Normal ST segment
A normal ST segment is usually isoelectric (flat), but in some healthy individuals it can be normal to have some degree of ST elevation, especially in anterior leads.
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Basics
Recording a 12-Lead ECG
- 12-Lead
- Chest leads
- Ladder diagram
- Lewis lead
- Limb leads
- Mirrored 12-Lead (dextrocardia)
- Paediatric
- Posterior leads
- Rhythm Strip
- Right leads
- Serial 12-lead
Artefact
- Nonspecific baseline artefact
- Chest compression artefact
- Electrical interference artefact
- Electrode Detachment
- Fistula artifact
- Incorrect Machine Interpretation
- Transcutaneous pacing artefact
- Wandering baseline
Calibration
- Standard Calibration
- Double speed 50 mm/sec
Electrode misplacement
- High V1/V2 misplacement
- LA/LL electrode reversal
- LA/LL + RA/RL electrode reversals
- LA/RA electrode reversal
- LA/RL electrode reversal
- RA/LL electrode reversal
- RA/RL electrode reversal
Signs
Rate
- Bradycardia
- Extreme tachycardia
- Normal rate
- Tachycardia
Regularity
- Grouped
- Irregular
- Regular
P wave
- Absent P waves
- Asymmetrical P in V1
- Extra P waves
- Fibrillation waves
- Flutter P waves
- Hidden P waves
- Inverted P waves
- Normal P waves
- Retrograde P waves
- Tall P waves
- Variable P waves
- Wide P waves
PR interval & segment
- Changing PR interval
- Long PR
- Normal PR
- PR segment depression
- Short PR
QRS axis
- Changing Axis
- Extreme Axis
- Indeterminate axis
- Left Axis Deviation
- Normal Axis
- Right Axis Deviation
- Vertical axis
QRS complex
- Capture beat
- Dagger Q waves
- Early R wave transition
- Electrical alternans
- Fragmented QRS
- Fusion beat
- Late R wave transition
- Lead I sign
- Narrow QRS
- Normal Q wave
- Normal R wave transition
- Pathological Q waves
- Prolonged R wave peak time
- R in aVR
- R in V1
- S1Q3T3
- Short QRS
- Tall QRS
- Terminal QRS distortion
- Wide QRS
ST segment
- Anterior ST depression
- Anterior ST elevation
- Concordant ST depression in V1-V3
- Concordant ST elevation
- Coved ST elevation
- Discordant ST changes
- Downsloping ST depression
- Excessive discordant ST depression.
- Excessive discordant ST elevation
- Flat ST segment
- Inferior ST depression
- Inferior ST elevation
- Lateral ST depression
- Lateral ST elevation
- Normal ST segment
- Pseudonormalised ST segment
- Reciprocal ST depression
- Saddleback ST elevation
- Septal ST elevation
- Shark fin ST elevation
- Horizontal ST depression
- ST elevation in a PVC
- ST elevation in aVL
- ST elevation in aVR
- ST elevation in III>II
- ST elevation in posterior leads V7-9
- ST elevation in V1
- ST elevation in V4R
- Straightened ST segment
- Tombstone ST elevation
- Upsloping ST depression
- Widespread ST depression
- Widespread ST elevation
T and U wave
- Biphasic T waves
- De Winter T waves
- Deeply inverted T waves
- Flat T waves
- Hyperacute T waves
- Inverted T waves
- Inverted U waves
- Normal T waves
- Normal U waves
- Peaked T waves
- Pseudo-normalised T waves
- T-U waves
- Tall U waves
- Wellens Waves
QT interval
- Long QT
- Normal QT
- Short QT
Other waves
- Cabrera's sign
- Chapman's sign
- Delta wave
- Epsilon wave
- J wave
- Osborn wave
- Pacemaker spikes
- Pseudo R' wave
- RSR'
- Sine wave
- Spiked helmet sign
- Spodick's sign
- Ta wave
Rhythms
Sinus Rhythms
- Normal Sinus Rhythm
- Sinus arrest
- Sinus arrhythmia
- Sinus bradycardia
- Sinus node re-entrant tachycardia
- Sinus pause
- Sinus tachycardia
Atrial Rhythms
- Atrial fibrillation
- Atrial flutter
- Atrial tachycardia
- Atrial tachycardia - multifocal
- AVRT antidromic
- AVRT orthodromic
- Coronary sinus rhythm
- Wandering atrial pacemaker
Junctional Rhythms
- Accelerated junctional rhythm
- AVNRT
- AVNRT fast-slow
- Junctional escape
- Junctional tachycardia
Ventricular Rhythms
- Accelerated idioventricular rhythm
- Non-sustained VT
- Right Ventricular Outflow Tract Tachycardia
- Torsades de Pointes
- Ventricular escape
- Ventricular Fibrillation
- Ventricular flutter
- Ventricular standstill
- Ventricular tachycardia
- Ventricular tachycardia - bidirectional
- Ventricular tachycardia - fascicular
- Ventricular tachycardia - polymorphic
Pacemakers
- Atrial pacemaker
- Failure to capture
- ICD Overdrive Pacing
