DIAGNOSTIC CRITERIA FOR

RIGHT VENTRICULAR HYPERTHROPHY

Tall R in V1 > 0.6 mV
Increase R/S in V1 >1
Deep S in V5 > 1.0 mV
Deep S in V6 > 0.3 mV

DIAGNOSTIC CRITERIA FOR

LEFT VENTRICULAR HYPERTHROPHY
NORMAL ECG Sokolow-lyon voltage SV1 + RV5 > 3.5 mV
RaVL > 1.1 mV
Cornell voltage SV3 + RaVL > 2.8 mV (for men)
criteria SV3 + RaVL > 2.0 mV (for women)
Peguero - Lo - Presti Deepest S in any lead + S in V4
Criteria If deepest S wave is in V4: S in V4
NORMAL ECG x2
> 23 mm in WOMEN
> 28 mm in MEN

V1

NORMAL VALUES FOR DURATION OF

ELECTROCARDIOGRAM WAVES AND
INTERVALS IN ADULTS
P wave 120 msec
PR interval < 200 msec
QRS duration <110-120 msec
V6
QT interval (Corrected) ≤ 440-450

CHAMBER ENLARGEMENT
DIAGNOSTIC CRITERIA FOR
RIGHT ATRIAL ABNORMALITY
• Peaked P waves with amplitude in lead II to > 0.25 WIDE QRS COMPLEXES
mV (“P pulmonale”)
• Prominent initial positivity in lead V1 or V2 > 0.15 mV
DIAGNOSTIC CRITERIA FOR
• Increased area under initial positive portion of the P LEFT BUNDLE BRANCH BLOCK
wave in lead V1 to > 0.06 mm-sec
• QRS duration ≥ 120 msec
• Rightward shift of mean P wave axis to more than
• Broad, notched, or slurred R waves in leads I, aVL,
+75 degrees
V5 and V6
• Small or absent initial r waves in leads V1 and V2
DIAGNOSTIC CRITERIA FOR followed by deep S waves
LEFT ATRIAL ABNORMALITY • Absent septal q waves in leads I, V5 and V6
• Prolonged P wave duration to > 120 msec in lead II • Prolonged time to peak R wave (>60 msec) in V5
• Prominent notching of P wave, usually most obvious and V6
in lead II, while the interval between notches of > 40
msec (“P mitrale’)
• Ratio between the duration of the P wave in lead II DIAGNOSTIC CRITERIA FOR
and duration of the PR segment > 1.6 RIGHT BUNDLE BRANCH BLOCK
• Increased duration and depth of terminal-negative • QRS duration ≥ 120 msec
portion of P wave in lead V1 (P terminal force) so • rsr’, rsR’ , or rSR’, patterns in lead V1 and V2
that the area subtended by it is > 0.04 mm-sec • S waves in leads I and V6 ≥ 40 msec wide
• Leftward shift of mean P wave axis between -30 and • Normal time to peak R wave in leads V5 and V6 but
-45 degrees > 50 msec in V1
 ECG PATTERNS OF
ST ELEVATION OR LESION LOCATION
Q-WAVES
V1-2
Septal
Apical
V1-2 to V4-6 anteroseptal
LAD
Extensive
V1-6 occasionally aVL and I
anterior
Limited
aVL and I, V2-3
anterior
I and aVL, V5-6
LCX Lateral
ACUTE CORONARY SYNDROMES Reciprocal changes in V1-2

II, III*, aVF Inferior

DIAGNOSTIC CRITERIA FOR RCA,
MYOCARDIAL ISCHEMIA LCX
II, III*, aVF, I and aVL, V5-6 Infero-
ST-depression and T wave changes Reciprocal changes in V1-2 lateral
• New HORIZONTAL or DOWNSLOPING ST-
depression ≥0.5mm in 2 contiguous leads
*STE in III > II suggests RCA vs. LCx
T wave inversion >1mm in 2 contiguous leads with
prominent R wave or R/S ratio >1 ATRIOVENTRICULAR CONDUCTION
ABNORMALITIES

First Degree Second Degree Third degree

AV block AV block AV block

Mobitz Type I-
Prolonged PR • AV
progressive
interval conduction,
lengthening of PR
DIAGNOSTIC CRITERIA FOR (>0.20 sec) entirely
intervals with
MYOCARDIAL INFARCTION intermittent drop absent
New ST-elevation at the J-point in 2 contiguous leads beats • Ventricles,
• ≥1 mm in all leads other than leads V2-V3 Mobitz Type II- independently
• V2-V3 fixed PR interval driven by non-
Men >40 years old ≥2mm with intermittent atrial
Men <40 years old ≥2.5mm dropped pacemaker
Women ≥1.5mm regardless of age ventricular beats

BRADYARRHYTHMIA
x
Junctional Rhythm Idioventricular Rhythm
J-Point
• Absent, inverted, • Regular rhythm
buried or retrograde P • Rate 25-40 bpm
waves • Ventricular pacemaker
DIAGNOSTIC CRITERIA FOR OLD INFARCT • Regularly occurring is below the region of
• Any Q wave in leads V2–V3 >0.02 s or QS complex narrow QRS the block
in leads V2–V3 complexes • Wide QRS (>0.12 sec)
• Q wave ≥0.03 s and ≥1 mm deep or QS complex in • Rate of 40-60 beats/
leads I, II, aVL, aVF or V4–V6 in any 2 leads of a min
contiguous lead grouping
JUNCTIONAL RHYTHM ATRIAL FLUTTER

FF F F F F F F FF F F F F F F F F

DIOVENTRICULAR RHYTHM

TACHYARRHYTHMIA Ventricular Tachycardia Ventricular Fibrillation

(VT) (VF)
• At least 3 consecutive • Associated with
PVCs coarse or fine chaotic
ATRIAL FIBRILLATION • Rapid, bizarre, wide undulations of the
QRS complexes (> 0.10 ECG baseline
sec) • No P wave
• No P wave (ventricular • No true QRS
impulse origin) complexes
TACHYARRHYTHMIA • Indeterminate rate

Atrial Fibrillation (AF) Atrial Flutter

• No discernible P waves • Atrial rate of 250-350
• Fibrillatory waves or f beats per minute
waves (low-amplitude • Characteristic Saw-
VENTRICULAR TACHYCARDIA
baseline oscillations; tooth Flutter Waves
rate of 300-600 bpm; (with relatively
varying shape, uniform appearance,
amplitude, and timing); constant timing, and
in lead V1, f waves morphology)
sometimes appear • Mechanism: Re-entry
uniform and can mimic around the right
flutter waves atrium
• IRREGULAR rhythm or
R-R interval

VENTRICULAR FIBRILLATION
ATRIAL FIBRILLATION

References:
• Libby, P., Bonow, R., Mann, D., Tomaselli, G., Bhatt, D.,
Solomon, S. (2019). Braunwald’s Heart Disease: A Textbook
of Cardiovascular Medicine, 12th Edition. Elsevier
• Thygesen, K., Alpert, J., Jaffe, A., Chaitman, B., Bax, J.,
Morrow, D., White, H.(2018).Fourth Universal Definition of
Myocardial Infarction.Circulation