ECG Topics I (EKG Tételek I) - Department of Pathophysiology, University of Szeged

Comprehensive vocabulary flashcards covering the core electrocardiographic topics, arrhythmias, conduction blocks, ischemic patterns, and chamber hypertrophies from the Department of Pathophysiology at Albert Szent-Györgyi Medical School, University of Szeged.

Normal ECG (Normál EKG)

A standard 12-lead electrocardiogram demonstrating normal sinus rhythm originating from the sinoatrial node, characterized by a heart rate of $60\text{--}100\,\text{beats/min}$, upright P waves in lead II, consistent PR interval of $120\text{--}200\,\text{ms}$, narrow QRS complexes of duration $< 120\,\text{ms}$, and absence of pathological ST-segment displacement or T-wave abnormalities.

Atrial Premature Complex (Pitvari korai ütés)

A premature cardiac beat initiated by an ectopic focus within the atria rather than the sinoatrial node, displaying an early, morphologically abnormal P wave (which may be biphasic, notched, or inverted) followed by a normal, narrow QRS complex and typically an incomplete compensatory pause.

Atrial Bigeminy (Pitvari bigeminia)

A regular-irregular cardiac rhythm characterized by a repetitive 1:1 pairing where each normal sinus beat is consistently followed by a premature atrial complex (PAC).

Ventricular Premature Complex (Kamrai korai ütés)

An ectopic impulse arising prematurely from a focus within the ventricular myocardium or His-Purkinje network, presenting with an early, wide ($\ge 120\,\text{ms}$), and bizarre QRS morphology without a preceding P wave, discordant ST-T segment deflections, and a full compensatory pause.

Ventricular Bigeminy (Kamrai bigeminia)

A ventricular dysrhythmia characterized by an alternating 1:1 coupling pattern where every normal sinus beat is immediately followed by a premature ventricular complex (PVC).

Multifocal Ventricular Premature Complexes (Multifokális kamrai korai ütések)

Premature ventricular complexes that originate from two or more distinct anatomical ventricular foci, characterized on the ECG by varying QRS morphologies, varying axes, and non-uniform coupling intervals.

Sinus Arrhythmia (Sinus arrhythmia)

A physiological variation in sinoatrial node automaticity where P wave morphology remains identical, but the P-P and R-R intervals fluctuate significantly (typically by $> 120\,\text{ms}$ or $> 10\%$), most commonly corresponding to the respiratory cycle (accelerating during inspiration and decelerating during expiration).

Sinus Bradycardia (Sinus bradycardia)

A regular rhythm originating from the sinoatrial node with normal P wave morphology and 1:1 atrioventricular conduction, but at a discharge rate slower than $60\,\text{beats/min}$ ($RR\,\text{interval} > 1000\,\text{ms}$).

Sinus Tachycardia (Sinus tachycardia)

A regular cardiac rhythm generated by the sinoatrial node displaying normal upright P waves in leads I and II, 1:1 AV conduction, and a rate exceeding $100\,\text{beats/min}$ (typically between $100\text{--}180\,\text{beats/min}$).

Wolff-Parkinson-White Syndrome Type A (Wolff-Parkinson-White-szindróma, A típus)

A ventricular pre-excitation syndrome caused by an accessory atrioventricular pathway (bundle of Kent) located on the left side, presenting with a short PR interval ($< 120\,\text{ms}$), a slurred initial QRS upstroke (delta wave), widened QRS duration ($> 120\,\text{ms}$), and predominantly positive/upright delta waves and tall R waves in lead $V_1$.

Wolff-Parkinson-White Syndrome Type B (Wolff-Parkinson-White-szindróma, B típus)

A ventricular pre-excitation syndrome caused by a right-sided accessory pathway (bundle of Kent), characterized by a short PR interval ($< 120\,\text{ms}$), delta waves, widened QRS, and predominantly negative QRS deflections (QS or rS patterns with negative delta waves) in leads $V_1$ and $V_2$, mimicking left bundle branch block.