- Pacemaker failure
- Pacemaker mediated tachycardia
- Ventricular pacemaker
Extra Beats
- Atrial bigeminy
- Atrial escape beat
- Bigeminy
- Blocked premature atrial complex
- Premature atrial complex
- Premature junctional complex
- Premature ventricular complex
- Trigeminy
- Ventricular escape beat
Other Rhythms
- Asystole
- Change in rhythm
- Isorhythmic dissociation
- Multiple rhythms
- Parasystole
- Pulseless Electrical Activity
- SVT
- Wide complex tachycardia
Blocks
SA Blocks
- Type I SA block
- Type II SA block
AV Blocks
- First degree AV block
- High grade AV block
- Second degree AV block
- Second degree AV block 2:1
- Second degree AV block Mobitz type 2
- Second degree AV block type 1 - Wenckebach
- Third degree AV block
- Ventriculophasic sinus arrhythmia
BBB/Hemiblocks
- Ashman aberrancy
- Incomplete LBBB
- Incomplete RBBB
- Intraventricular conduction delay
- LAFB
- LBBB
- LPFB
- RBBB
Multiple Blocks
- Bifascicular block
- Trifascicular block
Ischemia
Basic STEMI localisation
- Acute Anterior MI
- Acute Inferior MI
- Acute Lateral MI
- Mid-anterior MI
- Multi-vessel disease
- Acute Posterior MI
- Right ventricular MI
Old vs new ischemia
- Old anterior MI
- Old Inferior MI
ST changes with LBBB
- Positive Sgarbossa criteria
ST depression and ischemia
- Diffuse subendocardial ischaemia
- Left main occlusion
- Left main stenosis
- Proximal LAD occlusion
Other Conditions
Electrolyte
- Hypercalcaemia
- Hyperkalemia
- Hypocalcaemia
- Hypokalemia
- Hypomagnesaemia
Hypertrophy and enlargement
- Hypertrophic cardiomyopathy
- Left atrial enlargement
- LVH
- Right atrial enlargement
- RVH
Pulmonary and Pericardial
- Acute right heart strain
- COPD
- Cor pulmonale
- Pericardial effusion
- Pericarditis
- Pulmonary embolism
STEMI Mimic
- CVA
- LV aneurysm
- MINOCA
- Myocardial rupture
Syndrome
- Arrhythmogenic Right Ventricular Cardiomyopathy
- Brugada syndrome
- Familial catecholaminergic polymorphic ventricular tachycardia
- Long QT syndrome
- Lown Ganong Levine syndrome
- Short QT syndrome
- Sick sinus syndrome
- Wellens syndrome
- Wolff Parkinson White syndrome
Toxicology / Overdose
- Beta blocker toxicity
- Calcium channel blocker toxicity
- Carbamazepine toxicity
- Digoxin effect
- Digoxin toxicity
- Propranolol toxicity
- Quetiapine toxicity
- Sodium channel blocker toxicity
- Sotalol toxicity
Other
- Aortic dissection
- Aortic stenosis
- Atrial Septal Defect
- Cardiac T-wave memory
- Coronary artery spasm
- Dextrocardia
- Dilated cardiomyopathy
- Hyperthermia
- Hyperthyroidism
- Hypothermia
- Hypothyroidism
- Juvenile T wave pattern
- Metabolic acidosis
- Myocardial Bridging
- Myocarditis
- Normal
- Normal ST elevation
- Raised intracranial pressure
- Restrictive cardiomyopathy
- Reverse Takotsubo
- Spontaneous coronary artery dissection
- Takotsubo cardiomyopathy
Clinical Problems
Cardiovascular symptoms
- Cardiac arrest
- Chest pain
- Hypertension
- Hypotension
- Palpitations
General symptoms
- Cough
- Dizziness
- Dyspnoea
- Fatigue
- Loss of consciousness
- Syncope
- Weakness
Other Problems
- Abdominal pain
- Blunt Trauma
- Chronic kidney disease
- Diarrhoea
- Fever
- Long lie
- Muscle pains
- Seizure
- Vomiting
ECG Paint
ECG Simulator
Chest pain and a non-diagnostic ECG. No worries, right?
This ECG is from a middle aged man presented with chest pain. This is the first prehospital ECG that was recorded.
Is this ECG diagnostic of coronary occlusion? Also: Inferior de Winter’s T-waves on prehospital ECG?? Baseline ECG
This ECG is from a man in his 50s presented with 1 hour of post exertional chest pressure associated with diaphoresis and nausea. He had a history of coronary artery disease, diabetes, and dyslipidemia.
A 54 yo male with sudden chest pain. Computer says normal. Paramedic disagrees. – repeat ECG after stenting
What is lurking underneath this new right bundle branch block? – next morning
Is this acute coronary occlusion? Simple ACS? Where is the culprit lesion? – post cath ECG
A 50-Something w Chest Pain, Anterior STE, and no Evolution on 3 Serial ECGs over 30 minutes, (-) POCUS. Baseline ECG
Echocardiography, even (or especially) with Speckle Tracking, can get you in trouble. Repeat 4 hours
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