The electrocardiograms (ECGs) in this Atlas supplement those illustrated in Chap. 228. The interpretations emphasize findings of specific teaching value.
All of the figures are from ECG Wave-Maven, Copyright 2003, Beth Israel Deaconess Medical Center, http://ecg.bidmc.harvard.edu.
The abbreviations used in this chapter are as follows:
LVH—left ventricular hypertrophy
RBBB—right bundle branch block
RVH—right ventricular hypertrophy
Myocardial Ischemia and Infarction
Anterior wall ischemia (deep T-wave inversions and ST-segment depressions in I, aVL, V3−V6) in a patient with LVH (increased voltage in V2−V5).
Acute anterolateral wall ischemia with ST elevations in V4−V6. Probable prior inferior MI with Q waves in leads II, III, and aVF.
Acute lateral ischemia with ST elevations in I and aVL with probable reciprocal ST depressions inferiorly (II, III, and aVF). Ischemic ST depressions also in V3 and V4. Left atrial abnormality.
Sinus tachycardia. Marked ischemic ST-segment elevations in inferior limb leads (II, III, aVF) and laterally (V6) suggestive of acute inferolateral MI, and prominent ST-segment depressions with upright T waves in V1−V4 are consistent with associated acute posterior MI.
Acute, extensive anterior MI with marked ST elevations in I, aVL, V1−V6 and small pathologic Q waves in V3−V6. Marked reciprocal ST-segment depressions in III and aVF.
Acute anterior wall MI with ST elevations and Q waves in V1−V4 and aVL and reciprocal inferior ST depressions.
NSR with premature atrial complexes. RBBB; pathologic Q waves and ST elevation due to acute anterior/septal MI in V1−V3.
Acute anteroseptal MI (Q waves and ST elevations in V1−V4) with RBBB (note terminal R waves in V1).
Extensive prior MI involving inferior-posterior-lateral wall (Q waves in leads II, III, aVF, tall R waves in V1, V2, and Q waves in V5, V6). T-wave abnormalities in leads I and aVL, V5, and V6.
NSR with PR prolongation ("1st degree AV block"), left atrial abnormality, LVH, and RBBB. Pathologic Q waves in V1−V5 and aVL with ST elevations (a chronic finding in this patient). Findings compatible with prior anterolateral MI and LV aneurysm.
Prior inferior-posterior MI. Wide (0.04 s) Q waves in the inferior leads (II, III, aVF); broad R wave in V1 (a Q wave "equivalent" here). Absence of right-axis deviation and the presence of upright T waves in V1−V2 are also against RVH.
NSR with RBBB (broad terminal R wave in V1) and left anterior fascicular block (hemiblock) and pathologic anterior Q waves in V1−V3. Patient had severe multivessel coronary artery disease, with echocardiogram showing septal dyskinesis and apical akinesis.
Acute pericarditis with diffuse ST elevations in I, II, III, aVF, V3−V6, without T-wave inversions. Also note concomitant PR-segment elevation in aVR and PR depression in the inferolateral leads.
Sinus rhythm; diffuse ST elevations (I, II, aVL, aVF, V2−V6) with associated PR deviations (elevated PR in aVR; depressed in V4−V6); borderline low voltage. Q-wave and T-wave inversions in II, III, and aVF. Diagnosis: acute pericarditis with inferior Q-wave MI.
Valvular Heart Disease and Hypertrophic Cardiomyopathy
NSR, prominent left atrial abnormality (see I, II, V1), right-axis deviation and RVH (tall, relatively narrow R wave in V1) in a patient with mitral stenosis.
NSR, left atrial abnormality, and LVH by voltage criteria with borderline right-axis deviation in a patient with mixed mitral stenosis (left atrial abnormality and right-axis deviation) and mitral regurgitation (LVH). Prominent precordial T-wave inversions and QT prolongation also present.
Coarse AF, tall R in V2 with vertical QRS axis (positive R in aVF) indicating RVH. Tall ...
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