Szom bath D .– Tornóci L.

: EKG w ork book

Alltracings

Se pte m be r 13, 2006.

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© D r. Szom bath D e zs ő, D r. Tornóci Lás zló, 2005

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 Conte nts

E01 Norm alECG E23 Full y com pe ns ate d ve ntricular pre m ature contractions (VPCs , 4:1 =
E02 Norm altracing (m e an axis ≈45°) + s inus tach ycardia q uadrige m iny), s inus tach ycardia
E03 Norm altracing, righ tdeviation (m e an axis ≈80°) E24 Sh ortruns of VPCs
E04 Norm altracing, leftdeviation (m e an axis ≈10°) + s inus bradycardia, E25 Nons ustaine d ve ntricul ar tach ycardia follow ing bige m iny
flatT w ave s E26 Runs of ve ntricul ar tach ycardia w ith s igns of re trograde conduction
E05 Effe ctof re s piration on th e m e an axis (0°– 30°). Th e pos itionalQ to th e atria
w ave dis appe ars during ins piration. E27 Ve ntricul ar tach ycardia
E06 Sinus tach ycardia, fre q ue ncy: ≈120/m in E28 Ve ntricul ar tach ycardia
E07 Sinus bradycardia, fre q ue ncy: ≈50/m in E29 Long QT s yndrom e (QT = 0.56 s , Qtc = 0.50 s )
E08 Re s piratory s inus arrh yth m ia (m e an axis ≈9 0°, righ tdeviation) E30 “Tors ade de pointe s ” type pol ym orph ic ve ntricul ar tach ycardia
E09 Sinus arre st, junctionale s cape be at E31 Ve ntricul ar flutte r
E10 Sick Sinus Syndrom e : s inus bradycardia, inte rm itte ntatrialflutte r E32 Ve ntricul ar flutte r, fibril
lation and cardiac arre st
w ith AVblock E33 Ve ntricul ar paras ystole w ith fus ion be ats
E11 Atrialpre m ature contractions (APCs ) w ith variable PR inte rvaland E34 Firstde gre e atriove ntricular (AV) block (PR ≈0.33 s )
abe rrantconduction E35 Se cond de gre e AVblock , W e nck e bach type (M obitz I) w ith a 4:3
E12 M ultifocalatrialtach ycardia conduction ratio. Progre s s ive s h orte ning of th e R R inte rvalis s e e n in
E13 Atrialfibril lation, abe rrantl y conducte d ve ntricular com plexe s , th e firstcycle.
tach yarrh yth m ia E36 Se cond de gre e AVblock , M obitz II
E14 Atrialfibril lation, abs ol ute arrh yth m ia E37 Se cond de gre e AVblock , w ith 2:1 conduction ratio
E15 Atrialflutte r E38 Th ird de gre e AVblock
E16 Junctional(or atrial) pre m ature contractions in a 4:1 (q uadrige m iny) E39 Th ird de gre e AVblock , ve ntricular e s cape rh yth m
patte rn E40 H igh grade AVblock . Th e firstQR S is a fus ion be at, th e fourth is a
E17 Junctionale s cape rh yth m (m e s onodalbe ats ), fre q ue ncy ≈40/m in capture .
E18 Acce lerate d junctionalrh yth m , (inve rte d P w ave s pre ce de th e QR Ss ) E41 Se cond de gre e s inuatrial(SA) block (M obitz I)
E19 Acce lerate d junctionalrh yth m , (inve rte d P w ave s com e afte r th e E42 Se cond de gre e SA bl ock (M obitz II)
QR Ss ) E43 Com pl e te righ tbundle branch block (R BBB) (QR S ≈0.12 s )
E20 Junctionaltach ycardia (re e ntry), fre q ue ncy 150/m in E44 Com pl e te leftbundle branch block (LBBB) (QR S ≈0.12 s )
