a pattern of localized or diffuse ST segment elevation. This is especially seen in leads with prominent R waves. In this example leads I, II, V5 and V6 illustrate the early repolarization pattern. ST segments usually have a concave upwards pattern and ta...Knowledge Weavers ECG
10 AV dissociation by usurpationNormal sinus rhythm is interrupted by an accelerated ventricular rhythm whose rate is slightly faster than the sinus rhythm. Fusion QRS complexes occur whenever the sinus impulse enters the ventricles at the same time the ectopic ventricular focus initiates its depolarization.Knowledge Weavers ECG
11 Long QT mischiefThe long QT ECG has many causes: electrolyte abnormalities including hypo-K, hypo-Mg, and hypo-Ca; drugs including type I antiarrhythmics; CNS injury; and hereditary syndromes. Ventricular arrhythmias are thought to be caused by afterdepolarizations or triggered automaticity.Knowledge Weavers ECG
12 Nonconducted and conducted PAC'sThe pause in this example is the result of a nonconducted PAC, as indicated by the first arrow. The second arrow points to a conducted PAC. The most common cause of an unexpected pause in rhythm is a nonconducted PAC.Knowledge Weavers ECG
13 Atypical LBBB with Q waves in leads I and aVLIn typical LBBB, there are no initial Q waves in leads I, aVL, and V6. If Q waves are present in 2 or more of these leads, myocardial infarction is present.Knowledge Weavers ECG
14 Old inferior MI, PVCs, and atrial fibrillationOld inferior MI, PVCs, and atrial fibrillationKnowledge Weavers ECG
15 Frontal plane QRS axis = -45 degreesFrontal plane QRS axis = -45 degreesKnowledge Weavers ECG
16 LVH & PVCs: Precordial LeadsLVH & PVCs: Precordial LeadsKnowledge Weavers ECG
17 Atrial flutter with variable AV block and rate-dependent LBBBThe basic rhythm is atrial flutter with variable AV block. When 2:1 conduction ratios occur there is a rate-dependent LBBB. Don't be fooled by the wide QRS tachycardia on the bottom strip. It's not ventricular tachycardia, but atrial flutter with 2:1 conduction and LBBB. Lidocaine is not needed ...Knowledge Weavers ECG
18 three fates of PAC'sAs illustrated, PAC's can have three fates: PAC-1enters the ventricles and encounters no conduction delays, therefore causing a narrow QRS; PAC-2 occurs a little earlier and can't get through the AV junction, therefore beingnonconducted; PAC-3 seen inlead V1 makes it into the ventricles but encounte...Knowledge Weavers ECG
19 Ventricular tachycardia with AV dissociation, captures, and fusionsApproximately 50 percent of ventricular tachycardias are associated with AV dissociation. In these cases atrial impulses can enter the ventricles and either fuse with a ventricular ectopic beat or completely capture the ventricles. This ladder diagram illustrates these events.Knowledge Weavers ECG
20 Frontal plane QRS axis = +75 degreesSince there is no isoelectric lead in this ECG, the two closest leads are I and aVL. If I were isoelectric, the axis would be +90 degrees; if aVL were isoelectric, the axis would be +60 degrees. A nice compromize is +75 degrees. (The two closest leads are always 30 degrees apart.)Knowledge Weavers ECG
21 Right axis deviation: QRS axis = +130 degreesLead aVR is almost isoelectric; lead I is mostly negative, and lead III is very positive. The QRS axis, therefore, is +130 degrees. Note that the slightly more positive AVR moves the axis slightly beyond +120 degrees; i.e., closer to the + pole of the aVR lead.Knowledge Weavers ECG
22 Extensive anterior/anterolateral MI: precordial leadsExtensive anterior/anterolateral MI: precordial leadsKnowledge Weavers ECG
23 LVH: strain pattern + left atrial enlargementLVH: strain pattern + left atrial enlargementKnowledge Weavers ECG
24 Ventricular asystole - marquetteVentricular asystole - marquetteKnowledge Weavers ECG
25 Multifocal PVC's - marquetteMultifocal PVC's - marquetteKnowledge Weavers ECG
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