1.

2.
3.
4.

Normal sinus rhythm

3rd degree AV block
Right bundle branch block
Right axis deviation

 1. Atrial fibrillation
2. Atrial flutter with variable
conduction
3. Multifocal atrial tachycardia
(MAT).

1. Normal sinus rhythm

2. Inferior ST elevation
myocardial infarction
3. Posterior myocardial infarction
4. Left atrial enlargement

A posterior wall MI frequently occurs along with an inferior wall

MI due to the shared blood supply from the right coronary artery.
The posterior wall demonstrates ECG changes the opposite of
other myocardial segments due to the location, thus instead of
ST segment elevation, a posterior myocardial infarction is
characterized by ST depression in lead V1 and frequently V2. The
R wave is large in lead V1. Turn the ECG upside down and you
will see ST segment elevation in V1 and a large Q wave which are
normal findings of a myocardial infarction. For a detalied review,
click the Posterior MI ECG Review button below.
Note that the causes of a R wave being larger than the S wave in
lead V1 include a posterior myocardial infarction, right bundle
branch block, WPW Type A, right ventricular hypertrophy,
ventricular tachycardia with a right bundle branch block pattern
and isolated posterior wall hypertrophy (can occur with
Duchenne's muscular dystrophy).

 1. Atrial tachycardia
Note that the P wave is not
upright in lead II (indicating that
it originates at a site other than
the sinus node, a.k.a. "ectopic").
Each P wave is followed by a QRS
complex which is narrow
(supraventricular in origin). Click
below for a detalied review of
ECG findings in ectopic atrial

 1. Sinus tachycardia
2. Acute anterior myocardial infarction
This ECG demonstrates an "extensive anterior" and
"tombstoning" of the ST segment seen during a large
acute anterior myocardial infarction. This is usually the
result of thrombosis of the left anterior descending
coronary artery. In this ECG, the thrombosis would be
proximal in the left anterior descending since the septal
leads (V1 and V2) are involved. Also, note the inferior
changes. Some left anterior descending coronary arteries
"wrap around" the cariac apex and can supply part of the
inferior wall as well which was indeed the case in this
situation. For a complete, detalied review of the ECG
changes during an anterior myocardial infarction, click the
Anterior MI ECG Review button below.

1. Atrial flutter with a slow

ventricular response - clockwise
rotation
This ECG has typical atrial flutter
waves in a "sawtooth" pattern
rotating in a clockwise direction.
For a complete review of atrial
flutter including determining
rotation direction, typical versus
atypical and multiple
images/examples, click the atrial
flutter review link below.

 Normal
yolo

 1. Sinus tachycardia
2. Left ventricular hypertrophy

 1. Normal sinus rhythm

2. Second degree type I AV block
3. Right bundle branch block
4. Left anterior fascicular block
5. Left atrial enlargement - Pmitrale pattern

 1. Normal sinus rhythm

2. Pericarditis

 1. Sinus tachycardia
2. Anterior myocardial infarction
3. Hyperacute T wave abnormality
Many different T wave abnormalities exist.
Hyperacute T waves are the very first sign of a
myocardial infarction, however are frequently missed
on the ECG since they are only transient during the
first few minutes of the infarction. Hyperacute T
waves tend to be a bit more symmetric and broad at
the top than those "peaked" T waves seen in
hyperkalemia, although this is difficult to distinguish
at times. On this ECG, the ST elevation gives away the
fact that the T waves are hyperacute. Some different
T wave abnormalities are pictorally shown below: