Stepwise interpretation - ECG #3
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A 68-year-old man presented to the emergency department after an accidental fall. An ECG was performed which showed sinus rhythm at a rate of 100 bpm with frequent premature ventricular complexes. The PR interval and QRS complexes were normal, indicating no signs of conduction abnormalities. There was also no evidence of chamber enlargement, myocardial infarction, or ischemia. The final diagnosis was sinus rhythm with frequent premature ventricular complexes, but an otherwise normal ECG.
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Stepwise interpretation of ECG - #3 ID659
A 68-year-old man presented to the emergency department after an accidental fall. An ECG was performed which showed sinus rhythm at a rate of 100 bpm with frequent premature ventricular complexes. The PR interval, QRS axis, and QRS duration were normal with no signs of chamber enlargement, conduction blocks, ventricular hypertrophy, or myocardial infarction. The final diagnosis was sinus rhythm with frequent premature ventricular complexes, with an otherwise normal ECG.
Shadechapter11.ppt [read only]
This document defines and describes various types of ventricular dysrhythmias. It notes that ventricular dysrhythmias occur when the atria, AV junction, or both cannot initiate an electrical impulse or there is enhanced excitability of the ventricular myocardium. Key features include wide, bizarre QRS complexes with T waves in the opposite direction of R waves and no P waves. Specific dysrhythmias covered include premature ventricular contractions, ventricular escape rhythms, ventricular tachycardia, ventricular fibrillation, asystole, idioventricular rhythm, and pulseless electrical activity. Characteristics and identifying features of each dysrhythmia are provided.
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The third step of analyzing an ECG is examining the P waves. P waves can look different if they originate from outside the sinoatrial node or if there is damage to the atria. P' waves from other sites like the atrioventricular junction will have a different morphology. Rapid atrial rates may cause flutter waves or fibrillatory waves instead of P waves. More P waves than QRS complexes indicates block above the ventricles.
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This document discusses different types of atrioventricular (AV) heart blocks. It defines heart blocks as delays or interruptions in conduction between the atria and ventricles. It then proceeds to describe the characteristics of 1st-degree AV block, 2nd-degree AV block types I and II, and 3rd-degree AV block. Specifically, it notes that 2nd-degree type I block shows a regularly irregular rhythm with a progressively lengthening PR interval, while 2nd-degree type II block maintains a constant PR interval with more P waves than QRS complexes. 3rd-degree block results in independent atrial and ventricular rhythms that can decrease cardiac output if the ventricular rate is too slow.
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This document discusses different types of junctional dysrhythmias:
- Junctional rhythms originate in the atrioventricular (AV) junction and can cause inverted or absent P waves.
- A premature junctional complex is a single early impulse from the AV junction.
- A junctional escape rhythm arises from the AV junction at a rate of 40-60 beats per minute.
- An accelerated junctional rhythm has a rate of 60-100 beats per minute from the AV junction.
- Junctional tachycardia is a fast rhythm of 100-180 beats per minute from the bundle of His.
Shadechapter09.ppt [read only]
Atrial dysrhythmias originate outside the SA node and are caused by three mechanisms: increased automaticity, triggered activity, and reentry. Key characteristics include abnormal P waves and P-R intervals with normal QRS complexes. Wandering atrial pacemaker produces changing P waves as the pacemaker site shifts. Premature atrial complexes originate outside the SA node and cause rhythm irregularity with different P wave morphologies. Atrial tachycardia and multifocal atrial tachycardia involve rapid atrial rates while supraventricular tachycardia cannot identify a specific origin. Atrial flutter shows sawtooth waves at 250-350 bpm and atrial fibrillation is chaotic firing with no P waves
ECG: Toxin induced First degree Heart Block
A 17-year-old female presented with retrosternal and epigastric burning after consuming 50ml of bleach containing sodium hypochlorite. Her initial ECG showed first-degree AV block with a prolonged PR interval of 320ms that normalized to 140ms on a follow up ECG 3 days later, likely after elimination of the toxin. First-degree AV block is defined as a PR interval over 200ms and can be caused by various conditions. It typically has no symptoms but may reduce exercise tolerance and cause syncope in rare cases of infranodal block or left ventricular dysfunction. Treatment involves discontinuing any medications that may cause AV block and permanent pacing may be indicated in severe cases.
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- Hypertrophy is a thickening of the ventricular wall, while dilation is an enlargement of a chamber to accommodate increased blood volume. Enlargement affects the atria, while hypertrophy affects the ventricles.
- The P wave is used to identify atrial enlargement, while changes in the QRS complex indicate ventricular hypertrophy. Increased duration, amplitude or axis deviation serve as indicators.
- Right atrial enlargement increases the first part of the P wave amplitude. Left atrial enlargement increases the terminal P wave amplitude in V1 and the P wave duration.
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Stepwise interpretation of ECG - #3 ID659
A 68-year-old man presented to the emergency department after an accidental fall. An ECG was performed which showed sinus rhythm at a rate of 100 bpm with frequent premature ventricular complexes. The PR interval, QRS axis, and QRS duration were normal with no signs of chamber enlargement, conduction blocks, ventricular hypertrophy, or myocardial infarction. The final diagnosis was sinus rhythm with frequent premature ventricular complexes, with an otherwise normal ECG.
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This document defines and describes various types of ventricular dysrhythmias. It notes that ventricular dysrhythmias occur when the atria, AV junction, or both cannot initiate an electrical impulse or there is enhanced excitability of the ventricular myocardium. Key features include wide, bizarre QRS complexes with T waves in the opposite direction of R waves and no P waves. Specific dysrhythmias covered include premature ventricular contractions, ventricular escape rhythms, ventricular tachycardia, ventricular fibrillation, asystole, idioventricular rhythm, and pulseless electrical activity. Characteristics and identifying features of each dysrhythmia are provided.
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Shadechapter12.ppt [read only]
This document discusses different types of atrioventricular (AV) heart blocks. It defines heart blocks as delays or interruptions in conduction between the atria and ventricles. It then proceeds to describe the characteristics of 1st-degree AV block, 2nd-degree AV block types I and II, and 3rd-degree AV block. Specifically, it notes that 2nd-degree type I block shows a regularly irregular rhythm with a progressively lengthening PR interval, while 2nd-degree type II block maintains a constant PR interval with more P waves than QRS complexes. 3rd-degree block results in independent atrial and ventricular rhythms that can decrease cardiac output if the ventricular rate is too slow.
