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1 LVH - best seen in the frontal plane leads!LVH - best seen in the frontal plane leads!Knowledge Weavers ECG
2 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
3 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
4 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
5 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
6 RV vs LV PVC's - marquetteRV vs LV PVC's - marquetteKnowledge Weavers ECG
7 RBBB: Precordial leadsRBBB: Precordial leadsKnowledge Weavers ECG
8 Inferior MI and RBBBInferior MI and RBBBKnowledge Weavers ECG
9 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
10 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
11 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
12 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
13 Pacemaker failure to capture - marquettePacemaker failure to capture - marquetteKnowledge Weavers ECG
14 WPW type preexcitation - marquetteWPW type preexcitation - marquetteKnowledge Weavers ECG
15 Sinus pause or arrest - marquetteSinus pause or arrest - marquetteKnowledge Weavers ECG
16 SA exit block - marquetteSA exit block - marquetteKnowledge Weavers ECG
17 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
18 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
19 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
20 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
21 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
22 RBBB with primary ST-T abnormalities: Precordial leadsRBBB with primary ST-T abnormalities: Precordial leadsKnowledge Weavers ECG
23 Bifascicular block: RBBB + LAFBBifascicular block: RBBB + LAFBKnowledge Weavers ECG
24 PVC with R-on-T - marquettePVC with R-on-T - marquetteKnowledge Weavers ECG
25 PVCs - marquettePVCs - marquetteKnowledge Weavers ECG
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