Normal Axis

A normal axis means that the overall direction of ventricular depolarisation is normal. This direction can be between -30 degrees (up towards the left shoulder) to +90 degrees (vertically down to the feet).

If the axis is normal, Lead I, Lead II and Lead aVF will all be positive.

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ECG Library (271)

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In the ECGquest archives, this ECG has been tagged with: - Chest pain Dyspnoea 12-Lead Absent P waves Bradycardia Hidden P waves Irregular Narrow QRS Normal Axis Short PR Change in rhythm Junctional escape Multiple rhythms Sinus arrhythmia Sinus bradycardia Dr Smith's ECG Blog CC BY-NC
What is the Rhythm?

This ECG is from a young man who presented shortly after a 45 min episode of palpitations, shortness of breath, chest pressure and presyncope. He was an athlete.

This ECG shows marked sinus bradycardia with AV dissociation by default (not AV block) with junctional escape beats.

In the ECGquest archives, this ECG has been tagged with: - 12-Lead Coved ST elevation Normal Axis Upsloping ST depression Hyperthermia Dr Smith's ECG Blog CC BY-NC
Hyperthermia and ST Elevation

This ECG is from an elderly woman who presented with altered mental status on a hot summer day.

This ECG shows sinus tachycardia (124), ST elevation in V1-2 and III and upsloping ST depression in I, aVL and V4-6. POCUS did not show a regional wall motion abnormality. The ST changes resolved with active cooling.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Anterior ST elevation Normal Axis Acute Inferior MI Acute Lateral MI Dr Smith's ECG Blog CC BY-NC
Anterior ST Elevation and a High Initial Troponin.

This ECG is from a man in his 40s who presented with intermittent left sided pleuritic chest pain for 3 days.

This ECG shows anterior ST elevation, but there was no anterior wall motion abnormality on echo - there was an inferolateral regional wall motion abnormality instead. Initial troponin was very high. He was found to have a 100% obtuse marginal occlusion. The ECG did not evolve over the next few days, suggesting that it was the patient's baseline ECG.

In the ECGquest archives, this ECG has been tagged with: - Palpitations 12-Lead Absent P waves Extreme tachycardia Narrow QRS Normal Axis Regular ST elevation in aVR Tachycardia Widespread ST depression SVT ECG of the Week CC-BY-NC-SA
ECG of the Week – 7th January 2019 – Interpretation

This ECG is from a woman in her 20s who presented with palpitations for an hour.

This ECG shows a regular narrow complex tachycardia (SVT) with secondary ST segment changes due to the extreme rate (205 bpm).

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Anterior ST elevation Normal Axis Normal rate Regular Acute Anterior MI Dr Smith's ECG Blog CC BY-NC
Is this ST elevation normal or abnormal?

This ECG is from a man in his 50s who presented with less than an hour of chest pain. This was his initial ECG.

This ECG shows subtle ST elevation in V2 and V3 with a very small amount of ST depression in V4-6. He was monitored and the ECG progressed into a clear STEMI. Catheterisation showed 95% proximal LAD stenosis and occluded 1st diagonal.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Nonspecific baseline artefact Biphasic T waves Normal Axis Dr Smith's ECG Blog CC BY-NC
Dynamic, Reversible, Ischemic T-wave inversion mimics Wellens’. All trops negative.

This ECG is from a middle aged man who presented with intermittent chest tightness and nausea on walking that resolved with rest. This had happened twice over the past two days. He was likely pain free at the time that this ECG was recorded.

This ECG shows terminal T wave inversion in V2-4, resembling Wellens' waves. There was no wall motion abnormality on echo and troponins were negative (so it was not a true Wellens' syndrome), but a stress echo was markedly positive. Angiogram showed a 95% LAD stenosis and 70% first diagonal stenosis. The cause of the T wave changes was likely ischemia without infarction, ie. unstable angina.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Paediatric Inverted T waves Normal Axis Tall QRS Normal Sinus Rhythm Normal ECG Guru CC-BY-NC-SA
Instructors’ Collection ECG: Normal ECG in Seven-year-old Girl

This ECG is from a young girl with mild chest pain.

This ECG shows normal sinus rhythm with inverted T waves in V1 and a tall QRS complex. This was a normal paediatric ECG.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Dyspnoea 12-Lead Bradycardia Inverted T waves Normal Axis Regular ECG of the Week CC-BY-NC-SA
ECG of the Week – 3rd December 2018 – Interpretation

This ECG is from a man in his 50s who had an episode of chest pain and shortness of breath. This ECG was recorded when he was pain free.

This ECG shows sinus bradycardia with T wave inversion in the inferior leads, which was caused by reperfusion of a critical stenosis of the RCA.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Dyspnoea 12-Lead Absent P waves Anterior ST depression Extreme tachycardia Inferior ST elevation Narrow QRS Normal Axis Reciprocal ST depression Regular Tachycardia Atrial flutter Multi-vessel disease Dr Smith's ECG Blog CC BY-NC
Arrhythmia? Ischemia? Both? Electricity, drugs, lytics, cath lab? You decide.

This ECG is from a man in his 60s who presented with intermittent shortness of breath and chest pressure over the past few days. This was his initial ECG.

This ECG shows a regular narrow complex tachycardia around 200 bpm, without P waves, with marked ST elevation in inferior leads and ST depression in anterior leads and aVL. The cause was thought to be atrial flutter from newly started flecainide. He also underwent angiography and had stents inserted to the left circumflex and right coronary arteries.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Dyspnoea 12-Lead Anterior ST depression Inferior ST elevation Narrow QRS Normal Axis Normal P waves Reciprocal ST depression Regular Tachycardia Sinus tachycardia Multi-vessel disease Dr Smith's ECG Blog CC BY-NC
Arrhythmia? Ischemia? Both? Electricity, drugs, lytics, cath lab? You decide. Repeat 1 min later.

This ECG is from a man in his 60s who presented with intermittent shortness of breath and chest pressure over the past few days. This was his repeat ECG after the rhythm changed.

This ECG shows a sinus tachycardia with ST elevation in inferior leads and ST depression in anterior leads and aVL. He underwent angiography and had stents inserted to the left circumflex and right coronary arteries.

In the ECGquest archives, this ECG has been tagged with: - 12-Lead Narrow QRS Normal Axis Normal P waves Normal R wave transition Regular Normal Dr Smith's ECG Blog CC BY-NC
Arrhythmia? Ischemia? Both? Electricity, drugs, lytics, cath lab? You decide. Baseline ECG.

This ECG is from a man in his 60s who presented with intermittent shortness of breath and chest pressure over the past few days. This was his baseline ECG for comparison.

This ECG shows a normal ECG.

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