Shadechapter10.ppt [read only]
This document discusses different types of junctional dysrhythmias:
- Junctional rhythms originate in the atrioventricular (AV) junction and can cause inverted or absent P waves.
- A premature junctional complex is a single early impulse from the AV junction.
- A junctional escape rhythm arises from the AV junction at a rate of 40-60 beats per minute.
- An accelerated junctional rhythm has a rate of 60-100 beats per minute from the AV junction.
- Junctional tachycardia is a fast rhythm of 100-180 beats per minute from the bundle of His.
Shadechapter09.ppt [read only]
Atrial dysrhythmias originate outside the SA node and are caused by three mechanisms: increased automaticity, triggered activity, and reentry. Key characteristics include abnormal P waves and P-R intervals with normal QRS complexes. Wandering atrial pacemaker produces changing P waves as the pacemaker site shifts. Premature atrial complexes originate outside the SA node and cause rhythm irregularity with different P wave morphologies. Atrial tachycardia and multifocal atrial tachycardia involve rapid atrial rates while supraventricular tachycardia cannot identify a specific origin. Atrial flutter shows sawtooth waves at 250-350 bpm and atrial fibrillation is chaotic firing with no P waves
ECG: Toxin induced First degree Heart Block
A 17-year-old female presented with retrosternal and epigastric burning after consuming 50ml of bleach containing sodium hypochlorite. Her initial ECG showed first-degree AV block with a prolonged PR interval of 320ms that normalized to 140ms on a follow up ECG 3 days later, likely after elimination of the toxin. First-degree AV block is defined as a PR interval over 200ms and can be caused by various conditions. It typically has no symptoms but may reduce exercise tolerance and cause syncope in rare cases of infranodal block or left ventricular dysfunction. Treatment involves discontinuing any medications that may cause AV block and permanent pacing may be indicated in severe cases.
Shadechapter14.ppt [read only]
- Hypertrophy is a thickening of the ventricular wall, while dilation is an enlargement of a chamber to accommodate increased blood volume. Enlargement affects the atria, while hypertrophy affects the ventricles.
- The P wave is used to identify atrial enlargement, while changes in the QRS complex indicate ventricular hypertrophy. Increased duration, amplitude or axis deviation serve as indicators.
- Right atrial enlargement increases the first part of the P wave amplitude. Left atrial enlargement increases the terminal P wave amplitude in V1 and the P wave duration.
Premature Atrial complexes
The document discusses three types of atrial premature complexes:
1. Normally conducted complexes which have an early P wave that conducts normally with a PR interval that may be normal, increased, or decreased and a QRS similar to sinus rhythm.
2. Non-conducted complexes where an early P wave is not followed by a QRS and the P wave is often hidden in the T wave.
3. Complexes with aberrant conduction where the early P wave is followed by a QRS with an abnormal conduction pattern most commonly right bundle branch block but sometimes left bundle branch block.
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The document provides guidance on interpreting 12-lead electrocardiograms (ECGs). It discusses evaluating the rate, rhythm, axis, signs of hypertrophy, and evidence of infarction on ECGs. Key steps include determining the heart rate using a "300, 150, 100" counting method and identifying abnormalities in rate, rhythm, conduction, hypertrophy, or signs of injury or necrosis. Interpreting ECGs involves analyzing the P wave, QRS complex, T wave, and ST segment to evaluate for conditions like myocardial infarction, bundle branch blocks, ventricular hypertrophy, and more.
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- Sinus dysrhythmias are ECG rhythms that differ from normal sinus rhythm (NSR), which has a rate of 60-100 BPM.
- Sinus bradycardia and sinus tachycardia have the characteristics of NSR but with heart rates slower than 60 BPM or faster than 100 BPM respectively.
- Sinus dysrhythmia has the same characteristics as NSR but with a patterned irregularity of slowing and speeding up corresponding to respiration. Sinus arrest causes pauses in the ECG rhythm until another pacemaker site resumes the rhythm.
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- The ST segment and T wave can change with myocardial ischemia, injury, or infarction as seen on an electrocardiogram (ECG). ST segment elevation is an early sign of acute myocardial infarction.
- Pathologic Q waves indicate irreversible heart muscle damage from myocardial infarction and help locate the affected area.
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- The ECG detects the mean vector, which is the average of all instantaneous vectors representing the direction of electrical flow in the heart. This mean vector direction is called the mean electrical axis.
- The QRS axis represents the average of all vectors during ventricular depolarization. It normally points downward and leftward but can deviate right or left.
- The limb leads are used to determine if the QRS axis is normal or deviated by examining the orientations of the QRS complex in leads I and aVF.
Heart block
This document provides information about heart block, including its definition, types, causes, characteristics, and significance. It begins with an introduction to heart block and the electrical conduction system of the heart. It then defines and describes the three types of heart block - first, second, and third degree heart block - and provides details about their characteristics, causes, and clinical significance. Mobitz types I and II are discussed as subtypes of second degree heart block. The document aims to explain heart block and its different classifications to nursing students.
Atrial arrhythmia
This document summarizes various types of atrial arrhythmias:
- Wandering pacemaker involves the pacemaker site transferring between the SA node and other areas of the atria.
- Premature atrial contractions (PACs) are early atrial impulses followed by normal sinus rhythm.
- Atrial tachycardia overrides the SA node impulse with a rapid atrial rate over 150 bpm.
- Atrial flutter involves the AV node conducting impulses to the ventricles at a ratio, with the ventricular rate either controlled or uncontrolled.
- Atrial fibrillation involves rapid discharges from multiple foci in the atria, so no organized depolarization is detectable
ECG: Type II Second degree SA Block
This ECG shows a 58-year-old female patient who presented with chest pain. The ECG reveals sinus rhythm with 5:4 second-degree sinoatrial exit block, where every fifth impulse is blocked at the SA junction. This type of SA block is characterized by no change in P-R interval before the pause and a pause interval that equals approximately two to four times the normal P-P cycle length. SA node dysfunction can be intrinsic, due to degenerative causes like fibrosis, or extrinsic, due to autonomic influences or drugs that suppress the SA node. Diagnosis is usually clinical or via ECG and pacemaker implantation may be indicated for symptomatic patients.