E21 Ve ntricular bige m iny (2:1) E45 R ate de pe nde ntLBBB
E22 Full y com pe ns ate d ve ntricular pre m ature contractions (VPCs , 3:1 = E46 Le ftante rior fas cicular bl ock (h e m ibl
ock , m e an axis ≈– 50°), APC
trige m iny)
E47 R igh tve ntricul ar h ype rtroph y (m e an axis ≈100°), firstde gre e AV E69 H ype racute , h igh late ralinfarction
block E70 H ype racute infe rior and poste rior infarction
E48 Le ftposte rior h e m ibl ock , incom pl e te R BBB E71 Acute infe rior infarctre corde d atdiffe re nttim e points
E49 Ve ntricular pre excitation, W ol ff-Park ins on-W h ite (W PW ) s yndrom e E72 O ld infe rior infarction
E50 W PW s yndrom e , tach ycardia w ith w ide QR S com plexe s , junctional E73 Infe rior and poste rior infarction
e s cape be at, s inus rh yth m E74 Subacute poste rior infarction
E51 Alte rnating W PW com pl exe s E75 Acute infe rior, poste rior, and late ralinfarction
E52 Sh ortPR , narrow QR S, APC, l e ftante rior h e m ibl
ock E76 Exte ns ive ante rior non-Q infarction (NQM I)
E53 H ypok al e m ia E77 H ype racute infe rior infarction, atrialfibril lation
E54 H ype rk alem ia E78 Acute exte ns ive ante rior infarction, atrialfibrillation
E55 Signs of digitalis e ffe ct E79 Subacute ante rior and old infe rior infarction, firstde gre e AVblock
E56 Signs of l e ftve ntricul ar strain E80 H ype racute infe rior infarction, s e cond de gre e AVblock (M obitz I)
E57 Le ftve ntricular h ype rtroph y E81 Acute infe rior infarction, s e cond de gre e AVbl ock (M obitz I)
E58 R igh tve ntricul ar h ype rtroph y E82 Acute infe rior infarction, s e cond de gre e AVbl ock (2:1)
E59 Le ftatrialabnorm al ity (P m itral e) E83 H ype racute infe rior infarction, th ird de gre e AVbl ock w ith junctional
E60 Le ftatrialabnorm al ity (P m itral e ), righ tdeviation e s cape rh yth m
E61 R igh tatrialabnorm al ity (P pul m onal e) E84 Acute ante rior infarction, R BBB, s inus tach ycardia
E62 Sube ndocardialis ch e m ia E85 Acute ante rolate ralinfarction, com plete LBBB
E63 H ype racute exte ns ive ante rior infarct, R-re duction. M irror im age s in E86 ECG of a patie ntw ith acute pe ricarditis
th e infe rior l e ads . E87 Acute ove rload of th e righ tve ntricle (cor pul m onal e acutum , SIQIII
E64 Acute exte ns ive ante rior and l ate ralinfarction. M irror im age s in th e patte rn), firstde gre e AVblock
infe rior l e ads . P pul m onale E88 “Ce re bral” T w ave s caus e d by intracranialh e m orrh age . Long QT
E65 Acute ante rolate ralinfarction s yndrom e (QT = 0.46 s , Qtc = 0.52 s )
E66 Ante rior infarction (R re duction in V3), s inus tach ycardia, “s coope d” E89 Pace m ak e r rh yth m (LBBB patte rn – th e e lectrode is in th e righ t
ST ve ntricle)
E67 Subacute ante rior infarction E9 0 ECG of a patie ntw ith a dualch am be r (atrialand ve ntricul ar)
E68 Subacute l ate ralinfarction pace m ak e r
 E01
I aVR

