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Instructors' Collection ECG: Normal Adult 12-Lead ECG

From time to time, we like to publish an ECG that is "within normal limits".  While ECGs each look slightly different, there are defined parameters that are considered to be normal.  Using the taxonomy terms in the Scrollable List provided on this site, you can easily find and compare the "normal" ECGs.  This is taken from a 45-year-old male with a lean body type.

A few of the characteristics that make this ECG normal include, but are not limited to:

*  Rate 85 bpm.  Rhythm regular.  P waves present before QRS complexes.  NORMAL SINUS RHYTHM.

*  All intervals within normal limits, including a narrow QRS.

*  No pathological ST segment elevations, depressions, or Q waves.

*  Frontal plane axis is normal. Slightly early R wave transition in the precordial leads.

*  No ectopic beats or pauses.

It is very important for students to become familiar with normal ECG characteristics before they learn abnormalities.  The normal features become a "template" for the interpreter to compare abnormal ECGs to.

 

Our thanks to David Morris, Palm Beach County Fire Rescue, for the donation of this ECG.

Dr A Röschl's picture

POLYMORPHIC VT

What can we learn from this 3-channel ECG?
A sinus rhythm can be seen in the left half of the image, which merges into a ventricular tachycardia on the right. The QRS complexes of the VT change their shape and polarity, this is called polymorphic.
The question is: can this be called TdP (Torsade de Pointes) tachycardia or not? The clear answer is: no! A polymorphic VT may only be called TdP if there is a prolonged QT/QTc duration in the native rhythm. This is obviously not the case here. Therefore, the term polymorphic VT is retained here

Dr A Röschl's picture

SGARBOSSA CRITERIA

This ECG was sent to me by a friend, I don't know if he did it himself. The question was whether a heart attack can be recognized here.
The patient is a 55-year-old man who has typical angina pectoris lasting more than 1 hour.
What can you answer?

Dr A Röschl's picture

CONCEALED CONDUCTION

This ECG (3 rhythm strips) initially shows a sinus rhythm with 1st degree AVB grade I and wide QRS complexes (presumably RBBB pattern). A PAC (P-wave premature, different form than in sinus rhythm) appears approximately in the middle of the ECG, this is not conducte . Due to the strong prematurity, this is not surprising. But why is the 2nd PAC also blocked? The answer can be found inthe second picture.

Dr A Röschl's picture

CONCEALED CONDUCTION AND VENTRICULOPHASIC SINUS ARRHYTHMIA

Sometimes in a simple 1-lead ECG strip, various interesting ECG phenomena can be recognized, such as here.
One could briefly look over the ECG, make the diagnosis of ventricular bigeminus and then be satisfied.
On closer inspection, however, 3 questions arise:
1. Is the P wave behind the PVC a sinus node P or an atrial extrasystole?
2. + 3. after one comes to the conclusion that it is a sinus node P: why is it not conducted and why is the PP distance smaller when there is a QRS complex in between than when there is not.

Dr A Röschl's picture

PAROXYSMAL ATRIAL FIBRILLATION

Atrial fibrillation is a very common arrhythmia, affecting hundreds of millions of people worldwide. The diagnosis of atrial fibrillation is of great importance, as the timely initiation of oral anticoagulation can in many cases significantly reduce the risk of embolism (which is associated with this arrhythmia).
The risk of cardiac embolism is particularly high in the presence of paroxysmal atrial fibrillation, in which there is frequent alternation between sinus rhythm and atrial fibrillation.
Such a sequence is recorded here in a 3-lead ECG.

Dr A Röschl's picture

2nd Degree Sino-atrial Exit Block, Mobitz Type II

This 3-lead ECG comes from an 80-year-old gentleman who went for a cardiological examination after a syncope.
The ECG shows a sinus rhythm with wide QRS complexes, the QRS morphology in lead I suggests an LBBB, heart rate here just under 60 bpm. After 3 sinus node beats there is a pause of just under 2 seconds.
There are no P waves during this pause. Then sinus rhythm again for 6 beats, followed by a pause of just under 3 seconds, then sinus rhythm again.
How can the pauses be explained?

Dr A Röschl's picture

SICK-SINUS-SYNDROME

This ECG is from a 65-year-old woman who had previously had no cardiac abnormalities but has now suffered several syncopes within 2 weeks. During the last syncope she suffered a fracture of the left femur.

Dr A Röschl's picture

Smartwatch Rhythm Strip

Here we see a 30 s long strip of a 1-lead ECG rhythm strip, recorded with a modern Smartwatch (Apple watch). The ECG has been graphically processed for better visualization. The paper speed is 25 mm/s as usual. The lead shown corresponds to ECG lead I of the limb leads.

Dawn's picture

ECG Basics: Baseline Respiratory Artifact

This strip shows normal sinus rhythm at a rate of 95 bpm.  The isoelectric line shows the effects of the patient's breathing.  Placing the limb electrodes on the limbs rather than on the chest will eliminate this artifact. 

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ECG HISTORY:     ECG was first put into clinical use in the early 1900s.  In 1909, it helped diagnose an arrhythmia.  A year later, indications of a heart attack were noted.

 

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