1. Stepwise interpretation of ECG
ID 111

2. ID #111 – 56 year old man who had an episode of syncope

3. ID #111 – 56 year old man who had an episode of syncope
Can you see P waves?

4. ID #111 - 56 year old man who had an episode of syncope
Yes, there are sinus P waves, rare 80/min.
Are the waves followed by QRS complexes?

5. ID #111 - Sinus rhythm with complete heart block –P rate 80/min, QRS rate 43/min
No – The rhythm of the P waves and the rhythm of the QRS complexes are regular, but the two
rhythms are dissociated. The atrial rate is 50/min, the ventricular rate 83/min
There is complete heart block
As atria and ventricles are dissociated, where is the activation of the ventricles coming from?

6. ID #111 - Sinus rhythm, with complete heart block – Sinus rate 80/min.
Escape junctional rhythm. Ventricular rate 43/min.
The QRS complexes are narrow – The escape pacemaker is in the area of the AV junction

7. ID #111 - Sinus rhythm, with complete heart block – Sinus rate 80/min.
Escape junctional rhythm. Ventricular rate 43/min.
The QRS axis is normal (near 0 degrees). There is no bundle branch block or non-specific block
No LVH or QRS signs of myocardial infarction. The ST segment and T waves are normal.

8. ID #111 Final diagnosis: Sinus rhythm, with complete heart block –
Escape junctional rhythm. Ventricular rate 43/min.