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ELECTROCARDIOGRAPHY
Medical Unit-I
Holy Family Hospital
Rawalpindi
A 26yrs old lady who has complained of palpitations in past, is admitted
in ER with palpitations. HER ECG shows:
Rate about 200/min
Narrow QRS complex
No P waves
No P waves
• Narrow complex tachycardia
• Rate about 200/min
• NO P waves
• Normal axis
• Regular QRS complexes
• Normal ST segments & T waves
 Diagnosis:
Supraventricular tachycardia (SVT)
A 55yr old man presented with h/o chest pain at rest for 6 Hrs. There are
no abnormal physical findings. His ECG tracing shows:
ST segment depression,
downward sloping
ST segment depression, Horizontal
• Sinus rhythm
 Diagnosis:
• Normal axis
Anterolateral Ischemia(unstable angina)
• Normal QRS complexes
• ST segment depressions, Horizontal in V3-V4
• ST segment depressions, Downward sloping in lead 1, aVL, V5-V6
These 3 rhythm strips (all lead II) came from the ECGs of three different
patients. They were all in their eighties & C/O breathlessness. What
diagnosis would you consider?
a.
No P waves
Broad, regular, slow QRS
b.
Constant PR interval
2:1 conduction defect
c.
No correlation b/w P waves & QRS complex
A. No P waves
Irregular baselines
QRS complexes are broad, regular & slow
 Diagnosis:
Atrial fibrillation with complete block
B. Constant PR interval
2:1 conduction defect
Diagnosis:
Sinus rhythm with 2nd degree block
C. No correlation between P waves &
QRS complexes
 Diagnosis:
Complete (3rd degree)
heart block
This ECG was recorded from a 60 yrs old man being treated as an out patient for
severe CCF. What might be diagnosis of underlying heart conduction?
ST depression
No P waves. Irregular HR.
(AF)
 Diagnosis:
• Atrial fibrillation
AF with uncontrolled Ventricular rate &
• Ventricular rate of 75-200/min
digoxin effect (ST segmrnt depressions)
• Normal axis
• Normal QRS complexes
• Downward sloping ST segment depression
esp, V5-V6
A 15yr old boy was referred to the outpatient for heart murmur. He had no
symptoms. What does this ECG shows?
RSR pattern
Broad QRS complex
Wide & slurred S waves
• Sinus rhythm
• Normal axis
• Broad QRS complexes
• RSR pattern in lead I
• Wide & slurred S waves in V5
• Normal ST segments & T waves
 Diagnosis:
Right bundle branch block (RBBB)
This ECG was recorded from a 25yr old pregnant women. She
complaints of an irregular heart beat. Auscultation revealed a soft systolic
murmur but her heart was otherwise normal
Ventricular Extra systole
• Sinus rhythm
 Diagnosis:
• Normal axis
Sinus rhythm with ventricular extra systoles
• Normal QRS complexes & T waves
• Ventricular extra systoles
A 50yr old man is seen in A & E department with severe central chest pain
which has been present for 18hrs. What does this ECG shows?
Inverted T waves
Inverted T waves
ST elevation
Q waves
• Sinus rhythm
• Normal axis
• Q waves in V2-V4
• Raised ST segments in V2-V4
• Inverted T waves in lead I ,aVL , V2-V6
 Diagnosis:
Acute anterior Myocardial infarction
This ECG was recorded from 60yr old women with rheumatic heart
disease. She had been in heart failure but this had been treated & she was
no longer breathless. What does this ECG shows?
No P waves (AF)
U waves
Downward sloping
ST segments
• AF with ventricular rate of 60-65/min
 Diagnosis:
• Normal axis
AF with Digoxin effect
• Normal QRS complexes
• Prominent U waves in V2 (Suggest Hypokalemia)
• Downward sloping ST segments in V5-V6 (Suggest Digoxin effect)
This ECG was recorded from 65yrs old women admitted in A&E
department with sever chest pain for 1 hr. What does this ECG shows?
ST elevation
ST elevation
Depressed ST segments
Depressed ST segments
• Sinus rhythm
 Diagnosis:
• Normal axis
Acute anterolateral MI
• Probably normal QRS complexes
• Grossly ST segment elevation in anterior & lateral leads
• Depressed ST segments in inferior leads, lead III, aVF
This ECG was recorded from 60yr old man seen in clinic because of
severe breathlessness which had developed over several years. His JVP is
raised. What does his ECG shows?
Dominant R waves
Right axis
Extra systole
Peaked P waves
• Sinus rhythm, rate 140/min
• One ventricular Extra systole
• Peaked P waves (best in lead II, III, aVF)
• Normal PR interval
• Right axis
• Dominant R waves in V1
• Deep S waves In V6
• Normal ST segments & T waves
Deep S waves
 Diagnosis:
Sinus tachycardia with 1
ventricular extra systole, Right atrial
& right ventricular hypertrophy &
clockwise rotation suggests COPD
ECG Quizzes
Q. 01
• What is the PR interval in this ECG?
• A. 0.12 se
B. 0.16 sec C. 0.20 sec D. 0.28 sec E. 0.50 sec
Q. 02
What is the QRS duration seen here?
A. 0.04 sec B. 0.06 sec C. 0.10 sec D. 0.12 sec E. 0.14
Q. 3
What is the approximate heart rate?
A. 50 bpm B. 65 bpm C. 75 bpm D. 90 bpm E. 100 bpm
Q. 04
What type of arrhythmia is
pointed out by the two
arrows?
A. PACs (Premature Atrial
Complexes)
B. PVCs (Premature
Ventricular Complexes)
C. 1 is a PAC, and 2 is a
PVC
D. PSVT (Paroxysmal
Supraventricular Tachycardia)
E. Left Bundle Branch Block
Q. 05
Choose from the following
responses to interpret this
ECG.
A. PJC (Premature
junctional complex)
B. Atrial flutter
C. Atrial fibrillation
D. AV nodal reentrant
tachycardia
E. Accelerated junctional
rhythm