Paroxysmal Focal Atrial Tachycardia (Paroxysmalis fokális pitvari tachycardia)

A rapid supraventricular tachycardia with sudden onset and termination originating from a discrete ectopic atrial focus outside the sinus node, characterized by a rapid, regular atrial rate ($150\text{--}250\,\text{beats/min}$), distinct non-sinus P waves differing in axis and morphology from normal sinus P waves, and typically narrow QRS complexes.

Atrial Flutter (Pitvari flutter)

A macro-reentrant supraventricular arrhythmia characterized by rapid, continuous, identical regular flutter waves (F waves) producing a 'sawtooth' baseline pattern at an atrial rate of $250\text{--}350\,\text{beats/min}$ (prominently in leads II, III, and aVF), typically accompanied by fixed atrioventricular block (e.g., 2:1 AV block yielding a ventricular rate of $\approx 150\,\text{beats/min}$).

Atrial Fibrillation (Pitvarfibrilláció)

A chaotic supraventricular arrhythmia characterized by rapid, disorganized atrial electrical activation ($350\text{--}600\,\text{beats/min}$) with absence of distinct P waves (replaced by undulating fibrillatory 'f' waves) and an irregularly irregular ventricular response with variable R-R intervals.

AV Nodal Reentry Tachycardia (Slow-Fast) [AV nodális reentry tachycardia (lassú-gyors)]

The most common (typical) form of AVNRT involving dual atrioventricular nodal pathways with anterograde conduction down the slow pathway and retrograde conduction up the fast pathway, presenting as a regular narrow-complex tachycardia ($140\text{--}220\,\text{beats/min}$) with retrograde P waves that are either obscured by the QRS complex or visible as pseudo-$r'$ in lead $V_1$ or pseudo-$S$ waves in inferior leads.

Junctional Rhythm (Junkcionális ritmus)

An automatic escape rhythm arising from the atrioventricular junction (AV node or bundle of His) at an intrinsic rate of $40\text{--}60\,\text{beats/min}$, presenting with regular narrow QRS complexes and retrograde P waves (inverted in leads II, III, and aVF) that can occur immediately before, during (hidden), or immediately after the QRS complex.

Monomorphic Ventricular Tachycardia (Monomorf kamrai tachycardia)

A broad-complex tachycardia ($QRS \ge 120\,\text{ms}$) originating distal to the bundle of His at a rate typically exceeding $100\,\text{beats/min}$, wherein every consecutive QRS complex exhibits a uniform, identical morphology and axis from beat to beat.

Ventricular Flutter (Kamrai flutter)

A severe, rapid ventricular tachydysrhythmia ($200\text{--}300\,\text{beats/min}$) displaying a regular, continuous sinusoidal wave appearance where distinct QRS complexes and T waves cannot be differentiated, representing an intermediate stage between ventricular tachycardia and ventricular fibrillation.

Torsades de Pointes (Torsades de pointes)

A distinctive polymorphic ventricular tachycardia occurring in the presence of a prolonged baseline QT interval ($QT_c > 440\text{--}500\,\text{ms}$), characterized by a rapid rate ($200\text{--}250\,\text{beats/min}$) and periodic twisting of the QRS peaks and axis around the isoelectric line.

Ventricular Fibrillation (Kamrafibrilláció)

A chaotic, fatal cardiac arrhythmia marked by uncoordinated, rapid, and irregular electrical undulations of variable amplitude without identifiable P waves, QRS complexes, or T waves, leading to the immediate absence of effective cardiac output.

1st Degree AV Block (I. fokú AV-blokk)

A delay in atrioventricular conduction characterized by a constant, prolonged PR interval exceeding $200\,\text{ms}$ ($> 0.20\,\text{s}$ or 5 small squares) on every beat, maintaining 1:1 AV conduction with no dropped QRS complexes.

2nd Degree AV Block, Type Mobitz 1 (II. fokú AV-blokk, Mobitz 1-es típus)

An atrioventricular conduction defect (Wenckebach phenomenon) characterized by progressive, beat-to-beat prolongation of the PR interval until an atrial impulse (P wave) fails to conduct to the ventricles (dropped QRS complex), after which the cycle repeats.

