Various abnormal rhythms in ECG

1. ECG
Dr Sravan kumar G
Assistant Professor
MRIMS

4. SINUS RHYTHM

5. SINUS BRADYCARDIA

6. SINUS TACHCARDIA

7. AVNRT

8. ATRIAL FLUTTER

9. ATRIAL FIBRILLATION

10. ATRIAL TACHYCARDIA

11. AV JUNCTIONAL RHYTHM

12. ORTHODOMIC AVRT

13. TYPE A WPW

14. TYPE B WPW

15. AIVR

16. VENTRICULAR TACHYCARDIA

17. VENTRICULAR TACHYCARDIA

18. VENTRICULAR FLUTTER

19. VENTRICULAR FIBRILLATION

20. FIRST DEGREE AV BLOCK

21. AV Block: 2nd degree, Mobitz I
(Wenckebach Phenomenon)

22. Mobitz type II second-degree AV block.

23. CHB

25. P PULMONALE

26. P Mitrale

28. LVH

29. RVH

31. LBBB

32. RBBB

33. LAFB

34. LPFB

35. Bifascicular block
• RBBB and LAFB
– RBBB plus left axis deviation beyond -45 degrees
• RBBB with LPFB
– RBBB plus Right axis deviation beyond +120 degrees
• LBBB alone

36. 2:1 Mobitz type 2 AV Block
RBBB
LAD (LAFB)

37. 2:1 Mobitz type 2 AV Block
RBBB
RAD (LPFB)

38. RBBB
PR(7) – 280 ms
LBBB
PR – (4.5) – 180 ms

39. Axis
NORMAL -30 to 90
Right Axis 90 to 180
Left Axis -30 to -90
Indeterminate -90 to -180

40. • I, II, AvF - +ve QRS – Normal Axis, to confirm
see aVR - -ve QRS

41. • QRS not +ve in any of I, II, aVF
• Look III and aVL
• + QRS aVL - left Axis
• + QRS III - Right Axis

42. QRS not +ve in any of I, II, aVF
Look III and aVL
+ QRS aVL - left Axis
+ QRS III - Right Axis
LEFT AXIS DEVIATION

43. QRS not +ve in any of I, II, aVF
Look III and aVL
+ QRS aVL - left Axis
+ QRS III - Right Axis
RIGHT AXIS DEVIATION

44. QRS + ve aVR
Extreme Axis deviation or Right Superior Axis deviation

45. INDETERMINATE AXIS - overall direction of ventricular
depolarisation cannot be determined from the 6 standard limb leads
Depolarisation mainly moves anterior-posterior (i.e. front-to-back) and there is little overall
movement in the frontal plane that the limb leads record in.
If the axis is indeterminate, all of the limb leads (I, II, III, aVL, aVR, aVF) may look similar, e.g
isoelectric.

47. Wall Artery ECG leads
Anterior wall LAD V2-V4
Inferior wall RCA /LCx II, aVF, III
RCA ST Elevation III > II
LCx ST Elevation II > III
Posterior wall LCx V1-V3 (V7,V8,V9)
Lateral wall LCx V5, V6, I, aVL
Right Ventricle RCA V1

49. Repolarization (ST-T Wave) Abnormalities

51. ST Elevation
• New ST elevation at the J point in two
contiguous leads with the following cut points:
≥ 1mm in all leads (except V2-V3)
• In leads V2-V3 the following cut points apply
≥ 2mm in men
≥ 1.5 mm in women

52. ST Depression and T Wave Changes
• horizontal or downsloping ST depression ≥
0.5mm in two contiguous leads
• T-wave inversion ≥ 1mm in two contiguous
leads with a prominent R wave or R/S ratio >1

57. AWSTEMI (LAD)

58. IWSTEMI-RCA

59. Posterior wall STEMI (LCx)

60. Anterolateral STEMI

61. ST elevation II, III, aVF,
Lead III > II – RCA
Right Side leads – ST elevation

62. ST elevation – I, aVL, II
V4, V5,V6
PR depression - I, aVL, II
V4, V5,V6
ST depression – aVR,
PR elevation - aVR

63. PERICARDITIS

64. • Hyperkalemia (RMP (ex: -70) –depolarised)-
increased K conductance
• Hypokalemia (RMP (ex: -100)–
Hyperpolarised)– decreased K conductance

66. • Increased Permeability of the Sodium
Channels When There Is a Defcit of Calcium
Ions

68. Escape beat /Escape rhythm
• Atrial
Escape
• Junctional
Escape
• Ventricular
• Escape

69. Premature Beats
• Atrial Premature
Beat
• Junctional
Premature Beat
• Ventricular
Premature Beat

70. VENTRICULAR COUPLETS

71. VENTRICULAR TRIPLET

72. VENTRICULAR BIGEMINI

73. VENTRICULAR TRIGEMINI

74. RP Interval

75. Q) Cardiac arrest preceded by central retrosternal chest pain radiating the the left arm.
Succesful CPR, awake and responding.
1) Pacemaker rhythm 2) Anterior STEMI 3) RBBB 4) LBBB

76. Q) Retrosternal chest pain radiating to the neck and left shoulder for 3 hours.
1) Normal ECG 2) Inferior STEMI 3) Posterior STEMI 4) Lateral STEMI

77. Q) Cardiac arrest. Extreme bradycardia at ambulance arrival. Hemodynamically stable.
1) Anterior STEMI 2) RBBB 3) Inferior-posterior-lateral STEMI 4) Accelerated idioventricular rhythm

78. Q ) Intense chest pain, clammy skin.
1) Anterior STEMI 2) Inferoposterior STEMI 3) Left bundle branch block
4) Accelerated idioventricular rhythm

79. Q) Oppressive left lateral chest pain for 5 hours and impression sleeping left arm.
BP 177/95 mmHg. Nitroglycerin spray has some effect on the pain.
1) Left bundle branch block 2) Right bundle branch block 3) Pacemaker rhythm
4) Atrial fibrillation

80. Q ) Young patient with one hour of palpitation, mild chest oppression and discrete
shortness of breath and dizziness. Has had several similar episodes among the last few years.
1) AVNRT 2) AVRT 3) Left main coronary artery occlusion 4) Atrial flutter

81. • DDD Pacemaker rhythm
• Left bundle branch block
Q ) CABG 15 years ago. Transcatheter aortic valve implantation 1 month ago.
Severe chest pain and shortness of breath for one hour, palor and cold sweats.
BP 160/90 mmHg.
1) Anterior STEMI 2) VVI Pacemaker rhythm 3) Atrial fibrillation
4) Left bundle branch block

82. Q ) Patients with diarrhea, who suddenly became dizzy and got shortness of breath.
1) 3rd degree AV block 2) Right bundle branch block 3) Ventricular escape rhythm
4) Pacemaker rhythm

83. 1) Anterior STEMI 2) Accelerated idioventricular rhythm 3) RBBB 4) Nodal rythm

84. 1) LPFB 2) LAFB 3) Bifasicular block 4) LBBB

85. Patient of COPD with worsening breathlessness
1) AVNRT 2) AVRT 3) PACs 4) PVCs

86. Ashman phenomenon
Refractory period of Right bundle is greater than left bundle
Long Cycles – long RP-next Premature atrial complex conducts through AV node
But finds Right bundle refractory – RBBB pattern following long RR interval

87. 1) LAFB 2) LPFB 3) Bifasicular block 4) LBBB

88. S1Q3T3

89. Wellens syndrome – T inversion V2, V3,V4