ARCHIVES and ANSWERS |
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OCTOBER 2009 |
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SEPTEMBER 2009 |
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SEPTEMBER 2009 ANSWERS |
ECG#1
1. Normal Sinus Rhythm
2. Premature atrial complexes
3. RSR Prime V1 V2 suggesting right ventricular conduction delay
4. Left anterior fascicular block
5. Possible old anterolateral myocardial infarction
ECG#2
1. Sinus bradycardia
2. 1° AV block
3. Premature ventricular complexes
4. Anterior ischemia
5. Inferior wall myocardial infarction, age undetermined
6. Prolonged QT
ECG#3
1. Sinus bradycardia at 55 bpm
2. Short PR interval
3. Low voltage, possible left atrial abnormality
4. Anteroseptal myocardial infarction, age undetermined
ECG#4
1. Sinus rhythm at approximately 100bpm
2. Sine wave pattern consistent with hyperkalemia (potassium 8.9 mg/dl)
3. AV sequential pacemaker rhythm with long AV delay
4. Premature atrial complexes
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JULY 2009 |
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JULY 2009 ANSWERS |
ECG #1
1. Normal Sinus Rhythm
2. Premature ventricular complexes
3. Old anteroseptal myocardial infarction
ECG#2
1. Normal Sinus Rhythm at approx. 100bpm
2. 3° AV block
3. Ventricular escape rhythm
(Alternate Reading)
1. Junctional escape with right bundle branch block
2. Left anterior fascicular block
3. Left ventricular hypertrophy and possible septal myocardial infarction
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MAY 2009 |
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MAY 2009 ANSWERS |
ECG#1
1. Normal sinus rhythm at 68bpm
2. 1st degree AV block
3. Accelerated idioventricular rhythm at 90bpm initially and accelerating to approx 100bpm. AV disassociation noted.
ECG#2
1. Normal sinus rhythm
2. Premature atrial complexes
3. Left axis deviation
4. Acute anterolateral MI
5. Acute inferior subepicardial injury
ECG#3
1. AV sequential pacemaker rhythm
2. Premature atrial complexes with ventricular tracking
3. Pseudofusion beats
4. Inferior and lateral subendocardial injury
5. Appropriate atrial and ventricular sensing and capture
ECG#4
1. Underlying sinus rhythm at approximately 90bpm
2. Intraventricular conduction delay
3. Toursades de Point
ECG#5
1. Underlying atrial fibrillation
2. Ventricular demand pacemaker rhythm
3. Premature ventricular complexes
4. Pseudofusion beats
5. Adequate ventricular sensing and capture
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APRIL 2009 |
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APRIL 2009 ANSWERS |
ECG#1
1. Sinus tachycardia
2. Premature ventricular complexes
3. Left atrial abnormality
4. Superior axis
5. Right ventricular hypertrophy
6. Low QRS voltage
ECG#2
1. Sinus tachycardia
2. Possible left abnormality
3. Low QRS voltage
4. Superior axis
5. Anterolateral MI age undetermined
6. Cannot exclude right sided ECG
ECG#3
1. Sinus tachycardia with an atrial rate of approximately 110bpm
2. 3rd degree AV block
3. Acelerated Junctional rhythm
4. Possible left atrial abnormality
5. Intraventricular conduction delay
6. Left ventricular hypertrophy with secondary ST-T wave changes
7. Lateral MI age undetermined
8. Possible septal MI age undetermined
ECG#4
This ecg is on an 8 year old male
1. Lead reversal ecg corrects for reversal
2. Normal sinus rhythm with sinus arrhythmia
3. Possible left atrial abnormality
4. RSR Prime V1, V2
5. Possibly representing right ventricular conduction delay
ECG#5
1. AV sequential pacemaker rhythm
2. Premature atrial complexes
3. Premature ventricular complexes
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FEBRUARY 2009 |
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FEBRUARY 2009 ANSWERS |
ECG#1
1. Junctional rhythm with fusion beats
2. Acelerated idioventricular rhythm with premature ventricular complexes
ECG#2
1. Sinus tachycardia
2. Premature atrial complexes
3. Pericarditis ( patient has known history of renal failure)
ECG#3
1. Sinus tachycardia
2. Right axis deviation
3. Left atrial abnormality
4. Acute anterolateral MI
5. Premature ventricular complexes / fusion beats
ECG#4
1. Ventricular flutter approximately 280bpm
2. Antitacycardia pacing leading to ventricular fibrillation
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JANUARY 2009 |
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JANUARY 2009 ANSWERS |
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January 2009
ECG#1
1. Sinus tachycardia
2. Anterolateral MI age undertermined
3. Nonspecific ST segment changes, cannot exclude Borgada syndrome
ECG#2
1. Normal sinus rhythm
2. Left axis deviation
3. Left ventricular hypertrophy with QRS widening and secondary ST-T wave changes
4. Anterior T wave changes consistent with ischemia
5. Cannot exclude lateral ischemia
ECG#3
1. Atrial fibrillation with rapid ventricular response
2. Right axis deviation
3. Right ventricular hypertrophy
4. Nonspecific ST segment changes
(clinical history: Patient has a history of rheumatic heart disease and mitral stenosis. He underwent a mitral valve commissurotomy approximately 20 years ago. An echo shows normal LV function; borderline right ventricular hypertrophy; right atrial and right ventricular enlargement. Pulmonary artery pressure of 90mmHg)
ECG#4
1. Sinus bradycardia at 55bpm
2. Ventricular escape beats at approximately 25bpm
3. Premature atrial complexes
(Clinical history: Patient is a 63 year old man. Rhythm taken while patient was asleep.)