2nd Degree AV Block, Type Mobitz 2 (II. fokú AV-blokk, Mobitz 2-es típus)

An infranodal conduction block characterized by constant, fixed PR intervals in conducted beats, accompanied by intermittent, unexpected failure of P wave conduction (dropped QRS complexes) without prior PR lengthening.

3rd Degree AV Block with Narrow QRS Complex (III. fokú AV-blokk keskeny QRS komplexummal)

Complete atrioventricular dissociation wherein no atrial impulses conduct to the ventricles, sustained by a junctional escape pacemaker originating proximal to the His bifurcation that produces regular narrow QRS complexes ($< 120\,\text{ms}$) at a rate of $40\text{--}60\,\text{beats/min}$ independent of the faster atrial rate.

3rd Degree AV Block with Wide QRS Complex (III. fokú AV-blokk széles QRS komplexummal)

Complete atrioventricular block with absolute independence between atrial P waves and ventricular beats, sustained by an infranodal ventricular escape rhythm that produces broad, bizarre QRS complexes ($\ge 120\,\text{ms}$) at an intrinsic rate of $20\text{--}40\,\text{beats/min}$.

Left Bundle Branch Block (Bal Tawara-szár blokk)

An intraventricular conduction abnormality characterized by a QRS duration of $\ge 120\,\text{ms}$, broad, notched, or slurred R waves in lateral leads (I, aVL, $V_5$, $V_6$) without septal Q waves, deep QS or rS complexes in leads $V_1$ and $V_2$, and secondary discordant ST-T segment changes.

Left Anterior Fascicular Block / Hemiblock (Bal anterior fascicularis blokk/hemiblokk)

A conduction block of the anterior division of the left bundle branch characterized by marked left axis deviation ($-45^\circ\text{ to }-90^\circ$), a $qR$ pattern in leads I and aVL, an $rS$ pattern in inferior leads (II, III, aVF), and a normal QRS duration ($< 120\,\text{ms}$).

Left Posterior Fascicular Block / Hemiblock (Bal posterior fascicularis blokk/hemiblokk)

A conduction block through the posterior division of the left bundle branch presenting with marked right axis deviation ($> +90^\circ$ or $+120^\circ$), an $rS$ pattern in leads I and aVL, a $qR$ pattern in leads II, III, and aVF, and normal QRS duration ($< 120\,\text{ms}$), after excluding right ventricular hypertrophy.

Right Bundle Branch Block (Jobb Tawara-szár blokk)

An intraventricular conduction defect characterized by a widened QRS duration ($\ge 120\,\text{ms}$), an $rsr'$, $rsR'$, or 'M-shaped' rabbit-ear pattern in right precordial leads ($V_1$, $V_2$), and broad, slurred S waves in lateral leads (I, aVL, $V_5$, $V_6$).

NSTEMI (NSTEMI)

Non-ST-Elevation Myocardial Infarction; an acute coronary syndrome presenting without acute ST-segment elevation, electrocardiographically displaying ST-segment depression ($\ge 0.5\,\text{mm}$), T-wave inversion ($\ge 1\,\text{mm}$), or transient ST-T changes in the presence of positive myocardial necrosis biomarkers.

Anterior STEMI (Anterior STEMI)

An acute transmural myocardial infarction typically resulting from occlusion of the left anterior descending (LAD) coronary artery, characterized by convex ST-segment elevation ($\ge 1\text{--}2\,\text{mm}$) across anterior precordial leads ($V_1\text{--}V_4$), frequently with reciprocal ST depression in inferior leads.

Lateral STEMI (Laterális STEMI)

An acute transmural myocardial infarction involving the lateral wall of the left ventricle (supplied by the left circumflex or diagonal branch of the LAD), presenting with ST-segment elevation in high lateral leads (I, aVL) and/or lateral chest leads ($V_5$, $V_6$), often with reciprocal ST depression in inferior leads.

Anterolateral STEMI (Anterolaterális STEMI)

An extensive transmural myocardial infarction caused by proximal LAD occlusion, characterized by ST-segment elevation spanning precordial leads $V_1\text{--}V_6$ as well as limb leads I and aVL, accompanied by reciprocal ST depression in inferior leads (II, III, aVF).