Cardiovascular system
The document discusses several topics related to cardiac physiology including:
1. The cardiac action potential and ion channel movements that underlie it.
2. Regulation of heart rate by the sympathetic and parasympathetic nervous systems. The sympathetic system increases heart rate while the parasympathetic system decreases it.
3. Factors that influence cardiac contractility including sympathetic stimulation, calcium levels, digitalis, and hypoxia. Contractility can be increased or decreased by various factors.
ECG - Junctional Arrhythmia & Ventricular Arrhythmia
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AV block ecg analysis
The document discusses atrio-ventricular (AV) block, which refers to delays or interruptions in the conduction pathway between the atria and ventricles of the heart. There are several types of AV block defined by the degree of conduction block, including first-degree, second-degree Mobitz types I and II, and third-degree AV block. The causes, ECG characteristics, and descriptions of each type of AV block are provided. The document emphasizes practicing ECG interpretation to determine the type of cardiac dysrhythmia.
Arrhythmias
Arrhythmias are abnormal heart rhythms that can be caused by issues with the heart's electrical conduction system or structural problems with heart muscles or valves. Common causes include ischemia, electrolyte imbalances, cardiomyopathy, and genetic conditions. Arrhythmias are classified based on heart rate, regularity, site of origin in the heart, and ECG characteristics. They are often due to reentry circuits, abnormal automaticity, or heart block. Treatment involves medications to suppress arrhythmias or restore normal rhythm, ablation procedures, or pacemakers.
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ID 352 –Sinus rhythm With premature atrial complex
A 62-year-old man presented with palpitations. An analysis of his ECG found sinus rhythm at 83 bpm with premature atrial complexes, where every third P wave was premature in a pattern of trigeminy. The ECG further showed normal P waves, QRS axis, duration and complexes, as well as normal ST segments and T waves. The final diagnosis was sinus rhythm with atrial premature complexes in a pattern of trigeminy, but an otherwise normal ECG.
Stepwise interpretation of ECG - #14 no Dx ID123
A 67-year-old woman presented with palpitations. Her ECG showed a narrow-QRS tachycardia of 160 beats per minute. P waves were visible and preceded the QRS complexes, with a PR interval of 140 msec. The arrhythmia was diagnosed as atrial tachycardia based on the P wave morphology and timing.
#01 ID380 - NML
This document summarizes the stepwise interpretation of a 53-year-old man's ECG in the pre-anesthesia clinic. The interpreter found the man to have a normal sinus rhythm of 60 beats per minute, with normal P waves, PR interval, QRS axis and duration, and no signs of atrial or ventricular enlargement, bundle branch blocks, or evidence of myocardial infarction. The final diagnosis was a completely normal ECG and normal sinus rhythm.
Stepwise interpretation ECG #5
A 58-year-old man with a history of coronary artery disease presented with normal sinus rhythm of 88 beats per minute and left bundle branch block. Left bundle branch block was diagnosed due to the prolonged QRS duration of 145 milliseconds with characteristic morphology. The presence of left bundle branch block can mask signs of left ventricular hypertrophy and prior myocardial infarction on electrocardiogram. Abnormal repolarization is also commonly seen in the form of ST depression and negative T waves in leads with broad R waves in left bundle branch block.
stepwise interpretation ECG #6
This document summarizes the stepwise interpretation of an ECG for a 78 year old woman with a heart murmur. It was found that she had sinus rhythm at 77 beats per minute with sinus arrhythmia. She also had first degree AV block seen by a prolonged PR interval of 230 ms. Examination of the QRS complexes and axes found normal duration and no signs of bundle branch blocks. There were findings of left ventricular hypertrophy seen with ST-T abnormalities indicating strain pattern. No signs of myocardial infarction were seen.
Disabled lead cables
Disconnected or malfunctioning limb cables can lead to errors in ECG lead readings. If the left-leg cable is disconnected, Lead II will be flat. If the left-arm cable is disconnected, Lead I will be flat. If the right arm cable is disconnected, all limb leads will be flat. The computer uses the abnormal lead readings to calculate the augmented leads, which will be incorrect if a cable is malfunctioning. This can lead to significant diagnostic errors if not properly recognized.
Stepwise interpretation of ECG - #03 no Dx ID659
A 68-year-old man presented to the emergency department after an accidental fall. An ECG was performed which showed sinus rhythm at a rate of 100 bpm with frequent premature ventricular complexes. The PR interval and QRS complexes were normal, indicating no signs of conduction abnormalities. There was also no evidence of chamber enlargement, myocardial infarction, or ischemia. The final diagnosis was sinus rhythm with frequent premature ventricular complexes, but an otherwise normal ECG.
Stepwise interpretation of ECG ID123
A 67-year old woman presented with palpitations. Her ECG showed a narrow-QRS tachycardia at a rate of 160 beats per minute. P waves were visible preceding the QRS complexes and were negative in leads II, III, aVF and V3-V6, with a PR interval of 140 msec. The diagnosis was determined to be atrial tachycardia based on the ECG findings.
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Premature Atrial complexes
The document discusses three types of atrial premature complexes:
1. Normally conducted complexes which have an early P wave that conducts normally with a PR interval that may be normal, increased, or decreased and a QRS similar to sinus rhythm.
2. Non-conducted complexes where an early P wave is not followed by a QRS and the P wave is often hidden in the T wave.
3. Complexes with aberrant conduction where the early P wave is followed by a QRS with an abnormal conduction pattern most commonly right bundle branch block but sometimes left bundle branch block.
1382531 634694433533008750
The document provides guidance on interpreting 12-lead electrocardiograms (ECGs). It discusses evaluating the rate, rhythm, axis, signs of hypertrophy, and evidence of infarction on ECGs. Key steps include determining the heart rate using a "300, 150, 100" counting method and identifying abnormalities in rate, rhythm, conduction, hypertrophy, or signs of injury or necrosis. Interpreting ECGs involves analyzing the P wave, QRS complex, T wave, and ST segment to evaluate for conditions like myocardial infarction, bundle branch blocks, ventricular hypertrophy, and more.
