ECG Library

ECG Library (2408)

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Shark Fin morphology recognized only by EM physician

This ECG is from a man in his 70s who complained of acute chest pain followed by a witnessed cardiac arrest. This ECG was taken after ROSC following 35 min down time.

This ECG shows Shark-fin morphology with RBBB + LAFB and massive anterolateral ST elevation. The cause was an acute proximal LAD occlusion.

Shark fin ST elevation LAFB RBBB 12-Lead Dr Smith's ECG Blog CC BY-NC
Look at this ST Depression

This ECG is from a man in his 30s who presented with 2 days of chest heaviness

This ECG shows Sinus tachycardia with atrial depolarisation waves (Ta waves) mimicking ST depression.

Ta wave Sinus tachycardia 12-Lead Dr Smith's ECG Blog CC BY-NC
A man in his 70s with chest pain during a bike ride

This ECG is from a man in his 70s who presented with chest pain that started during bike riding.

This ECG shows subtle ST depression in V2-6 and ST elevation in III. He had multi vessel disease with a near-occlusive culprit RCA lesion.

Chest pain Anterior ST depression 12-Lead Dr Smith's ECG Blog CC BY-NC
ECG Blog #168 (STEMI – complex AV Block – Laddergram – Calipers)

This ECG is from a middle-aged woman who presented with syncope and hypotension.

This ECG shows sinus tachycardia with inferior ST elevation and reciprocal ST depression in aVL. Also ST elevation in V1 and ST depression in V2-4. The most likely cause was acute inferoposterior MI due to proximal RCA occlusion.

Hypotension Syncope Sinus arrhythmia Sinus tachycardia High grade AV block Ventriculophasic sinus arrhythmia 12-Lead ECG Interpretation CC-BY-NC-SA
Chest pain with NonDiagnostic ECG but Diagnostic CT Scan

This ECG is from an elderly woman who presented with several hours of chest pain radiating to the back.

This ECG shows flat T waves in aVL but otherwise normal. Troponin was elevated. CT showed no dissection but an area of transmural ischemia. Serial ECGs showed no change. The cause was an occluded OM1.

Chest pain Flat T waves 12-Lead Dr Smith's ECG Blog CC BY-NC
A 50-something woman with chest pain, BP 230/120, and LBBB with 7 mm ST Elevation

This ECG is from a woman in her 50s who presented with chest pressure on a background of heart failure and hypertension. BP 223/125.

This ECG shows sinus rhythm, LBBB and anterior ST elevation. Sgarbossa positive but modified sgarbossa negative. Echo showed LVH, troponin did show a rise and fall, MIBI showed normal perfusion. The most likely cause was a type II MI. The ECG changes did not evolve and were likely baseline changes.

Chest pain Hypertension Discordant ST changes Tall QRS Wide QRS LBBB 12-Lead Dr Smith's ECG Blog CC BY-NC
A 40-something healthy male with transient chest squeezing: next morning

This ECG is from a man in his 40s who presented with intermittent chest tightness, shortness of breath and diaphoresis. This was taken the next day after symptoms resolved.

This ECG shows biphasic T waves caused by Wellens' syndrome.

Biphasic T waves Wellens syndrome 12-Lead Serial 12-lead Dr Smith's ECG Blog CC BY-NC
A 40-something healthy male with transient chest squeezing

This ECG is from a man in his 40s who presented with intermittent chest tightness, shortness of breath and diaphoresis.

This ECG shows ST elevation in V1-6 and hyperacute T waves out of proportion to the size of the QRS. There is terminal QRS distortion in V3. The cause was an acute proximal LAD occlusion.

Chest pain Anterior ST elevation Hyperacute T waves Terminal QRS distortion Chest leads Dr Smith's ECG Blog CC BY-NC
Teach your learners: when the QRS is wide, the J-point will hide, so trace it down and copy it over!

This ECG is from a middle aged man who presented with chest pain and diaphoresis while exercising. He had a VSD repair at age 6.

This ECG shows sinus tachycardia with RBBB + LPFB. ST elevation in III and aVF with reciprocal ST depression in aVL. ST depression in V2-5. The cause was inferoposterior MI, due to severe triple vessel disease and a culprit 100% circumflex occlusion.

Chest pain Anterior ST depression Inferior ST elevation Wide QRS LPFB RBBB 12-Lead Dr Smith's ECG Blog CC BY-NC
Unusual: Troponin Trajectory to Help Determine Ongoing/Recurrent Infarction vs. Completed Infarction.

This ECG is from a man in his 40s who presented with a cough, shortness of breath and several episodes of chest pressure over the past week or so.

This ECG shows anterior ST elevation and deep QS waves. There was a 100% LAD occlusion that was approximately 2 weeks old.

Anterior ST elevation Pathological Q waves 12-Lead Dr Smith's ECG Blog CC BY-NC
Chest pain, pelvic and abdominal pain, hypotension, and severe ischemia on the ECG

This ECG is from an elderly male who presented with lethargy and pelvic pain. He was hypotensive (66/31), pulse 80.

This ECG shows widespread ST depression and reciprocal ST elevation in aVR due to diffuse subendocardial ischemia. The most likely cause was septic shock.

Hyperacute T waves ST elevation in aVR Widespread ST depression 12-Lead Dr Smith's ECG Blog CC BY-NC
Do you recognize this ECG yet?

This ECG is from a man in his 30s who presented with chest pain and RUQ abdominal pain, on a background of type 1 diabetes. His BSL was high.

This ECG shows sinus tachycardia with a wide QRS, R in aVR, coved ST elevation and peaked T waves. The cause was hyperkalemia.

Abdominal pain Chest pain Coved ST elevation Peaked T waves Tachycardia Wide QRS Sinus tachycardia Hyperkalemia 12-Lead Dr Smith's ECG Blog CC BY-NC
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This is a library of 2408 free, open access, re-usable ECGs from across the web.

Where did they come from?

These ECGs were collected from Free Open Access Medical Education (#FOAMed) blogs, with the permission of their authors. You can find out more about each ECG's source by clicking on it.

Why are they here?

This is an experiment in digital curation. The idea is to collect resources to increase awareness and accessibility. Over time, more ECGs in the collection will be tagged to make it easier to find them and reused in new interactive quizzes.

How can I use these ECGs?

You can use these ECGs for your own learning, teaching or research - as long as you abide by the terms of each ECG's copyright licence as stipulated by the original author.