A normal adult 12-lead ECG

Normal adult 12-lead ECG
The diagnosis of the normal electrocardiogram is made by excluding any recognised abnormality. It's description is therefore quite lengthy.

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normal sinus rhythm o each P wave is followed by a QRS o P waves normal for the subject o P wave rate 60 - 100 bpm with <10% variation  rate <60 = sinus bradycardia  rate >100 = sinus tachycardia  variation >10% = sinus arrhythmia normal QRS axis normal P waves o height < 2.5 mm in lead II o width < 0.11 s in lead II

o Causes of long QT interval  myocardial infarction. hyperkalaemia.5 small squares)  for short PR segment consider Wolff-Parkinson-White syndrome or Lown-Ganong-Levine syndrome (other causes .g.g. hypothyrodism  subarachnoid haemorrhage. type II glycogen storage disease (Pompe's). normal variants (e.g. anterior. ventricular rhythm. hyperkalaemia normal PR interval o 0. diffuse myocardial disease  hypocalcaemia. anxiety. drinking iced water. hyperacute myocardial infarction and left bundle branch block  causes of small. left bundle branch block normal T wave  causes of tall T waves include hyperkalaemia.g.R interval. sotalol. inferior). HOCM)  for long PR interval see first degree heart block and 'trifasicular' block normal QRS complex o < 0.12 to 0. acute posterior MI. Normal = 0. drugs (e.12 s duration (3 small squares)  for abnormally wide QRS consider right or left bundle branch block. flattened or inverted T waves are numerous and include ischaemia.Duchenne muscular dystrophy. digoxin). left atrial hypertrophy. hyperventilation. pericarditis.      for abnormal P waves see right atrial hypertrophy. athletic heart.42 s. Edeiken pattern. atrial premature beat. myocarditis. age.20 s (3 . intracerebral haemorrhage  drugs (e. race. intraventricular conduction delay (e. RBBB)and electrolyte disturbance. normal U wave  . high-take off). ventricular hypertrophy. LVH. acute pericarditis  causes of depression include myocardial ischaemia. pulmonary embolus. etc. PE. amiodarone)  hereditary  Romano Ward syndrome (autosomal dominant)  Jervill + Lange Nielson syndrome (autosomal recessive) associated with sensorineural deafness normal ST segment o no elevation or depression  causes of elevation include acute MI (e. o no pathological Q waves o no evidence of left or right ventricular hypertrophy normal QT interval o Calculate the corrected QT interval (QTc) by dividing the QT interval by the square root of the preceeding R . digoxin effect. left bundle branch block.g.

2 glances actually.The electrical axis at a glance . If the axis is in the "left" quadrant take your second glance at lead II.left sided accessory pathway atrial septal defect ..     both I and aVF +ve = normal axis both I and aVF -ve = axis in the Northwest Territory lead I -ve and aVF +ve = right axis deviation lead I +ve and aVF -ve o lead II +ve = normal axis o lead II -ve = left axis deviation causes of a Northwest axis (no man's land)      emphysema hyperkalaemia lead transposition artificial cardiac pacing ventricular tachycardia causes of right axis deviation         normal finding in children and tall thin adults right ventricular hypertrophy chronic lung disease even without pulmonary hypertension anterolateral myocardial infarction left posterior hemiblock pulmonary embolus Wolff-Parkinson-White syndrome .. Using leads I and aVF the axis can be calculated to within one of the four quadrants at a glance.

right sided accessory pathway tricuspid atresia ostium primum ASD injection of contrast into left coronary artery note: left ventricular hypertrophy is not a cause left axis deviation . ventricular septal defect causes of left axis deviation          left anterior hemiblock Q waves of inferior myocardial infarction artificial cardiac pacing emphysema hyperkalaemia Wolff-Parkinson-White syndrome .

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