Uploaded byTaiwan Heart Rhythm Society
ECG workbook
This document contains EKG readings and brief descriptions for various arrhythmias and cardiac conditions. It includes summaries of sinus tachycardia, atrial bigeminy, atrial fibrillation, atrial flutter, complete heart block, Wolff-Parkinson-White syndrome, ventricular premature beats, ventricular bigeminy, ventricular tachycardia, ventricular fibrillation, polymorphous ventricular tachycardia, and ventricular fibrillation. For each condition, it provides the characteristic features visible on EKG and sometimes brief patient history information.
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ECG workbook
- 1.
- 2. Sinus tachycardia • Pwave rate greater than 100 bpm
- 3. A 34 yearold lady with asthma
- 4.
- 5. Atrial Bigeminy • eachbeat is followed by an atrial premature beat
- 6. A 60 yearold man with hypertension
- 7. Atrial fibrillation withrapid ventricular response • Irregularly irregular ventricular rhythm. • Sometimes on first look the rhythm may appear regular but on closer inspection it is clearly irregular.
- 8. A 76 yearold man with breathlessness
- 9. Atrial flutter • Acharacteristic 'sawtooth' or 'picket-fence' waveform of an intra-atrial re-entry circuit usually at about 300 bpm.
- 10. An 57 yearold lady with palpitations
- 11. • Complete AVblock
- 12. A 70 yearold man with exercise intolerance
- 13. Wolff-Parkinson-White Preexcitation • QRScomplex represents a fusion between two ventricular activation fronts: – Early ventricular activation in region of the accessory AV pathway (Bundle of Kent) • ECG criteria include all of the following: – Short PR interval (<0.12s) – Initial slurring of QRS complex (delta wave) representing early ventricular activation through normal ventricular muscle in region of the accessory pathway – Prolonged QRS duration (usually >0.10s) – Secondary ST-T changes due to the altered ventricular activation sequence
- 14. Wolf-Parkinson-White syndrome with atrial fibrillation • irregularly irregular, wide complex tachycardia • impulses from the atria are conducted to the ventricles via either – both the AV node and accessory pathway producing a broad fusion complex – or just the AV node producing a narrow complex (without a delta wave) – or just the accessory pathway producing a very broad 'pure' delta wave • people who develop this rhythm and have very short R - R intervals are at higher risk of ventricular fibrillation
- 15. A 47 yearold man with a long history of palpitations and, lately, blackouts
- 16. Ventricular premature beats LongQT interval • The QT interval normally varies with heart rate - becoming shorter at faster rates. It is usually corrected using the cycle length (R-R interval) as shown opposite. • normal QTc = 0.42 seconds Ventricular premature beats (VPBs) • 2 ventricular premature beats are also shown in this ECG • They are – broad – occur earlier than normal – and are followed by a full compensatory pause (the distance between the normal beats before and after the VPB is equal to twice the normal cycle length).
- 17. A lady withRomano-Ward syndrome
- 18. Ventricular bigeminy • Ventricularbigeminy • a ventricular premature beat follows each normal beat • There are also features of an acute inferior myocardial infarction
- 19. A 50 yearold man with chest pain for 24 hours
- 20. Ventricular tachycardia • Ventriculartachycardia • A wide QRS tachycardia is VT until proven otherwise (1). Features suggesting VT include:- • evidence of AV dissociation – independent P waves (shown by arrows here) – capture or fusion beats – beat to beat variability of the QRS morphology • very wide complexes (> 140 ms) • the same morphology in tachycardia as in ventricular ectopics • history of ischaemic heart disease • absence of any rS, RS or Rs complexes in the chest leads (2) • concordance (chest leads all positive or negative)
- 21. A 45 yearold lady with palpitations and history of chronic renal failure
- 22. Ventricular fibrillation Ventricular fibrillation •bizarre, irregular, random waveform • no clearly identifiable QRS complexes or P waves • wandering baseline
- 23. A 60 yearold man with 2 hours of "crushing" chest pain suddenly collapses
- 24. Polymorphous ventricular tachycardia (Torsade de pointes) • This is a form of VT where there is usually difficulty in recognizing its ventricular origin. • wide QRS complexes with multiple morphologies • changing R - R intervals • the axis seems to twist about the isoelectric line • it is important to recognize this pattern as there are a number of reversible causes – heart block – hypokalemia or hypomagnesaemia – drugs (e.g. tricyclic antidepressant overdose) – congenital long QT syndromes – other causes of long QT (e.g. IHD)
- 25. A 60 yearold man with Ischaemic Heart Disease.