This document contains an ECG report that summarizes various cardiac conditions including: 1) Ischemic heart diseases such as ST elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI). 2) Tachyarrhythmias such as sinus tachycardia, supraventricular tachycardia, atrial fibrillation, and atrial flutter. 3) Bradyarrhythmias including junctional escape rhythm and sinus arrest. 4) Ventricular hypertrophy of the left and right ventricles. 5) Bundle branch blocks including left and right bundle branch blocks. 6) Premature complexes including premature atrial, junctional, and

1. ECG CAS ES
EMAD WORLD
1

2. 1. Ischemic Heart Diseases
A/ STEMI
Acute inferior infarction
• Sinus rhythm
• Normal axis
• Small Q waves in leads II–III, VF
• Raised ST segments in leads II–III, VF
• Depressed ST segments in leads I, VL, V2–V3
• Inverted T waves in leads I, VL, V3
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3. Anterior infarction
• Sinus rhythm
• Normal axis
• Raised ST segments in leads V2–
V5
3

4. B/ NSTEMI
Anterior non-ST segment elevation
acute
coronary syndrome (NSTEMI)
• Sinus rhythm
• Left axis deviation
• Normal QRS complexes
• Inverted T waves in all
chest leads
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5. 2. Tachyarrythmia
A, Narrow complex QRS
B. Broad complex QRS
A/ sinus tachycardia
Sinus tachycardia
• Normal P–QRS–T waves
• R–R interval 500 ms
• Heart rate 120 bpm
5

6. B/ PSVT
Supraventricular
tachycardia
• Narrow complex tachycardia
• No P waves visible
• Some ST segment depression,
suggesting ischaemia
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7. C/ Atrial fibrillation
Atrial fibrillation
• Irregular narrow complex
tachycardia, 150 bpm
• During long R–R intervals, irregular
baseline can be
seen
• Suggestion of flutter waves in lead
V1
7

8. D/ Atrial flutter
Atrial flutter with 2:1 block
• Regular narrow complex tachycardia
• ‘Sawtooth’ of atrial flutter most easily
seen in lead II
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9. 3. Bradyarrythmias
A/ Junctional Escape Rhythm
Rate 40-60/bpm
P wave
Inverted in leads that are normally upright; this happens when
the atrial depolarization wave moves towards a negative . P
waves may occur before, during or after the QRS, depending
on where the pacemaker is located in the AV junction.
QRS Normal
Conduction P-R interval < .12 seconds if present.
Rhythm Irregular as a result of the escape beats. 9

10. B/ Sinus Arrest
• Sinus rhythm
•After three beats, there is a ‘sinus pause’
with no P wave
• Sinus rhythm is then restored, but the
cycle has been
Sinus Arrest
10

11. C/ Heart blocks
First degree heart block
• the PR interval is prolonged – to .32 seconds.
• The ECG also shows ST segment depression in
I,aVL and V5 and V6.
• There is T wave flattening or inversion in these
leads in addition.
• There is no evidence from the presence of Q
waves or loss of R wave of previous myocardial
infarction.
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12. Second degree block (2:1)
• Sinus rhythm
• Second degree block, 2 :1 type
• Ventricular rate 33 bpm
• Long PR interval in the conducted beats (not
characteristic of second degree block)
•Normal QRS complexes and T waves
12

13. Complete heart block
• Sinus rate 70 bpm
• Regular ventricular rate, 40 bpm
• No relationship between P waves
and QRS complexes
• Wide QRS complexes
• Right bundle branch block pattern
13

14. 4. Ventricular hypertrophy
A/ Left Ventricular Hypertrophy
Left ventricular
hypertrophy
• Sinus rhythm
• Bifid P waves suggest left atrial
hypertrophy (best seen in
leads V4–V5)
• Normal axis
• Tall R waves and deep S waves
• T waves inverted in leads I, VL,
V5–V6
14

15. B/ Right Ventricular Hypertrophy
Right ventricular
hypertrophy
• Sinus rhythm
• Right axis deviation
• Dominant R waves in lead V1
• Inverted T waves in leads V1–V4
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16. 5. Bundle branch blocks
A Left Bundle Branch Block
Left bundle branch block
• Sinus rhythm
• Normal axis
• Wide QRS complexes with
LBBB pattern
• Inverted T waves in leads I,
VL, V5–V6
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17. Right bundle branch block and
anterior infarction
• Sinus rhythm
• Normal axis
• RBBB pattern
• Raised ST segments in leads V2–V5
B/ Right bundle branch block
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18. 6. Premature Complexes
A/ Premature Atrial complex
• The irregular shape of the P' wave.
• irregular duration of the PP
interval
• extended duration of the P'R
interval to greater than 0.12
seconds.
Premature Atrial complex
18

19. Premature ventricular
complexes
• are recognized as single or paired
unifocal beats, with no preceding
P wav.
• a wide QRS complex of increased
amplitude characteristically
lasting greater than 0.14 seconds.
• Although no P waves precede the
wide QRS complex
C/ premature ventricular complex
19

20. • P wave is either: Absent, Abnormal with PR
< 120ms, OR Retrograde, which may be
inverted in inferior leads
B/ Premature junctional complex
Premature junctional complex
20