Shadechapter08.ppt [read only]
This document provides information on different types of sinus dysrhythmias:
- Sinus dysrhythmias are ECG rhythms that differ from normal sinus rhythm (NSR), which has a rate of 60-100 BPM.
- Sinus bradycardia and sinus tachycardia have the characteristics of NSR but with heart rates slower than 60 BPM or faster than 100 BPM respectively.
- Sinus dysrhythmia has the same characteristics as NSR but with a patterned irregularity of slowing and speeding up corresponding to respiration. Sinus arrest causes pauses in the ECG rhythm until another pacemaker site resumes the rhythm.
Shadechapter15.ppt [read only]
- The coronary arteries deliver oxygenated blood to the heart while coronary veins return deoxygenated blood to the right atrium. Increased coronary blood flow through vasodilation meets higher oxygen demands.
- The ST segment and T wave can change with myocardial ischemia, injury, or infarction as seen on an electrocardiogram (ECG). ST segment elevation is an early sign of acute myocardial infarction.
- Pathologic Q waves indicate irreversible heart muscle damage from myocardial infarction and help locate the affected area.
Shadechapter13.ppt [read only]
- The ECG detects the mean vector, which is the average of all instantaneous vectors representing the direction of electrical flow in the heart. This mean vector direction is called the mean electrical axis.
- The QRS axis represents the average of all vectors during ventricular depolarization. It normally points downward and leftward but can deviate right or left.
- The limb leads are used to determine if the QRS axis is normal or deviated by examining the orientations of the QRS complex in leads I and aVF.
Heart block
This document provides information about heart block, including its definition, types, causes, characteristics, and significance. It begins with an introduction to heart block and the electrical conduction system of the heart. It then defines and describes the three types of heart block - first, second, and third degree heart block - and provides details about their characteristics, causes, and clinical significance. Mobitz types I and II are discussed as subtypes of second degree heart block. The document aims to explain heart block and its different classifications to nursing students.
Atrial arrhythmia
This document summarizes various types of atrial arrhythmias:
- Wandering pacemaker involves the pacemaker site transferring between the SA node and other areas of the atria.
- Premature atrial contractions (PACs) are early atrial impulses followed by normal sinus rhythm.
- Atrial tachycardia overrides the SA node impulse with a rapid atrial rate over 150 bpm.
- Atrial flutter involves the AV node conducting impulses to the ventricles at a ratio, with the ventricular rate either controlled or uncontrolled.
- Atrial fibrillation involves rapid discharges from multiple foci in the atria, so no organized depolarization is detectable
ECG: Type II Second degree SA Block
This ECG shows a 58-year-old female patient who presented with chest pain. The ECG reveals sinus rhythm with 5:4 second-degree sinoatrial exit block, where every fifth impulse is blocked at the SA junction. This type of SA block is characterized by no change in P-R interval before the pause and a pause interval that equals approximately two to four times the normal P-P cycle length. SA node dysfunction can be intrinsic, due to degenerative causes like fibrosis, or extrinsic, due to autonomic influences or drugs that suppress the SA node. Diagnosis is usually clinical or via ECG and pacemaker implantation may be indicated for symptomatic patients.
Cardiovascular system
The document discusses several topics related to cardiac physiology including:
1. The cardiac action potential and ion channel movements that underlie it.
2. Regulation of heart rate by the sympathetic and parasympathetic nervous systems. The sympathetic system increases heart rate while the parasympathetic system decreases it.
3. Factors that influence cardiac contractility including sympathetic stimulation, calcium levels, digitalis, and hypoxia. Contractility can be increased or decreased by various factors.
ECG - Junctional Arrhythmia & Ventricular Arrhythmia
Brief explanation of Junctional arrhythmia and Ventricular Arrhythmia. Slide 15, 16 and 18 are animations but cannot be viewed through the slide. Mail me if you need the animation or visit the website on the reference (number 7) and choose the animation according to your preference.
AV block ecg analysis
The document discusses atrio-ventricular (AV) block, which refers to delays or interruptions in the conduction pathway between the atria and ventricles of the heart. There are several types of AV block defined by the degree of conduction block, including first-degree, second-degree Mobitz types I and II, and third-degree AV block. The causes, ECG characteristics, and descriptions of each type of AV block are provided. The document emphasizes practicing ECG interpretation to determine the type of cardiac dysrhythmia.
Arrhythmias
Arrhythmias are abnormal heart rhythms that can be caused by issues with the heart's electrical conduction system or structural problems with heart muscles or valves. Common causes include ischemia, electrolyte imbalances, cardiomyopathy, and genetic conditions. Arrhythmias are classified based on heart rate, regularity, site of origin in the heart, and ECG characteristics. They are often due to reentry circuits, abnormal automaticity, or heart block. Treatment involves medications to suppress arrhythmias or restore normal rhythm, ablation procedures, or pacemakers.
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A 62-year-old man presented with palpitations. An analysis of his ECG found sinus rhythm at 83 bpm with premature atrial complexes, where every third P wave was premature in a pattern of trigeminy. The ECG further showed normal P waves, QRS axis, duration and complexes, as well as normal ST segments and T waves. The final diagnosis was sinus rhythm with atrial premature complexes in a pattern of trigeminy, but an otherwise normal ECG.
Stepwise interpretation of ECG - #14 no Dx ID123
A 67-year-old woman presented with palpitations. Her ECG showed a narrow-QRS tachycardia of 160 beats per minute. P waves were visible and preceded the QRS complexes, with a PR interval of 140 msec. The arrhythmia was diagnosed as atrial tachycardia based on the P wave morphology and timing.
#01 ID380 - NML
This document summarizes the stepwise interpretation of a 53-year-old man's ECG in the pre-anesthesia clinic. The interpreter found the man to have a normal sinus rhythm of 60 beats per minute, with normal P waves, PR interval, QRS axis and duration, and no signs of atrial or ventricular enlargement, bundle branch blocks, or evidence of myocardial infarction. The final diagnosis was a completely normal ECG and normal sinus rhythm.