ECG#5
1. Normal sinus rhythm
2. Possible left atrial abnormality
3. Left axis deviation
4. Probable right bundle branch block
5. Inferior and posterior subendocardial injury
6. Cannot exclude septal subepicardial injury
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DECEMBER 2008 ANSWERS |
ECG#1
1. Normal sinus rhythm
2. Septal MI / recent
3. Anterior T wave changes consistent with ischemia
ECG#2
1. Normal sinus rhythm possible left atrial abnormality
2. dextrocardia
ECG#3
1. Ectopic atrial rhythm at 55 bpm
2. Episode of atrial tachycardia at approximately 160bpm, with complete heart block and Junctional escape beats.
3. Cannot exclude lateral MI – age undetermined. (Q wave 1 and AVL)
ECG #4
1. Normal sinus rhythm
2. 1st degree AV block
3. Possible left atrial abnormality
4. Left bundle branch block
5. Left axis deviation
6. Premature ventricular complex
7. Cannot exclude lateral subendocardial injury
ECG#5
1. Sinus bradycardia
2. Changes consistent with hypokalemia (prolonged QT , U waves, flatten T waves)
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NOVEMBER 2008 |
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November 2008 Answers: |
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| 1. Sinus bradycardia / intermittent accelerated Junctional rhythm / premature Junctional complex / |
| 2. Normal sinus rhythm / possible left atrial abnormality / left ventricular hypertrophy / recent inferior wall MI / recent anterior wall MI |
| 3. Normal sinus rhythm / 2nd degree AV block Mobitz type I / Baseline artifact / Prolonged QT / Nonspecific ST-T wave changes |
| 4. Sinus bradycardia / 1st degree AV block / LBBB / borderline left axis deviation |
| 5. Supraventriculartachycardia (probably AV nodal re-entrant tachycardia) / inferior and lateral ST-T wave changes / possible injury |
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OCTOBER 2008 |
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October 2008 Answers: |
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***Please note ECG 1 and ECG 4 are exactly the same*** |
| 1. Normal sinus rhythm / R-wave reversal consider anterior wall myocardial infarction / cannot exclude lateral wall MI |
| 2. Normal sinus rhythm / premature atrial complexes / anterolateral myocardial infarction, age undetermined / low QRS voltage |
3. Probably sinus rhythm, although cannot exclude atrialfibrillation / flutter with accelerated Junctional rhythm / probable baseline artifact/ non-specific ST-T wave changes (suggest repeat ECG would consider digoxin toxicity |
| 4. Normal sinus rhythm / R-wave reversal consider anterior wall myocardial infarction / cannot exclude lateral wall MI |
| 5. Underlying sinus bradycardia at 52bpm / ventricular pacemaker beats with intermittent capture / appropriate ventricular sensing / possible LA abnormality / (intermittent ventricular failure to capture) |
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SEPTEMBER 2008 |
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September 2008 Answers: |
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1. Normal sinus rhythm / 1st degree AV block / premature ventricular complexes / left axis deviation / RBBB/ inferior wall MI, age undetermined
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| 2. Normal sinus rhythm / Anterolateral ischemia |
| 3. Accelerated idioventricular rhythm |
| 4. Sinus bradycardia / possible LVH / acute inferior wall subepicardial injury/ acute posterior wall subepicardial injury / poor R wave progression |
| 5. Sinus tachycardia at 110bpm / second degree AV block Mobitz type II with ventricular conduction at approximately 34 beats per minute |