Anterior Q-MI (Anterior Q-MI)

A completed or subacute anterior myocardial infarction displaying pathological Q waves ($\ge 40\,\text{ms}$ in width or $\ge 25\%$ of R wave amplitude, or QS complexes) across leads $V_1\text{--}V_4$, associated with poor anterior R-wave progression and inverted T waves.

Inferior STEMI (Inferior STEMI)

An acute transmural myocardial infarction of the diaphragmatic/inferior left ventricular wall (typically due to right coronary artery occlusion), demonstrating ST-segment elevation in leads II, III, and aVF, with reciprocal ST depression in high lateral leads I and aVL.

Inferolateral and Posterior STEMI (Inferolaterális és posterior STEMI)

An extensive acute myocardial infarction involving the inferior, lateral, and true posterior walls, displaying ST elevations in inferior leads (II, III, aVF) and lateral leads ($V_5$, $V_6$), paired with mirror-image posterior signs in leads $V_1\text{--}V_3$ (horizontal ST depression, tall upright R waves, and prominent upright T waves).

Inferior Q-MI (Inferior Q-MI)

An established or healed transmural myocardial infarction of the inferior wall, characterized by pathological Q waves ($\ge 40\,\text{ms}$ duration or $\ge 25\%$ of R wave height) in leads II, III, and aVF.

Inferolateral Q-MI (Inferolaterális Q-MI)

A chronic or completed transmural myocardial infarction involving both the inferior and lateral walls of the left ventricle, evidenced by pathological Q waves in inferior leads (II, III, aVF) as well as lateral leads (I, aVL, $V_5$, $V_6$).

Inferior and Right Ventricular STEMI (Inferior és jobb kamrai STEMI)

An acute inferior myocardial infarction with contiguous involvement of the right ventricle (proximal RCA occlusion), characterized by ST elevations in leads II, III, and aVF (with $ST\,\text{elevation in lead III} > \text{lead II}$) and diagnostic ST elevation ($\ge 0.5\text{--}1\,\text{mm}$) in right-sided precordial leads ($V_3R\text{--}V_6R$, especially $V_4R$).

Left Ventricular Hypertrophy (Bal kamrai hypertrophia)

An electrocardiographic manifestation of increased left ventricular wall thickness, defined by high voltage criteria (e.g., Sokolow-Lyon: $S_{V1} + R_{V5}\text{ or }R_{V6} \ge 35\,\text{mm}$; or Cornell: $R_{aVL} + S_{V3} > 28\,\text{mm}$ in men, $> 20\,\text{mm}$ in women), left axis deviation, and secondary repolarization changes with downsloping ST depression and asymmetrical T-wave inversion ('strain pattern') in lateral leads.

Right Ventricular Hypertrophy (Jobb kamrai hypertrophia)

Hypertrophy of the right ventricular musculature characterized by a dominant R wave in lead $V_1$ ($R/S\,\text{ratio} > 1$ or $R > 7\,\text{mm}$), deep S waves in lateral precordial leads ($V_5$, $V_6$), right axis deviation ($> +90^\circ$), and secondary ST-T strain in leads $V_1\text{--}V_3$.

Right Atrial and Right Ventricular Hypertrophy (Jobb pitvari és jobb kamrai hypertrophia)

Concurrent enlargement of both right-sided heart chambers, presenting with tall, peaked P waves ($> 2.5\,\text{mm}$ in leads II, III, and aVF; P pulmonale) signifying right atrial enlargement, accompanied by tall R waves in lead $V_1$, deep lateral S waves, and right axis deviation indicating right ventricular hypertrophy.

Left Atrial and Right Ventricular Hypertrophy (Bal pitvari és jobb kamrai hypertrophia)

Combined cardiac chamber enlargement characterized by broad, notched bifid P waves ($\ge 120\,\text{ms}$ in lead II with peak separation $> 40\,\text{ms}$; P mitrale) and negative terminal P deflection in $V_1$ indicating left atrial enlargement (classic in mitral stenosis), occurring alongside tall R waves in lead $V_1$ and right axis deviation indicating right ventricular hypertrophy.