Stepwise interpretation ECG #5
A 58-year-old man with a history of coronary artery disease presented with normal sinus rhythm of 88 beats per minute and left bundle branch block. Left bundle branch block was diagnosed due to the prolonged QRS duration of 145 milliseconds with characteristic morphology. The presence of left bundle branch block can mask signs of left ventricular hypertrophy and prior myocardial infarction on electrocardiogram. Abnormal repolarization is also commonly seen in the form of ST depression and negative T waves in leads with broad R waves in left bundle branch block.
stepwise interpretation ECG #6
This document summarizes the stepwise interpretation of an ECG for a 78 year old woman with a heart murmur. It was found that she had sinus rhythm at 77 beats per minute with sinus arrhythmia. She also had first degree AV block seen by a prolonged PR interval of 230 ms. Examination of the QRS complexes and axes found normal duration and no signs of bundle branch blocks. There were findings of left ventricular hypertrophy seen with ST-T abnormalities indicating strain pattern. No signs of myocardial infarction were seen.
Disabled lead cables
Disconnected or malfunctioning limb cables can lead to errors in ECG lead readings. If the left-leg cable is disconnected, Lead II will be flat. If the left-arm cable is disconnected, Lead I will be flat. If the right arm cable is disconnected, all limb leads will be flat. The computer uses the abnormal lead readings to calculate the augmented leads, which will be incorrect if a cable is malfunctioning. This can lead to significant diagnostic errors if not properly recognized.
Stepwise interpretation of ECG - #03 no Dx ID659
A 68-year-old man presented to the emergency department after an accidental fall. An ECG was performed which showed sinus rhythm at a rate of 100 bpm with frequent premature ventricular complexes. The PR interval and QRS complexes were normal, indicating no signs of conduction abnormalities. There was also no evidence of chamber enlargement, myocardial infarction, or ischemia. The final diagnosis was sinus rhythm with frequent premature ventricular complexes, but an otherwise normal ECG.
Stepwise interpretation of ECG ID123
A 67-year old woman presented with palpitations. Her ECG showed a narrow-QRS tachycardia at a rate of 160 beats per minute. P waves were visible preceding the QRS complexes and were negative in leads II, III, aVF and V3-V6, with a PR interval of 140 msec. The diagnosis was determined to be atrial tachycardia based on the ECG findings.
ECG #6 - ID 168 LVH
The document summarizes the stepwise interpretation of an ECG for a 78-year-old woman with a heart murmur. It finds sinus rhythm at 77 beats per minute with sinus arrhythmia and first-degree AV block. There is also evidence of left ventricular hypertrophy with ST-T abnormalities and no signs of myocardial infarction.
Stepwise interpretation ECG #12
A 56-year-old man presented with an episode of syncope. An ECG showed sinus rhythm with complete heart block, where the atrial rate was 80/min and ventricular rate was 43/min. The dissociation between the P waves and QRS complexes indicated complete heart block. The narrow QRS complexes and normal axis suggested the escape pacemaker was in the AV junction, resulting in an escape junctional rhythm driving the ventricles. The ECG was otherwise normal.
Stepwise interpretation of ECG ID419
Ectopic atrial rhythm at a rate of 70 beats per minute. P waves are clearly seen and negative in several leads, indicating they do not originate from the sinus node but rather a low atrial region, consistent with an ectopic atrial rhythm. There is also an incomplete right bundle branch block present as shown by a prolonged QRS duration with an rSR' pattern. The final diagnosis is an ectopic atrial rhythm at 70 beats per minute with an incomplete right bundle branch block.
Stepwise interpretation of ECG ID123
A 67-year-old woman presented with palpitations. An ECG showed a narrow-QRS tachycardia at a rate of 160 beats per minute, with visible P waves preceding each QRS complex. The P waves were negative in leads II, III, aVF and V3-V6, with a PR interval of 140 msec. The diagnosis was determined to be atrial tachycardia based on the ECG findings.
Atrio-ventricular dissociation
Atrio-ventricular dissociation occurs when the atrial and ventricular rhythms are independent of each other. It can happen when the atrial rate slows below the intrinsic ventricular rate, or due to inappropriate acceleration of the ventricular rate. Typically in AV dissociation the distal pacemaker, such as the ventricles, beats faster than the proximal pacemaker like the atria. In complete heart block the proximal pacemaker usually beats faster than the distal one. However, there are exceptions to using pacemaker rates to distinguish the two.
ECG #1 - ID 380 – Normal ECG
The ECG is for a 53-year-old man undergoing pre-anesthesia evaluation. The interpreter found normal sinus rhythm at a rate of 60 bpm, normal P waves and PR interval, normal QRS axis and duration with no evidence of conduction blocks, no signs of chamber enlargement or hypertrophy, and normal ST segments and T waves. The final diagnosis was a normal ECG.
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ID 352 –Sinus rhythm With premature atrial complex
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Stepwise interpretation of ECG - #1 ID 380
This document summarizes the interpretation of an electrocardiogram (ECG) for a 53-year-old man. The ECG shows normal sinus rhythm at a rate of 60 beats per minute, with normal P waves, PR interval, QRS duration and axis, and no signs of atrial or ventricular enlargement, bundle branch blocks, or myocardial infarction. The overall interpretation is that the ECG is normal.
Stepwise interpretation of ECG - #1 ID 380
A 53-year-old man received an ECG in the pre-anesthesia clinic. The ECG interpreter found normal sinus rhythm at a rate of 60 beats per minute, with normal P waves, PR interval, QRS axis and duration, and no signs of chamber enlargement, bundle branch blocks, ventricular hypertrophy, or myocardial infarction. The final diagnosis was a completely normal ECG.
Stepwise interpretation of ECG - #01 ID 380
A 53-year-old man received an ECG in the pre-anesthesia clinic. The ECG interpreter found normal sinus rhythm at a rate of 60 beats per minute, with normal P waves, PR interval, QRS axis and duration, and no signs of chamber enlargement, bundle branch blocks, ventricular hypertrophy, or myocardial infarction. The final diagnosis was a completely normal ECG.