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August 2008 |
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August 2008 Answers |
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| 1. Sinus tachycardia / left atrial abnormality / possible right atrial abnormality / Incomplete RBBB |
| 2. Atrial fibrillation with controlled ventricular response / ventricular demand pacemaker beats / anterolateral ischemia / inferior ischemia |
| 3. Regular wide complex rhythm , artifact |
| 4. Junctional tachycardia / possible anteroseptal myocardial infarction, age undetermined |
| 5. Normal sinus rhythm / recent anterolateral myocardial infarction / right axis deviation |
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June2008 |
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May 2008 |
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April 2008 |
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January 2008 |
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December 19, 2007 - 7:15 AM, Location: TBA |
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December 2007 Answers: |
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| 1. NSR; possible left atrial enlargement; premature ventricular contractions; Poor R wave progression (consider right ventricular hypertrophy); right axis deviation. |
| 2. Sinus tachycardia; prolonged QTc; septal MI age undetermined; inferior MI age undetermined; nonspecific ST and T changes. |
| 3. NSR; left ventricular hypertrophy with secondary ST and T changes; early transition. |
| 4. NSR; right bundle branch block; prolonged QTc; left atrial abnormality; small lateral Q waves; (patient is 39 years old – consider right ventricular pressure / volume overload state [e.g. atrial septal defect]) |
| 5. Atrial fibrillation with rapid ventricular response at 150BPM; ventricular overdrive pacing at 180BPM. |
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28 November 2007 |
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November 2007 Answers: |
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ECG #1
1. Sinus tachycardia at approximately 115 bpm
2. 3rd degree atrial ventricular block
3. Ventricular escape rhythm at approximately 30 bpm
4. Possible left atrial abnormality |
ECG #2
1. Underlying atrial fibrillation
2. Ventricular demand pacemaker rhythm
3. Premature ventricular complexes
4. Pseudofusion |
ECG #3
1. Normal sinus rhythm
2. Left bundle branch block
3. Anterior t-wave changes consistent with ischemia |
ECG #4
1. Normal sinus rhythm
2. Right axis deviation
3. Probable right ventricular hypertrophy |
ECG#5
1. Atrial fibrillation with controlled ventricular response
2. Ventricular demand pacemaker rhythm at approximately 80 bpm
3. Premature ventricular complexes
4. Inferolateral ST-T wave changes consider subendocardial injury or digoxin effect
5. Left ventricular hypertrophy
6. Possible anteroseptal myocardial infarction, age undetermined |
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October 31, 2007 |
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August 22, 2007 |
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October 31, 2007 Answers |
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1. Sinus bradycardia
Right bundle branch block
Left fascicular block
Nonspecific inferior T changes |
2. Coarse atrial fibrillation with rapid ventricular response, RSr’V1, V2
Nonspecific inferior ST-T wave changes |
3. Atrial flutter with 2:1 conduction vs. Junctional tachycardia with V-A conduction
Consider Inferolateral subendocardial injury |
4. Atrial fibrillation with controlled ventricular response at 70 bpm
Ventricular asystole
Consider drug toxicity (e.g. digoxin).
