Rhythm identification

NSR

Sinus Brady

Sinus Brady

Sinus Arrhythmia

AF

Atrial Flutter 2:1

Atrial Tachy

Multifocal Atrial Tachycardia

Premature Atrial Complexes (PAC)

Sinus Exit Block

Junctional Escape Rhythm  40 – 60

Accelerated Junctional Escape Rhythm 60-100

Junctional Tachycardia 100-150

Supraventricular Tachycardia

Premature Junctional Complexes

1st Degree AV Block

1st Degree AV Block

2nd Degree Type 1 AV Block

2nd Degree Type 2 AV Block

2nd Degree Type 2 AV Block

3rd Degree AV Block

Idioventricular Rhythm <40

Accelerated Idioventricular Rhythm 40 – 100

Premature Ventricular Complexes

Ventricular Tachycardia 100 – 250, usually 150-200

Torsade de Pointes  "Tor-SAHD duh PWAHNT”

Ventricular Fibrillation

Asystole with pacemaker spikes

Paced Rhythms Usually 60 – 70

Left Bundle Branch Block

RBBB

Bigeminy

Trigeminy

Inferior STEMI

Lateral STEMI

Anterior STEMI

Posterior STEMI

de Winter T Waves

Positive Sgarbossa criteria in a patient with LBBB

There is 1mm concordant ST elevation in aVL

Positive Sgarbossa criteria in a patient with a ventricular paced rhythm

There is concordant ST depression in V2-5 (= Sgarbossa positive)

Positive Sgarbossa criteria in a patient with LBBB

excessively discordant ST elevation observed in this ECG in leads II, III, and aVF

Positive Sgarbossa criteria in a patient with a ventricular paced rhythm

Concordant ST elevation is observed in leads I and aVL

• Widespread concave ST elevation and PR depression is present throughout the precordial (V2-6) and limb leads (I, II, aVL, aVF).

• There is reciprocal ST depression and PR elevation in aVR.

• Acute Pericarditis

Massive bilateral pulmonary embolus

• RBBB

• Extreme right axis deviation (+180 degrees)

• S₁ Q₃ T₃

• T-wave inversions in V1-4 and lead III

Massive pulmonary embolus

• Sinus tachycardia.

• Simultaneous T-wave inversions in the anterior (V1-4) and inferior leads (II, III, aVF).

• Non-specific ST changes – slight ST elevation in III and aVF.

This patient has bilateral PEs confirmed on CTPA.

• Sinus tachycardia.

• Terminal T-wave inversion in V1-3 (this morphology is commonly seen in PE). There is also T-wave inversion in lead III.

pulmonary embolus

• Right axis deviation.

• T-wave inversions in V1-4 (extending to V5).

Left ventricular hypertrophy (LVH)

• Markedly increased LV voltages: huge precordial R and S waves that overlap with the adjacent leads (SV2 + RV6 >> 35 mm).

• R-wave peak time > 50 ms in V5-6 with associated QRS broadening.

• LV strain pattern with ST depression and T-wave inversions in I, aVL and V5-6.

• ST elevation in V1-3.

• Prominent U waves in V1-3.

• Left axis deviation.