Stepwise interpretation of ECG - #1 ID 380
A 53-year-old man received an ECG in the pre-anesthesia clinic. The ECG interpreter found normal sinus rhythm at a rate of 60 beats per minute, with normal P waves, PR interval, QRS axis and duration, and no signs of chamber enlargement, bundle branch blocks, ventricular hypertrophy, or myocardial infarction. The final diagnosis was a completely normal ECG.
stepwise interpretation ECG #1
A 53-year-old man received an ECG in the pre-anesthesia clinic. The ECG interpreter found normal sinus rhythm at a rate of 60 beats per minute, with normal P waves, PR interval, QRS axis and duration, and no signs of chamber enlargement, bundle branch blocks, ventricular hypertrophy, or myocardial infarction. The final diagnosis was a completely normal ECG.
Stepwise interpretation - ECG #1
A 53-year-old man received an ECG in the pre-anesthesia clinic. The ECG interpreter found normal sinus rhythm at a rate of 60 beats per minute, with normal P waves, PR interval, QRS axis and duration, and no signs of chamber enlargement, bundle branch blocks, ventricular hypertrophy, or myocardial infarction. The final diagnosis was a completely normal ECG.
Stepwise interpretation of ECG - #1 ID 380
A 53-year-old man received an ECG in the pre-anesthesia clinic. The ECG interpreter found normal sinus rhythm at a rate of 60 beats per minute, with normal P waves, PR interval, QRS axis and duration, and no signs of chamber enlargement, bundle branch blocks, ventricular hypertrophy, or myocardial infarction. The final diagnosis was a completely normal ECG.
Stepwise interpretation of ECG - #06 no Dx ID168
This document summarizes the stepwise interpretation of an ECG for a 78 year old woman with a heart murmur. It was found that she had sinus rhythm at 77 beats per minute with sinus arrhythmia and first degree AV block. The QRS duration was normal with no signs of bundle branch blocks. There were findings of left ventricular hypertrophy with ST-T abnormalities indicating a strain pattern. The final diagnosis was sinus rhythm with sinus arrhythmia, first degree AV block, and left ventricular hypertrophy with repolarization abnormality.
Stepwise interpretation of ECG - #6 no Dx ID168
This document summarizes the stepwise interpretation of an ECG for a 78 year old woman with a heart murmur. It finds sinus rhythm at 77 beats per minute with sinus arrhythmia and first degree AV block. The QRS axis and duration are normal with no signs of bundle branch blocks. There are findings of left ventricular hypertrophy with ST-T abnormalities indicating strain pattern. No signs of myocardial infarction are seen.
Stepwise interpretation of ECG - #06 no Dx ID168
This document summarizes the stepwise interpretation of an ECG for a 78 year old woman with a heart murmur. It finds sinus rhythm at 77 beats per minute with sinus arrhythmia and first degree AV block. The QRS axis and duration are normal with no signs of bundle branch blocks. There are findings of left ventricular hypertrophy with ST-T abnormalities indicating strain pattern. No signs of myocardial infarction are seen.
Stepwise interpretation of ECG - #06 no Dx ID168
A 78-year-old woman presented with a heart murmur. The ECG showed sinus rhythm at 77 beats per minute with sinus arrhythmia. There was first-degree AV block seen by a prolonged PR interval of 230 ms. Findings also included left ventricular hypertrophy with ST-T abnormalities consistent with left ventricular strain.
Ecg case
This document contains 6 ECG readings from patients presenting with various chest complaints. For each reading, it provides the clinical interpretation of the ECG findings and recommends next steps in management, such as administering thrombolytics, referring for angiography, or implanting a pacemaker. Common presentations included prior heart attacks, heart block, acute myocardial infarction, and supraventricular tachycardia. The recommended treatments were aimed at addressing the underlying cardiac issues and providing symptom relief.
Stepwise interpretation of ECG - #08 no Dx ID478
This document describes the stepwise interpretation of an ECG for a 58-year-old man with dilated cardiomyopathy. It was determined that the patient has normal sinus rhythm at a rate of 97 beats per minute, evidence of biatrial enlargement, left ventricular hypertrophy, and repolarization abnormality but no signs of myocardial infarction.
ECG #2 - ID 352 - Premature Atrial Complexes
A 62-year-old man presented with palpitations. An analysis of his ECG found sinus rhythm at 83 bpm with premature atrial complexes, where every third P wave was premature in a pattern of trigeminy. The QRS complexes, ST segments, and T waves were normal with no signs of right or left atrial enlargement, bundle branch blocks, ventricular hypertrophy, or myocardial infarction. The final diagnosis was sinus rhythm with atrial premature complexes in a pattern of trigeminy, but an otherwise normal ECG.
Stepwise interpretation of ECG ID168
A 78-year-old woman presented with a heart murmur. The ECG showed sinus rhythm at 77 beats per minute with sinus arrhythmia and first-degree AV block. There was no evidence of atrial enlargement and the QRS duration was normal with no conduction abnormalities. Signs of left ventricular hypertrophy and ST-T abnormalities were present, consistent with a strain pattern, but no signs of prior myocardial infarction.
Cardiac arrythmias
This document provides information on cardiac arrhythmias:
- It describes the normal cardiac conduction system and identifies structures involved like the SA node, AV node, Bundle of His, and Purkinje fibers.
- Common arrhythmias are defined including sinus bradycardia, sinus tachycardia, premature atrial contractions, atrial fibrillation, atrial flutter, junctional rhythms, premature ventricular contractions, ventricular tachycardia, ventricular fibrillation, and asystole.
- For each arrhythmia, the heart rate, rhythm, P wave presence, PR interval, and QRS duration are outlined to aid in identification. Understanding the normal cardiac cycle is essential for recognizing and
ECG#8 - ID478 - LVH BAE
The document discusses an ECG reading of a 58-year-old man with dilated cardiomyopathy. It finds evidence of biatrial enlargement from enlarged P waves and left ventricular hypertrophy shown by a widened QRS complex and ST abnormality, with a heart rate of 97 beats per minute and no signs of myocardial infarction.
