ELECTROCARDIOGRAPHY

Medical Unit-I

Holy Family Hospital

Rawalpindi

A 26yrs old lady who has complained of palpitations in past, is admitted in ER with palpitations. HER ECG shows:

• Narrow complex tachycardia• Rate about 200/min• NO P waves• Normal axis• Regular QRS complexes• Normal ST segments & T waves

Diagnosis: Supraventricular tachycardia (SVT)

Narrow QRS complex Rate about 200/min

No P waves

No P waves

A 55yr old man presented with h/o chest pain at rest for 6 Hrs. There are no abnormal physical findings. His ECG tracing shows:

• Sinus rhythm• Normal axis• Normal QRS complexes• ST segment depressions, Horizontal in V3-V4• ST segment depressions, Downward sloping in lead 1, aVL, V5-V6

Diagnosis: Anterolateral Ischemia(unstable angina)

ST segment depression, Horizontal

ST segment depression, downward sloping

These 3 rhythm strips (all lead II) came from the ECGs of three different patients. They were all in their eighties & C/O breathlessness. What

diagnosis would you consider?

A. No P waves Irregular baselines QRS complexes are broad, regular & slow Diagnosis: Atrial fibrillation with complete block

B. Constant PR interval 2:1 conduction defectDiagnosis: Sinus rhythm with 2nd degree block

C. No correlation between P waves & QRS complexes Diagnosis: Complete (3rd degree) heart block

a. No P waves Broad, regular, slow QRS

b.Constant PR interval 2:1 conduction defect

No correlation b/w P waves & QRS complexc.

This ECG was recorded from a 60 yrs old man being treated as an out patient for severe CCF. What might be diagnosis of underlying heart conduction?

• Atrial fibrillation• Ventricular rate of 75-200/min• Normal axis• Normal QRS complexes• Downward sloping ST segment depression esp, V5-V6

Diagnosis: AF with uncontrolled Ventricular rate & digoxin effect (ST segmrnt depressions)

No P waves. Irregular HR. (AF)

ST depression

A 15yr old boy was referred to the outpatient for heart murmur. He had no symptoms. What does this ECG shows?

• Sinus rhythm• Normal axis• Broad QRS complexes• RSR pattern in lead I• Wide & slurred S waves in V5• Normal ST segments & T waves

Diagnosis: Right bundle branch block (RBBB)

Broad QRS complexRSR pattern

Wide & slurred S waves

This ECG was recorded from a 25yr old pregnant women. She complaints of an irregular heart beat. Auscultation revealed a soft systolic

murmur but her heart was otherwise normal

• Sinus rhythm• Normal axis• Normal QRS complexes & T waves• Ventricular extra systoles

Diagnosis: Sinus rhythm with ventricular extra systoles

Ventricular Extra systole

A 50yr old man is seen in A & E department with severe central chest pain which has been present for 18hrs. What does this ECG shows?

• Sinus rhythm• Normal axis• Q waves in V2-V4

• Raised ST segments in V2-V4

• Inverted T waves in lead I ,aVL , V2-V6

Diagnosis: Acute anterior Myocardial infarction

ST elevation

Inverted T waves Inverted T waves

Q waves

This ECG was recorded from 60yr old women with rheumatic heart disease. She had been in heart failure but this had been treated & she was

no longer breathless. What does this ECG shows?

• AF with ventricular rate of 60-65/min• Normal axis• Normal QRS complexes• Prominent U waves in V2 (Suggest Hypokalemia)

• Downward sloping ST segments in V5-V6 (Suggest Digoxin effect)

U waves Downward sloping ST segments

No P waves (AF)

Diagnosis: AF with Digoxin effect

This ECG was recorded from 65yrs old women admitted in A&E department with sever chest pain for 1 hr. What does this ECG shows?

• Sinus rhythm• Normal axis• Probably normal QRS complexes• Grossly ST segment elevation in anterior & lateral leads• Depressed ST segments in inferior leads, lead III, aVF

ST elevation

ST elevation

Depressed ST segments

Depressed ST segments

Diagnosis: Acute anterolateral MI

This ECG was recorded from 60yr old man seen in clinic because of severe breathlessness which had developed over several years. His JVP is

raised. What does his ECG shows?

• Sinus rhythm, rate 140/min• One ventricular Extra systole• Peaked P waves (best in lead II, III, aVF)• Normal PR interval• Right axis• Dominant R waves in V1

• Deep S waves In V6

• Normal ST segments & T waves

Extra systole

Peaked P waves

Right axis Dominant R waves

Deep S waves

Diagnosis: Sinus tachycardia with 1 ventricular extra systole, Right atrial & right ventricular hypertrophy & clockwise rotation suggests COPD

ECG QuizzesECG Quizzes

• What is the PR interval in this ECG?

• A. 0.12 seB. 0.16 sec C. 0.20 sec D. 0.28 sec E. 0.50 sec

Q. 01

Q. 02

What is the QRS duration seen here?

A. 0.04 sec B. 0.06 sec C. 0.10 sec D. 0.12 sec E. 0.14

Q. 3

What is the approximate heart rate? A. 50 bpm B. 65 bpm C. 75 bpm D. 90 bpm E. 100 bpm

Q. 04

What type of arrhythmia is pointed out by the two arrows? A. PACs (Premature Atrial Complexes) B. PVCs (Premature Ventricular Complexes) C. 1 is a PAC, and 2 is a PVC D. PSVT (Paroxysmal Supraventricular Tachycardia)

E. Left Bundle Branch Block

Q. 05

Choose from the following responses to interpret this ECG. A. PJC (Premature junctional complex) B. Atrial flutter C. Atrial fibrillation D. AV nodal reentrant tachycardia E. Accelerated junctional rhythm