(The first part of the rhythm is very regular – consider third degree AV block with Junctional escape rhythm.) |
5. Normal sinus rhythm, pre-excitation (e.g. WPW)
Delta waves, Short PR interval |
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1. Normal sinus rhythm
Premature ventricular contractions
Poor R-wave progression (consider right ventricular hypertrophy)
Right axis deviation
Possible left atrial abnormality |
2. Sinus tachycardia
Prolonged QTc
Septal MI age undetermined
Inferior MI age undetermined
Non-specific ST-T changes |
3. Normal sinus rhythm
Left ventricular hypertrophy with secondary ST-T changes
Early transition |
4. 39 Year-old-man. Normal sinus rhythm
Right bundle branch block
Prolonged QTc
Left atrial enlargement
Small lateral Q waves
Clinical diagnosis should include RV pressure overload state (e.g. secundum atrial septal defect since right axis deviation. If left axis deviation, then should consider primum atrial septal defect.) |
5. Atrial fibrillation with rapid ventricular response at 150 bpm
Ventricular overdrive pacing from intracardiac defibrillator at 180 bpm |
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July 18, 2007 |
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July 18, 2007 Answers: |
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1. Normal sinus rhythm
Right bundle branch block |
2. Sinus tachycardia
Possible left atrial abnormality
Lateral ST elevation consistent with subepicardial injury
Reciprocal inferior ST and T changes |
3. Sinus rhythm with sinus arrhythmia |
4. Junctional rhythm at 50bpm
Ectopic atrial beat
Inferior subepicardial injury (acute vs. recent) |
5. Normal sinus rhythm lateral ischemia
Low voltage QRS voltage |
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June 13 ,
2007 |
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June 13, 2007 Answers |
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1. Sinus bradycardia at 50BPM; first degree AV block; early transition; nonspecific ST and T changes. |
2. NSR; Acute inferior and posterior wall MI; anterior and lateral ST segment depression consistent with subendocardial injury or reciprocal changes. |
3. This is a RIGHT SIDED ECG from the same person as #2; NSR; acute inferior and posterior MI; lateral ST segment depression consistent with subendocardial injury or reciprocal changes; No significant ST segment elevation in right V leads (e.g. EV3 or RV4) to suggest right ventricular MI) |
4. Ectopic atrial rhythm; inferior MI age undetermined; poor R wave progression; left axis deviation. |
5. Ectopic atrial tachycardia (cannot exclude atrioventricular reentrant tachycardia); nonspecific St and T changes. |
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May 16, 2007 |
MAY EKG "A" |
MAY EKG "B" |
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MAY 16, 2007 ANSWERS |
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1. NSR; Possible left atrial abnormality; left ventricular hypertrophy with secondary ST and T changes; cannot exclude inferior/lateral ischemia. |
2. Underlying sinus rhythm at 100BPM with premature ventricular complexes; Supraventricular tachycardia at 170BPM (? Ectopic atrial rhythm vs. atrioventricular reentrant tachycardia); nonspecific ST and T changes. |
3. NSR at 70BPM; second degree atrioventricular block – Mobitz type II; ventricular demand pacemaker rhythm at 50 BPM (appropriate ventricular capture and sensing). |
4. Junctional rhythm at 38BPM; RBBB; low QRS voltage. |
5. NSR; inferolateral Q waves— consider MI; possible posterior wall MI age undetermined; pericarditis. |
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APRIL 2007 |
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APRIL 2007 ANSWERS |
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FEBRUARY
2007 |
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FEBRUARY 2007 ANSWERS |
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1. NSR, LVH with QRS widening; Left axis deviation – consider anterior fasicular block; consider anterolateral MI. |
2. NSR, Incomplete right bundle branch block, possible left atrial abnormality. |
3. NSR, right axis deviation, probably right ventricular hypertrophy, anterior/inferior/lateral T wave inversion – consider ischemia, prolonged QT interval. |
4. Atrial flutter with rapid ventricular response; ventricular pacemaker rhythm at 115 beats per minute; fusion beats. |
5. Sinus tachycardia; right atrial abnormality; possible left atrial abnormality; anteroseptal MI age undetermined; low QRS voltage. |
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JANUARY 2007 |
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JANUARY 2007 ANSWERS |
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1. Sinus rhythm with sinus arrhythmia, Poor R wave progression – consider anterior MI age undetermined, Left axis deviation, Low QRS voltage, Short QT interval, Consider anterior ischemia. |
2. Atrial flutter with controlled ventricular response, Non-specific ST and T wave changes. |
3. Normal sinus rhythm, Premature ventricular complex, Right ventricular hypertrophy with secondary ST and T wave changes. |
4. Sinus rhythm, Paroxysmal atrial fibrillation with aberrancy, Probable premature atrial complex with aberrancy.
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5. Normal sinus rhythm, Right bunch branch block, Left anterior fascicular block, Non-specific inferior ST and T wave changes.
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DECEMBER
2006 |
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DECEMBER 2006 ANSWERS |
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1. Normal sinus rhythm; Left branch bundle block with secondary ST-T wave changes |
2. Normal sinus rhythm; with sinus arrhythmia; prolonged QT interval |
3. Sinus tachycardia; Low QRS voltage; Poor R-wave progression; R-wave reversal; Consider anterior MI; prolonged QT interval |
4. Sinus tachycardia; Inferior / posterior MI – possibly acute |
5. Junctional tachycardia; inferoposterior subepicordial injury; lateral reciprocal changes. |
6. Multifocal atrial tachycardia; non-specific ST-T wave changes. |
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