Ecg
The document contains ECG readings from multiple patients. It discusses cases of supraventricular tachycardia, anterolateral ischemia, atrial fibrillation with complete heart block, right bundle branch block, ventricular extra systoles, anterior myocardial infarction, hypokalemia, acute anterolateral myocardial infarction, and chronic obstructive pulmonary disease. Diagnoses are provided for each case.
Approach to Wide complex tachycardia /cardiology
1) Wide complex tachycardia can be caused by ventricular tachycardia, supraventricular tachycardia with abnormal conduction, or ventricular pacing. The document discusses approaches to distinguishing these based on history, examination, and electrocardiogram findings.
2) Ventricular tachycardia is characterized by a wide QRS complex greater than or equal to 120ms and can be monomorphic, polymorphic, or bidirectional. Features on electrocardiogram can provide clues about site of origin in the ventricles.
3) Sustained ventricular tachycardia can cause hemodynamic instability while non-sustained ventricular tachycardia typically does not. Distinguishing ventricular
Ecg example
This document contains 17 questions about ECG interpretations with corresponding answers. Each question provides an ECG reading and clinical scenario, and the answers analyze the ECG findings and provide a diagnosis. Some of the conditions addressed include atrial fibrillation, atrial flutter, ventricular tachycardia, STEMI, non-STEMI, Brugada syndrome, WPW syndrome, hyperkalemia, pulmonary embolism, pericarditis, hypothermia, and more. The document serves as a teaching aid with examples of ECG interpretations for various cardiac conditions and presentations.
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ECG #14 - ID 123 - Atrial Tachycardia
A 67-year-old woman presented with palpitations. An ECG showed a narrow-QRS tachycardia at a rate of 160 beats per minute, with visible P waves preceding each QRS complex. The P waves were negative in leads II, III, aVF and V3-V6, with a PR interval of 140 msec. Based on these characteristics, the patient was diagnosed with atrial tachycardia originating from the atria.
ECG #13 - ID 419 - EAR IRBBB
This ECG shows an ectopic atrial rhythm originating from a low atrial region at a rate of 70 beats per minute, as well as an incomplete right bundle branch block. P waves are clearly seen and negative in several leads, with a PR interval of 180ms indicating the rhythm is not junctional. The QRS axis is normal and duration is 100ms with an rSR' pattern consistent with incomplete right bundle branch block. The final diagnosis is an ectopic atrial rhythm at 70bpm with incomplete right bundle branch block.
ECG #12 - ID 111 - CHB
This document discusses the stepwise interpretation of an ECG for a patient. It identifies that the patient, a 56-year-old man who had an episode of syncope, has sinus rhythm with complete heart block. The atrial rate is 80/min while the ventricular rate is 43/min, showing dissociation between the two rhythms. The QRS complexes originate from the AV junction at a rate of 43/min, indicating an escape junctional rhythm. The final diagnosis is sinus rhythm with complete heart block and an escape junctional rhythm supplying the ventricles.
ECG #11 - ID 108 - 2nd degree AV block
This document summarizes the ECG findings for a 58-year-old man presenting to the emergency department with 2nd degree AV block, Mobitz type 1. The ECG shows regular sinus rhythm at a rate of 88 beats per minute with intermittent conduction block such that every third P-wave is not followed by a QRS complex, resulting in a ventricular rate of 59 beats per minute. Further analysis of the ECG found normal QRS axis, duration and morphology with no signs of infarction, hypertrophy, or other abnormalities. The final diagnosis was sinus rhythm with Mobitz type 1 2nd degree AV block and a ventricular rate of 58 beats per minute.
ECG #10 - ID122 - Atrial Flutter
This document describes the stepwise interpretation of ECG ID 122, which shows atrial flutter with variable atrioventricular block and a ventricular rate of 107 beats per minute in a 50-year-old man complaining of palpitations. The interpretation examines the P waves, QRS complex, QRS duration, signs of ventricular hypertrophy or myocardial infarction, and T waves. The final diagnosis is atrial flutter with variable AV block and a ventricular rate of 107 beats per minute.
ECG #9 - ID594a - acute ASMI
This ECG shows signs of an acute antero-septal myocardial infarction in a 49-year old man presenting with chest pain, requiring urgent therapy. The ECG reveals normal sinus rhythm, a normal QRS axis and duration, and marked ST elevation in leads V1-V4, consistent with an antero-septal injury pattern diagnostic of an acute antero-septal infarction.
ECG #7 - ID 279 - RVH
This ECG belongs to a 57-year-old woman with a history of rheumatic fever and recent symptoms of severe dyspnea and fatigue. The ECG shows normal sinus rhythm, left atrial enlargement, right axis deviation, and right ventricular hypertrophy. There are also ST depressions and negative T waves that may indicate ischemia from heart failure.
ECG #5 - ID 168 - Left bundle branch block
A 58-year-old man followed for coronary artery disease presented with an ECG showing sinus rhythm at 88 beats per minute, a prolonged QRS duration of 145 milliseconds consistent with left bundle branch block, and no evidence of right or left ventricular hypertrophy or atrial enlargement. The left bundle branch block precludes diagnosing left ventricular hypertrophy and can mask underlying myocardial infarction.
ECG #4 - ID 383 – Atrial fibrillation
A 76-year-old woman underwent an ECG examination in her family doctor's office which showed atrial fibrillation with an irregularly irregular ventricular rhythm of 66 beats per minute and no P waves. The QRS complexes were normal with no signs of conduction abnormalities, ventricular hypertrophy, or prior myocardial infarction. The final diagnosis was atrial fibrillation with a controlled ventricular rate of 66 bpm and no other abnormalities.
Lead errors: reversal of limb leads
This document discusses common errors involving limb leads in electrocardiograms (ECGs), including:
1) Lead reversal is a common error, such as switching the right and left arm leads. This can cause leads like aVR and aVL to be reversed.
2) Misplacing the ground cable, such as attaching it to the right arm instead of the right leg, is another error.
3) Complex misplacements of the limb leads are less common. Examples provided demonstrate how specific lead errors can cause abnormalities to appear or disappear on ECG tracings.
