Health Education Assets Library (HEAL)
 
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76 ECG of the century - part II: dual AV pathwaysAn astute cardiology fellow, yours truly, went to the patient's bedside on Day 2 and massaged the right carotid sinus as indicated by the arrow. Four beats later at a slightly slower heart rate the PR interval suddenly normalized suggesting an abrupt change from a slow AV nodal pathway to a fast AV...Knowledge Weavers ECG
77 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
78 Electrical and mechanical events diagram - marquetteElectrical and mechanical events diagram - marquetteKnowledge Weavers ECG
79 Electronic atrial pacing - marquetteElectronic atrial pacing - marquetteKnowledge Weavers ECG
80 Electronic ventricular pacemaker rhythm - marquetteElectronic ventricular pacemaker rhythm - marquetteKnowledge Weavers ECG
81 Extensive anterior/anterolateral MI: precordial leadsExtensive anterior/anterolateral MI: precordial leadsKnowledge Weavers ECG
82 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
83 First degree AV block - marquetteFirst degree AV block - marquetteKnowledge Weavers ECG
84 Frontal and horizontal plane lead diagramFrontal and horizontal plane lead diagramKnowledge Weavers ECG
85 Frontal plane QRS axis = +15 degreesFrontal plane QRS axis = +15 degreesKnowledge Weavers ECG
86 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
87 Frontal plane QRS axis = +30 degreesFrontal plane QRS axis = +30 degreesKnowledge Weavers ECG
88 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
89 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
90 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
91 Frontal plane QRS axis = -15 degreesFrontal plane QRS axis = -15 degreesKnowledge Weavers ECG
92 Frontal plane QRS axis = -45 degreesFrontal plane QRS axis = -45 degreesKnowledge Weavers ECG
93 Frontal plane QRS axis = -45 degreesFrontal plane QRS axis = -45 degreesKnowledge Weavers ECG
94 Frontal plane QRS axis = -75 degreesFrontal plane QRS axis = -75 degreesKnowledge Weavers ECG
95 Frontal plane QRS axis = 0 degreesFrontal plane QRS axis = 0 degreesKnowledge Weavers ECG
96 Frontal plane QRS axis = 90 degreesFrontal plane QRS axis = 90 degreesKnowledge Weavers ECG
97 Frontal plane lead diagramThe six frontal plane leads are illustrated with their respective positive and negative poles.When forced to intersect at a center point, the six leads inscribe a 360 degree circle. The normal frontal plane axis is from -30 degrees to + 90 degrees, shaded in grey. Left axis deviation is from -30 d...Knowledge Weavers ECG
98 Frontal plane: accelerated junctional rhythm and inferior MIFrontal plane: accelerated junctional rhythm and inferior MIKnowledge Weavers ECG
99 Fully evolved inferior MI: frontal planeFully evolved inferior MI: frontal planeKnowledge Weavers ECG
100 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
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