ECG Summary

Kishan Jethwa
Normal
http://www.ecglibr
ary.com/norm.php
L Axis
Deviation
http://cdn.lifeinthe
fastlane.com/wpcontent/uploads/2
011/02/LAD.jpg
R Axis
Deviation
011/02/rightaxis.jpg
STEMI
011/07/ECGAnatomy-LITFL.jpg
Anterior http://cdn.lifeinthe
011/12/anteriorSTEMIevolving.jpg
Rate
Rhythm
Axis
P Waves
6080bpm
Sinus
Normal
(Leads I
and II
+ve)
Present
(height =
<2.5mm
in lead II)
QRS axis
between
-30o and
-90o
QRS Axis
between
+90o and
+180o
PR
Interval
0.12s-0.2s
(3-5 small
sq)
QRS
Complex
0.12s (3
small sq)
ST
Segment
T Wave
Same
direction
as R wave
aVR
always -ve
Leads I
and II
QRS
complexes
Leaving
Lead I
and aVL =
+ve QRS
Lead II
and aVF =
-ve QRS
Leads I
and II QRS
Reaching
Lead I
and aVL =
-ve QRS
Leads II
and aVF =
+ve QRS
Anterior
STE (V1V6) LAD
Septal
leads =
V1-V2
Lateral
STE (I,
aVL, V5
and V6)
LCx
PBL Week 11 ECG Revision

Q Waves
QT
R Waves
Interval
Absent
<0.45s
R wave
or <1/3
progressio
of R wave
n in V1
V6
(become
more +ve)
Kishan Jethwa
Rate
Rhythm
Axis
P Waves
PR
Interval
QRS
Complex
Lateral http://cdn.lifeinthe
011/10/anterolater
al.jpg
ST
Segment
Inferior
STE (II, III
and aVF)
RCA
T Wave

Q Waves
QT
R Waves
Interval
Inferior http://cdn.lifeinthe
011/10/inf1.jpg
STEMI Changes over time

Acute
Hours
STE in
correspon
ding leads
STE
Days 1-2
STE
Days later
Normal
Weeks later
Normal
LBBB
(WiLliaM)
011/03/LBBB-Mand-W.jpg
RBBB
(MaRroW)
011/03/RBBB.png
Bundle Branch Block

Broad QRS
>0.12s (3
small sq)
Broad QRS
>0.12s (3
small sq)
RSRI
pattern in
V1
qRS
pattern in
T wave
inversion
T wave
inverted
Normal
Dominant
S wave in
V1
V1 V3 =
ST
depressio
n
Q wave
starts
Q wave
Smaller R
wave
Pathologic
al Q wave
(>1/3 of R
wave)
Broad
notched R
wave in
V6
V1-V3 = T
wave
inversion
Kishan Jethwa
Rate
Rhythm
L Anterior
Fasicular
Block/L
Anterior
Hemiblock
(Anterior
fascicle in L
bundle fails to
conduct)
Axis
L axis
deviation
P Waves
PR
Interval
QRS
Complex
V6
Fasicular Block
Leads I
and aVL Small Q
waves w/
tall R
waves
Leads II,
III and
aVF
small R
wave and
deep S
wave
V1 and
V6 - RBBB
pattern
011/02/LAFB4.jpg
Bifasicular
Block (RBBB
and L anterior
hemiblock)
L axis
deviation
http://www.learnth
eheart.com/ecgreview/ecgarchive/bifascicula
r-block-lafb-rbbbecg-1/
Trifasicular
Block
(Bifascicular
block + 3rd
Degree Heart
Block)
L axis
deviation
011/11/trifascicula
r-3.jpg
PR
interval
(>0.2s)
no relation
between P
wave and
QRS
V1 and
V6
RBBB
pattern
Sinus Node Dysfunction

