Health Education Assets Library (HEAL)
 
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TitleDescriptionSubjectCollection
26 Anteroseptal MI, fully evolved: precordial leadsAnteroseptal MI, fully evolved: precordial leadsKnowledge Weavers ECG
27 Anteroseptal MI: fully evolvedThe QS complexes, resolving ST segment elevation and T wave inversions in V1-2 are evidence for a fully evolved anteroseptal MI. The inverted T waves in V3-5, I, aVL are also probably related to the MI.Knowledge Weavers ECG
28 Atrial bigeminy - marquetteAtrial bigeminy - marquetteKnowledge Weavers ECG
29 Atrial echosIn this example a typical Wenckebach sequence is interrupted by what looks like a PAC - indicated by red arrows. Atrial echos are more likely, however, because the preceding beat has a long PR interval, a condition that facilitates reentry and echo formation.Knowledge Weavers ECG
30 Atrial fibrillation with moderate ventricular response - MarquetteAtrial fibrillation with moderate ventricular response - MarquetteKnowledge Weavers ECG
31 Atrial flutter with 2:1 and 4:1 conduction and rate dependent LBBBIn this example of atrial flutter with variable AV conduction, the faster rates are associated with rate-related LBBB. Don't confuse this for ventricular tachycardia.Knowledge Weavers ECG
32 Atrial flutter with 2:1 AV conductionIn this example of atrial flutter with 2:1 AV conduction the flutter waves are very hard to see. Atrial flutter with 2:1 block must be considered, however, because the heart rate is about 150 bpm. A careful look at V1 shows the two flutter waves for each QRS complex complex. One flutter wave imme...Knowledge Weavers ECG
33 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
34 Atrial flutter with 2:1 AV conductionAtrial flutter with 2:1 AV block is one of the most frequently missed ECG rhythm diagnoses because the flutter waves are often hard to find. In this example two flutter waves for each QRS are best seen in lead III and V1. The ventricular rate at 150 bpm should always prompt us to consider atrial fl...Knowledge Weavers ECG
35 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
36 Atrial flutter with 2:1 AV conduction: leads II, III, V1In leads II and III, the one of the flutter waves occurs at the end of the QRS complex and might be mistaken for part of the QRS itself; i.e., the S wave. In lead V1, the two flutter waves for every QRS are more easily identified.Knowledge Weavers ECG
37 Atrial flutter with 2:1 conduction: leads II, III, V1Atrial flutter with 2:1 conduction: leads II, III, V1Knowledge Weavers ECG
38 Atrial flutter with 3:2 AV conductionThis 12-lead ECG shows a subtle bigeminal rhythm resulting from atrial flutter with a 3:2 AV conduction ratio; RR intervals alternate by a small duration. This is uncommon! The impulses from the atrial flutter conduct through the AV junction in a Wenckebach sequence; for every 3 flutter waves the s...Knowledge Weavers ECG
39 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
40 Atrial flutter with variable AV block - marquetteAtrial flutter with variable AV block - marquetteKnowledge Weavers ECG
41 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
42 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
43 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
44 Atrial parasystoleThe evenly spaced dots indicate ectopic atrial activity from a parasystolic atrial pacemaker. Non-fixed coupled PACs are seen having a common inter-ectopic interval. One of the PACs is nonconducted.Knowledge Weavers ECG
45 Atrial tachycardia - marquetteAtrial tachycardia - marquetteKnowledge Weavers ECG
46 Atrial tachycardia with 2:1 AV block: a manifestation of digitalis intoxicationAtrial tachycardia with 2:1 AV block: a manifestation of digitalis intoxicationKnowledge Weavers ECG
47 Atrial tachycardia with 3:2 and 2:1 AV blockThe ectopic atrial rate is 150 bpm. Some of the ectopic P waves are easily seen and indicated by the arrows. Other P waves are burried in the T waves and not so easily identified. Atrial tachycardia with AV block is often a sign of digitalis intoxication. 3:2 and 2:1 AV block is seen in this examp...Knowledge Weavers ECG
48 Atrial tachycardia with 3:2 AV blockIn this rhythm the atrial rate from an ectopic focus is 160 bpm. Atrial activity can be seen on top of T waves, and before QRS's. Careful observation reveals a 3:2 Wenckebach relationship between P waves and QRS's. Atrial tachycardia with block is often a sign of digitalis intoxication.Knowledge Weavers ECG
49 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
50 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
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