II aVL

aVF
III

V4
V1

V5
V2

V6
V3

25 m m /s , 10 m m /m V
 E02

V1
I

V2
II

V3
III

aVR V4

aVL V5

aVF V6

25 m m /s , 10 m m /m V
 E03
I
V1

II
V2

III V3

aVR V4

aVL V5

aVF V6

25 m m /s , 10 m m /m V
 E04

I V1

II V2

III V3

aVR V4

aVL V5

aVF V6

25 m m /s , 10 m m /m V
 E05

II

III

25 m m /s , 10 m m /m V

be légzés /ins piration

 E06
I II III

aVR aVL aVF

V1 V2 V3

V4 V5 V6

25 m m /s , 10 m m /m V
 E07
I aVR

II aVL

III aVF

V1 V4

V2
V5

V3
V6

25 m m /s , 10 m m /m V
 E08
V1
I

II V2

III V3

aVR V4

aVL V5

aVF V6

25 m m /s , 10 m m /m V
 E09

aVL

25 m m /s , 10 m m /m V
 E10

V1
I

V2
II

III V3

Th e labe ls aVR-aVL-aVF and V1-V2-V3 are m ixe d up in th e pape r ve rs ion of th e w ork book .

aVR V4

aVL V5

aVF
V6

25 m m /s , 10 m m /m V
 E11

V1
I

V2
II

III V3

V4
aVR

V5
aVL

aVF V6

25 m m /s , 10 m m /m V
 E12
aVR
I

aVL
II

aVF
III

V1
V4

V2
V5

V3
V6
25 m m /s , 10 m m /m V
 E13

II

III

25 m m /s , 10 m m /m V
 E14

I aVR

II aVL

III aVF

V1 V4

V2
V5

V3
V6

25 m m /s , 10 m m /m V
 E15

I aVR

II aVL

III aVF

V1 V4

V2
V5

V3 V6

25 m m /s , 10 m m /m V
 E16
I

II

III

aVR

aVL

aVF

V1

V3

V5

V6

25 m m /s , 10 m m /m V
 E17

I aVR V1 V4

II aVL V2 V5

III aVF V3 V6

II

25 m m /s , 10 m m /m V
 E18
aVR
I

aVL
II

aVF
III

V1 V4

V2 V5

V3
V6

25 m m /s , 10 m m /m V
 E19

I aVR

II aVL

III aVF

25 m m /s , 10 m m /m V
 E20

II

III

aVR

aVL

aVF

25 m m /s , 10 m m /m V
 E21

II

III

25 m m /s , 10 m m /m V
 E22

25 m m /s , 10 m m /m V
 E23

II

III

25 m m /s , 10 m m /m V
 E24

V1

II
V2

III
V3

aVR V4

aVL V5

aVF V6

25 m m /s , 10 m m /m V
 E25
I

II

aVF

V2

V6

25 m m /s , 10 m m /m V
 E26

II

III

25 m m /s , 10 m m /m V
 E27
V4
I aVR V1

II aVL V2 V5

III aVF V3 V6

V1

25 m m /s , 10 m m /m V
 E28
V4
I aVR V1

II aVL V2
V5

V3
III aVF V6

aVL

25 m m /s , 10 m m /m V
 E29

I aVR

II aVL

aVF
III

Th e lead labe ls are m is s ing in th e pape r ve rs ion of th e w ork book .