Sinus
Bradycardia
>60bpm
Sinus
ST
Segment
T Wave

Q Waves
QT
R Waves
Interval
Kishan Jethwa
Rate
Rhythm
Sinus
Arrhythmia
Sinus
Sinus Arrest
No impulse
generated
from SAN
Irregular
pause
following
normal
sinus beat
(>3secs)
http://www.google
.co.uk/url?
sa=i&rct=j&q=&es
rc=s&source=ima
ges&cd=&cad=rja
&uact=8&ved=0C
AcQjRw&url=http
%3A%2F
%2Fwww.unm.edu
%2F~lkravitz
%2FEKG
%2Fsablockarrest.
html&ei=g8R4VK6
FF8jnaIm3gOgM&
bvm=bv.80642063
,d.ZGU&psig=AFQj
CNHm3nsjv9YYZG
WUXHxTUXxaXjHI
pQ&ust=14172870
56917694
Sinus Block
Impulse
generated
from SAN but
not conducted
out the node
http://www.google
.co.uk/url?
sa=i&rct=j&q=&es
rc=s&source=ima
ges&cd=&cad=rja
&uact=8&ved=0C
AcQjRw&url=http
Irregular
pause
after
normal
sinus
Beat
following
pause =
sinus
Axis
P Waves
Normal
sinus P
waves
Irregular
P-P
intervals
If the
next beat
is a
junctional
escape
beat then
P wave
will be
absent
PR
Interval
Normal PR
Interval
QRS
Complex
Normal
Junctiona
l escape
beat
(w/out
preceding
P wave) if
next beat
comes
from the
AVN
AVN
escape
beat =
narrow
QRS
Ventricul
ar escape
beat (from
below
AVN) =
broad QRS
Normal
QRS
following
pause
ST
Segment
T Wave

Q Waves
QT
R Waves
Interval
Pause is
NOT
multiple of
2 R-R
intervals
Pause =
multiple of
2 normal
R-R
intervals
Kishan Jethwa
Rate
Rhythm
Brady
(>60bp
m)
Periods
of tachy
(<100bp
m)
Sinus
brady
Followed
by tachy
(usually
supraventr
icular i.e.
AF)
Axis
P Waves
PR
Interval
QRS
Complex
%3A%2F
%2Fwww.ilecture.com
%2Fsinusblock.ht
ml&ei=0Md4VMvb
H4_zaurjgtgI&bvm
=bv.80642063,d.Z
GU&psig=AFQjCNF
6berc16hVbpL5j4jpq0HPlxpiA&u
st=141728798703
3789
Sick Sinus
Syndrome
(Bradycardiatachycardia
syndrome)
http://www.google
.co.uk/url?
sa=i&rct=j&q=&es
rc=s&source=ima
ges&cd=&cad=rja
&uact=8&ved=0C
AcQjRw&url=http
%3A%2F
%2Fwww.aafp.org
%2Fafp
%2F2003%2F0415
%2Fp1725.html&e
i=Nst4VOW8IMPm
aua7gcAF&bvm=b
v.80642063,d.ZGU
&psig=AFQjCNGW
dby7ssH94spwfjy1
oRkNSoqsjw&ust=
141728888037754
6
1st Degree AV
Block
011/02/1st-
May be
sinus
block/arre
st
following
tachy
Sinus
May be
junctional
escape
beats
following
tachy,
which
would
have
absent P
waves
Present
AV Block
PR
Interval
(>0.2s /
>3-5
small sqs)
ST
Segment
T Wave

Q Waves
QT
R Waves
Interval
Kishan Jethwa
Rate
Rhythm
Axis
P Waves
degree-heartblock-on-call.jpg
Prolonged http://cdn.lifeinthe
011/02/severefirst-degree-p1.jpg
2nd Degree ,
Mobitz I
(Wenkebach)
Irregular
011/04/Wenckebac
h.jpg
2nd Degree,
Mobitz II
http://www.google
.co.uk/url?
sa=i&rct=j&q=&es
rc=s&source=ima
ges&cd=&cad=rja
&uact=8&ved=0C
AcQjRw&url=http
%3A%2F
%2Fwww.emedu.o
rg%2Fecg
Irregular
Constant
P-P
interval
P waves
at
constant
rate
One P
wave not
followed
by QRS
2:1
PR
Interval
NOTE: if
PR
Interval
>0.3s =
Prolonge
d 1st
Degree
AV Block
and P
waves
hidden in
T wave
Progressiv
ely PR
interval
until
dropped
QRS
Longest
directly
before
dropped
QRS
Shortest
directly
after
dropped
QRS
Constant
QRS
Complex
QRS
dropped
after
longest PR
interval
ST
Segment
T Wave