Stepwise interpretation of ECG - #9 no Dx ID 594
This ECG shows a 49-year-old man experiencing severe chest pain for 1 hour who is presenting with an antero-septal injury pattern consistent with an acute myocardial infarction requiring urgent therapy. The ECG shows normal sinus rhythm at 84 beats per minute, a normal PR interval and QRS axis, and no signs of ventricular hypertrophy. It does reveal marked ST elevation in leads V1-V4, confirming the diagnosis of an acute antero-septal infarction.
Stepwise interpretation of ECG - #13 no Dx ID 419
This ECG shows an ectopic atrial rhythm originating outside the sinoatrial node at a rate of 75 beats per minute. The P waves precede each QRS complex but have an abnormal axis. There is also evidence of incomplete right bundle branch block seen by a widened QRS complex with a duration of 100 milliseconds and rSR' pattern. The final diagnosis is an ectopic atrial rhythm at 75 bpm with incomplete right bundle branch block and no signs of ventricular hypertrophy, myocardial infarction, or abnormal ST segments or T waves.
Stepwise interpretation of ECG - #13 no Dx ID 419
This ECG shows an ectopic atrial rhythm originating outside the sinoatrial node at a rate of 75 beats per minute. The P waves have an abnormal axis and precede each QRS complex, indicating the atrial origin. There is also an incomplete right bundle branch block seen by the prolonged QRS duration of 100 milliseconds and rSR' pattern. The final diagnosis is an ectopic atrial rhythm at a rate of 75 bpm with an incomplete right bundle branch block.
Stepwise interpretation of ECG - #13 no Dx ID 419
This ECG shows an ectopic atrial rhythm at a rate of 70 beats per minute with an incomplete right bundle branch block pattern. The QRS axis is normal and the duration is 100 msec. with an rSR' configuration. There are no signs of ventricular hypertrophy, myocardial infarction, or abnormal ST segments or T waves. The final diagnosis is an ectopic atrial rhythm at 75 beats per minute with an incomplete right bundle branch block.
Stepwise interpretation of ECG - #13 no Dx ID 419
This ECG shows an ectopic atrial rhythm at a rate of 70 beats per minute with an incomplete right bundle branch block pattern. The QRS axis is normal and the duration is 100 msec. with an rSR' configuration. There are no signs of ventricular hypertrophy, myocardial infarction, or abnormal ST segments or T waves. The final diagnosis is an ectopic atrial rhythm at 75 beats per minute with an incomplete right bundle branch block.
Stepwise interpretation of ECG - #13 no Dx ID 419
Ectopic atrial rhythm at a rate of 75 beats per minute. P waves are clearly seen and negative in several leads, indicating they do not originate from the sinus node but likely a low atrial region. There is also an incomplete right bundle branch block present as shown by a prolonged QRS duration of 100 milliseconds with an rSR' pattern. The final diagnosis is an ectopic atrial rhythm at a rate of 75 beats per minute with an incomplete right bundle branch block.
Stepwise interpretation of ECG - #13 no Dx ID 419
Ectopic atrial rhythm at a rate of 75 beats per minute. P waves are clearly seen and negative in several leads, indicating they do not originate from the sinus node but likely a low atrial region. There is also an incomplete right bundle branch block present as shown by a widened QRS duration of 100 milliseconds with an rSR' pattern. The final diagnosis is an ectopic atrial rhythm at a rate of 75 beats per minute with an incomplete right bundle branch block.
Stepwise interpretation of ECG - #12 no Dx ID 111
A 56-year-old man presented with an episode of syncope. An ECG was performed which showed sinus rhythm with complete heart block, where the atrial rate was 80/min and the ventricular rate was 43/min. The dissociation of the P waves and QRS complexes along with the narrow QRS escape rhythm indicated the ventricular activation was coming from the AV junctional area. The ECG was otherwise normal.
Stepwise interpretation of ECG - #12 no Dx ID111
A 56-year-old man presented with an episode of syncope. An ECG showed sinus rhythm with complete heart block, where the atrial rate was 80/min and ventricular rate was 43/min. The dissociation between the P waves and QRS complexes indicated complete heart block. The narrow QRS complexes and normal axis suggested the escape rhythm was originating from the AV junction. The final diagnosis was sinus rhythm with complete heart block and an escape junctional rhythm at a ventricular rate of 43/min.
Stepwise interpretation of ECG - #912 no Dx ID111
A 56-year-old man presented with an episode of syncope. An ECG showed sinus rhythm with complete heart block, where the atrial rate was 80/min and ventricular rate was 43/min. The dissociation between the P waves and QRS complexes indicated complete heart block. The narrow QRS complexes and normal axis suggested the escape pacemaker was in the AV junction, resulting in an escape junctional rhythm controlling the ventricles. The ECG was otherwise normal.
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Stepwise interpretation - ECG #3
- 1. Stepwise interpretation of ECG ID 619
- 2. ID 619 68 year old man in the Emergency Department after an accidental fall
- 3. ID 619 68 year old man in the Emergency Department after an accidental fall Can you see P waves?
- 4. ID 619 – Sinus rhythm with frequent premature ventricular complexes Yes – There is sinus rhythm, rate 100/min, with frequent premature ventricular complexes
- 5. ID619 - Sinus rhythm with frequent premature ventricular complexes The PR interval is normal – There is no left or right atrial enlargement
- 6. ID619 - Sinus rhythm with frequent premature ventricular complexes The PR interval is normal – There is no left or right atrial enlargement
- 7. ID619 - Sinus rhythm with frequent premature ventricular complexes Let’s now look at the QRS complexes: There is normal QRS axis (between O and 90 degrees)
- 8. ID619 - Sinus rhythm with frequent premature ventricular complexes The QRS complexes that follow the P waves have a normal duration – There is no right bundle branch block, left bundle branch block or non-specific block
- 9. ID619 - Sinus rhythm with frequent premature ventricular complexes There is no evidence of right or left ventricular hypertrophy
- 10. ID619 - Sinus rhythm with frequent premature ventricular complexes There are no QRS signs of myocardial infarction
- 11. ID619 - Sinus rhythm with frequent premature ventricular complexes The ST segment and T waves are normal
- 12. ID619 – Final diagnosis: Sinus rhythm with frequent premature ventricular complexes Otherwise, a normal ECG The ST segment and T waves are normal