V1
V4

V2
V5

V3
V6

25 m m /s , 10 m m /m V
 E30

II

V1

25 m m /s , 20 m m /m V
 E31
I

II

III

II

III

25 m m /s , 10 m m /m V
 E32
I

25 m m /s , 10 m m /m V
 E33

25 m m /s , 10 m m /m V
 E34

25 m m /s , 10 m m /m V
 E35

II

III

aVR

aVL

aVF

25 m m /s , 10 m m /m V
 E36

II

25 m m /s , 10 m m /m V
 E37

II

III

25 m m /s , 10 m m /m V
 E38

II

III

aVR

aVL

aVF

25 m m /s , 10 m m /m V
 E39

V1

V1

25 m m /s , 10 m m /m V
 E40

25 m m /s , 10 m m /m V
 E41

II

25 m m /s , 10 m m /m V
 E42

25 m m /s , 10 m m /m V
 E43
I aVR

II aVL

III aVF

V1 V4

V2 V5

V3 V6

25 m m /s , 10 m m /m V
 E44

I aVR

II aVL

III aVF

V4
V1

V5
V2

V6
V3

25 m m /s , 10 m m /m V
 E45

25 m m /s , 10 m m /m V
 E46

II

III

aVR

aVL

aVF

25 m m /s , 10 m m /m V
 E47

I II III

aVR aVL aVF

25 m m /s , 10 m m /m V
 E48

I aVR

II aVL

III aVF

V1 V4

V2 V5

V3 V6

25 m m /s , 10 m m /m V
 E49
V1
I

V2
II

V3
III

aVR V4

aVL V5

aVF
V6

25 m m /s , 10 m m /m V
 E50

II

III

25 m m /s , 10 m m /m V
 E51

I II

III

aVF

V1 V6

25 m m /s , 10 m m /m V
 E52

II

III

aVR V1 V4

V2
aVL V5

aVF V3
V6

25 m m /s , 10 m m /m V
 E53

I II III

aVR aVL aVF

V1 V2 V3

V4 V5 V6

25 m m /s , 10 m m /m V
 E54

I II III

aVR aVL aVF

V1 V2 V3

V4 V5 V6

25 m m /s , 10 m m /m V
 E55
I II III

aVR aVL aVF

V1 V2 V3

V4 V5 V6

25 m m /s , 10 m m /m V
 E56

V1
I

V2
II

III V3

aVR V4

aVL V5

aVF
V6

25 m m /s , 10 m m /m V
 E57
aVR
I

II
aVL

III
aVF

V1
V4

V2
V5

V3
V6

25 m m /s , 10 m m /m V
 E58

I aVR

II aVL

III aVF

V4
V1

V5
V2

V6
V3

25 m m /s , 10 m m /m V
 E59
aVR
I

II aVL

III aVF

V1 V4

V2
V5

V3
V6

25 m m /s , 10 m m /m V
 E60

I aVR

II
aVL

III aVF

V1 V4

V2
V5

V3
V6

25 m m /s , 10 m m /m V
 E61

I II III

aVR aVL aVF

V1

25 m m /s , 10 m m /m V
 E62

I aVR

II aVL

aVF
III

V1 V4

V2
V5

V3
V6

25 m m /s , 10 m m /m V
 E63
I aVR

II aVL

III aVF

V1 V4

V2 V5

V3
V6

25 m m /s , 10 m m /m V
 E64

I aVR

II
aVL

III aVF

V1
V4

V2

V5

V3

V6

25 m m /s , 10 m m /m V
 E65

I II III

aVR aVL aVF

V1 V2 V3

V4 V5 V6

25 m m /s , 10 m m /m V
 E66

I aVR

II aVL

aVF
III

V4
V1

V2 V5

V3 V6

25 m m /s , 10 m m /m V
 E67
I II III

aVR aVL aVF

V1 V2 V3

V4 V5 V6

25 m m /s , 10 m m /m V
 E68
I II III

aVR aVL aVF

V1 V2 V3

V4 V5 V6

25 m m /s , 10 m m /m V
 E69

I aVR

II aVL

III aVF

V1
V4

V2

V5

V3

V6

25 m m /s , 10 m m /m V
 E70

aVR
I

II aVL

III aVF

V1 V4

V2
V5

V3 V6

25 m m /s , 10 m m /m V
 E71
16:46 h
V1 V4
I aVR

V2 V5
II aVL

III aVF V3 V6

19 :13 h
I V1 V4
aVR

II aVL V2 V5

III aVF
V3 V6

25 m m /s , 10 m m /m V
 E72
I II III

aVR aVL aVF

V1 V2 V3

V4 V5 V6

25 m m /s , 10 m m /m V
 E73

I aVR V1 V4

II aVL V2 V5

III aVF V3 V6

II

25 m m /s , 10 m m /m V
 E74

V1 V7
I

V2
II V8

V3
III V9

aVR V4
VD 1

aVL V5 VD 2

aVF V6 VD 3

25 m m /s , 10 m m /m V
 E75
I II III

aVR aVL aVF

V1 V2 V3

V4 V5 V6

25 m m /s , 10 m m /m V
 E76

I II III

aVR aVL aVF

V1 V2 V3

V4 V5 V6

25 m m /s , 10 m m /m V
 E77

II

III

25 m m /s , 10 m m /m V
 E78

I II III

aVR aVL aVF

V1 V2 V3

V4 V5 V6

25 m m /s , 10 m m /m V
 E79

I II III

aVR aVL aVF

V1 V2 V3

V4 V5 V6

25 m m /s , 10 m m /m V
 E80

V1 V4
I aVR

V2 V5
II aVL

III aVF V3 V6

aVF

25 m m /s , 10 m m /m V
 E81

II

III

aVR

aVL

aVF

25 m m /s , 10 m m /m V
 E82

I II

III

aVR aVL aVF

25 m m /s , 10 m m /m V
 E83

I aVR

aVL
II

aVF
III

25 m m /s , 10 m m /m V
 E84

I II III

aVR aVL aVF

V1 V2 V3

V4 V5 V6

25 m m /s , 10 m m /m V
 E85
I aVR

II aVL

III aVF

V1 V4

V2 V5

V3 V6

25 m m /s , 10 m m /m V
 E86

I II III

aVR aVL aVF

V1 V2 V3

V4 V5 V6

25 m m /s , 10 m m /m V
 E87

I II III

aVR aVL aVF

V1 V2 V3

V4 V5 V6

25 m m /s , 10 m m /m V
 E88
I II III

aVR aVL aVF

V1 V2 V3

V4 V5 V6

25 m m /s , 10 m m /m V
 E89

I aVR

II aVL

III aVF

V1 V4

V2 V5

V3 V6

25 m m /s , 10 m m /m V
 E9 0

V1 V4
I aVR

II aVL V2 V5

aVF V3 V6
III

II

25 m m /s , 10 m m /m V