Q Waves
QT
R Waves
Interval
Kishan Jethwa
Rate
Rhythm
%2F2t2.htm&ei=T
tB4VNDRPMf1avb
qgLAO&psig=AFQj
CNHhgLgFNffu0W
14mHRtbkLSIsRAi
Q&ust=141729018
6481927
Axis
P Waves
PR
Interval
QRS
Complex
ST
Segment
Block
QRS rate
= P wave
rate x 2
(1 nonconductin
g P wave
following
a sinus
beat)
3:1
(Advance
d AV
Block)
3:1 = 2
nonconductin
g P waves
following
sinus
beat)
3rd Degree
No SAN
impulses
conducted to
ventricles
Irregular
Juntional/
ventricular
escape
rhythm
http://www.ecglibr
ary.com/chb4.html
Atrial
Fibrillation
012/01/af3.jpg
Fast
Ventricular
Ventricul
ar ~
100160bpm
Irregularly
irregular
P waves
at
constant
rate
PR
interval
QRS at
constant
rate
No
relation
between P
wave and
QRS
Supraventricular Tachycardias
Absent
Narrow
T Wave

Q Waves
QT
R Waves
Interval
Kishan Jethwa
Rate
Rhythm
Atrial
rate
~300bp
m
Vent.
Rate
depends
on block
2:1 =
150bpm
3:1 =
100bpm
Regular
(Unless,
Flutter
with
variable
block)
Usually
140280bpm
Regular
Rate
~200300bpm
Sinus
Axis
P Waves
PR
Interval
QRS
Complex
ST
Segment
T Wave

Q Waves
QT
R Waves
Interval
Rate http://cdn.lifeinthe
012/01/AF-rapidventricularresponse.jpg
Atrial Flutter
Caused by reentry circuit
within RA
012/01/Atrialflutter-with-2-1block.jpg
AVNRT
012/01/TypicalAVNRT1.jpg
Pseudo R wave
(V1 and V2)
Leads II,
III and
aVF Sawtooth
flutter
waves
Narrow
complex
tachy
(Narrow
complex
tachy,
~150bpm
suspect
Flutter)
V1
flutter
waves
may look
like P
waves
Absent
(Present P
waves =
inverted
in Leads
II, III and
aVF)
Narrow
(Unless
existing
BBB or
accessory
pathway)
012/01/Pseudo-Rwaves.jpg
AVRT (WolffParkinson
White)
Similar reentry circuit to
AVNRT but
PR
interval
(>0.12sec
/>3 small
Delta
wave
slurring at
start of
QRS
Possible
widesprea
d ST
depressio
n
Pseudo R
waves in
V1 and
V2 (small
upward
deflection
s at the
end of the
S
deflection)
WPW
can cause
RV
hypertrop
hy = Tall R
waves
Kishan Jethwa
Rate
circuit occurs
in an
accessory
bundle i.e.
Bundle of Kent
Type A http://cdn.lifeinthe
012/01/WPW-TypeA.jpg
Type B http://cdn.lifeinthe
010/05/WPW-ecg005.jpg
Rhythm
Axis
P Waves
PR
Interval
sqs)
QRS
Complex
AVRT w/
Orthodro
mic
Conducti
on
(antegrad
e
conductio
n down
AVN and
retrograde
conductio
n up
accessory
pathway)
Narrow
QRS
Antedromic
ECG
AVRT w/
antedro
mic
conducti
on
(antegrad
e
conductio
n down
accessory
pathway
and
retrograde
conductio
n down
AVN)
Wide
QRS
complex
012/01/AVRT-WPW-
Type B
WPW
Orthodromic
and
Antidromic
Conduction
Explanation
http://lifeinthefast
lane.com/ecglibrary/preexcitationsyndromes/
Orthodromic
ECG http://cdn.lifeinthe
012/01/Orthodromi
c-AVRT-1.jpg
ST
Segment
T Wave

Q Waves
QT
R Waves
Interval
Type A
WPW
dominant
R wave in
V1 (+ve
delta
wave)
Kishan Jethwa
Rate
Rhythm
>200bp
m
Irregular
>100bp
m
Regular
150500bpm
Irregularly
irregular
5yo-boy.jpg
AF w/ WPW
Accessory
pathway
allows impulse
conduction
directly to
ventricles,
instead of
going through
the AVN.
Rapid
ventricular
conduction can
lead to VT or
VF
Axis
P Waves
PR
Interval
QRS
Complex
dominant
S wave in
V1 and
V2
Wide
QRS
QRS
complexes
may
change
shape
010/05/WPW-ecg004.jpg
VT
012/01/VT6.jpg
VF
Rhythm strip http://cdn.lifeinthe
Ventricular Arrhythmias
Broad
QRS
(>0.16sec
s/>4 small
sq)
Uniform
QRS
complex
Absence
of RBBB or
LBBB
pattern
Not
Not
distinguis
distinguis
hable
hable
ST
Segment
T Wave

Q Waves
QT
R Waves
Interval
Kishan Jethwa
Rate
Rhythm
Axis
P Waves
PR
Interval
QRS
Complex
ST
Segment
T Wave

Q Waves
QT
R Waves
Interval
011/12/VF3.png
Torsades de
Pointes
~200bp
m
011/11/ECG91103Torsades.jpg
Pericarditis
http://nl.ecgpedia.
org/images/e/ed/1
2leadpericarditis.p
ng
Brugada
Syndrome
(*Brugada
Sign)
009/09/Coved-STelevation.JPG
Sinus
tachycar
dia
(becaus
e of pain
and
pericardi
al
effusion)
QT
Interval
(QT
>0.6secs)
(QTc
>0.45secs
)
QRS
complexes
rotate
180o
around
isoelectric
baseline
(QRS
complexes
go from
being ve
deflection
s to +ve
deflection
s and
back)
PR
interval
depressio
n
Widesprea
d, saddle
shaped ST
elevation
(esepically
Leads I,
II, III,
aVL and
aVF)
*Sloped
ST
elevation
(>2mm
from
junction)
must be in
>1 of
leads V1-
*Sloped
ST
elevation
followed
by ve T
wave
Kishan Jethwa
Rate
Brugada ECG
Rhythm
Axis
P Waves
PR
Interval
QRS
Complex
ST
Segment
V3
T Wave

Q Waves
QT
R Waves
Interval
http://nl.ecgpedia.
org/images/9/9b/B
rugada_syndrome_
type1_example2.p
ng
References:
1. Lilly, LS. Pathophysiology of Heart Disease: a collaborative project of medical students and faculty. 5th Edition. Baltimore ; Lippincott Williams and
Wilkins. 2011
2. Kumar, P and Clark, M. Kumar and Clarks Clinical Medicine. 8th Edition. Edinburgh ; Saunders Elsevier. 2013
3. Hampton, JR. The ECG Made Easy. 8th Edition. Edinburgh ; Churchill Livingstone/Elsevier. 2013
4. http://lifeinthefastlane.com/ecg-library/ - Last accessed 28/11/14

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Kishan Jethwa

PBL Week 11 ECG Revision

PBL Week 11 ECG Revision

STEMI Changes over time

Bundle Branch Block

Sinus Node Dysfunction

PBL Week 11 ECG Revision

PBL Week 11 ECG Revision

PBL Week 11 ECG Revision

PBL Week 11 ECG Revision

PBL Week 11 ECG Revision

PBL Week 11 ECG Revision

PBL Week 11 ECG Revision

PBL Week 11 ECG Revision

PBL Week 11 ECG Revision

PBL Week 11 ECG Revision

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