Transcript Chain of Survival and EMSC

12-Lead ECG Review
Copyright © 2006 by Mosby Inc. All rights reserved.
Instructions

The following screens provide examples of normal
and abnormal 12-lead ECGs. Examine each of them
closely, and then interpret the 12-lead.

When you are finished, advance to the next slide to
check your answer.

Because these 12-leads were obtained from many
different sources, not all answers are in a consistent
format.
 For example, some 12-leads show the measurements
for the PR interval, QRS duration, axis measurements,
etc., and some do not.
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #1
I
Lateral
aVR
------------
V1 Septum
V4 Anterior
V4R Right Ventricle
II Inferior
aVL Lateral
V2 Septum
V5 Lateral
V5R Right Ventricle
III Inferior
aVF Inferior
V3 Anterior
V6 Lateral
V6R Right Ventricle
Baseline wander or artifact?
Yes  No 
ST-segment elevation?
Leads: _________
Underlying rhythm?
_________________
ST-segment depression?
Leads: _________
Pathologic Q waves?
Leads: __________
T-wave changes?
Leads: _________
Poor R-wave progression?
Leads: __________
Interpretation:
______________________________________
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #1
Baseline wander or
artifact?
V6
Underlying rhythm?
Sinus
tachycardia
at 108 bpm
ST-segment
elevation?
None
ST-segment
depression?
None
T-wave changes?
None
Interpretation:
Sinus tachycardia,
otherwise normal ECG
PR interval 146 ms
QRS 104 ms
QT/QTc 322/431 ms
P-R-T axes 60 39 28
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #2
I
Lateral
aVR
------------
V1 Septum
V4 Anterior
V4R Right Ventricle
II Inferior
aVL Lateral
V2 Septum
V5 Lateral
V5R Right Ventricle
III Inferior
aVF Inferior
V3 Anterior
V6 Lateral
V6R Right Ventricle
Baseline wander or artifact?
Yes  No 
ST-segment elevation?
Leads: _________
Underlying rhythm?
_________________
ST-segment depression?
Leads: _________
Pathologic Q waves?
Leads: __________
T-wave changes?
Leads: _________
Poor R-wave progression?
Leads: __________
Interpretation:
______________________________________
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #2
Baseline wander or
artifact?
None
Underlying rhythm?
Sinus rhythm
at 60 bpm
ST-segment
elevation?
None
ST-segment
depression?
None
T-wave changes?
None
Interpretation:
Sinus rhythm, right atrial
enlargement; increased
R/S ratio in V1, consider
early transition or
posterior infarct
PR interval 184 ms
QRS 84 ms
QT/QTc 378/378 ms
P-R-T axes 47 48 48
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #3
I
Lateral
aVR
------------
V1 Septum
V4 Anterior
V4R Right Ventricle
II Inferior
aVL Lateral
V2 Septum
V5 Lateral
V5R Right Ventricle
III Inferior
aVF Inferior
V3 Anterior
V6 Lateral
V6R Right Ventricle
Baseline wander or artifact?
Yes  No 
ST-segment elevation?
Leads: _________
Underlying rhythm?
_________________
ST-segment depression?
Leads: _________
Pathologic Q waves?
Leads: __________
T-wave changes?
Leads: _________
Poor R-wave progression?
Leads: __________
Interpretation:
______________________________________
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #3
Baseline wander or
artifact?
None
Underlying rhythm?
Atrial flutter at
175 bpm
ST-segment
elevation?
None
ST-segment
depression?
None
T-wave changes?
Inverted V1, V2,
V3
Interpretation:
Atrial flutter with
variable block;
nonspecific ST and
T-wave changes
PR interval None
QRS 84 ms
QT/QTc 248/420 ms
P-R-T axes 67 -3 12
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #4
I
Lateral
aVR
------------
V1 Septum
V4 Anterior
V4R Right Ventricle
II Inferior
aVL Lateral
V2 Septum
V5 Lateral
V5R Right Ventricle
III Inferior
aVF Inferior
V3 Anterior
V6 Lateral
V6R Right Ventricle
Baseline wander or artifact?
Yes  No 
ST-segment elevation?
Leads: _________
Underlying rhythm?
_________________
ST-segment depression?
Leads: _________
Pathologic Q waves?
Leads: __________
T-wave changes?
Leads: _________
Poor R-wave progression?
Leads: __________
Interpretation:
______________________________________
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #4
Baseline wander or
artifact?
Wander V5;
artifact II, III
Underlying rhythm?
Sinus
tachycardia at
136 bpm
ST-segment
elevation?
V1, V2, V3?
ST-segment
depression?
I, II, III, aVL,
aVF, V5, V6
T-wave changes?
Inverted I, II
Interpretation:
Sinus tachycardia, left atrial
enlargement; nonspecific
intraventricular block;
T-wave abnormality,
consider lateral ischemia
PR interval 182 ms
QRS 138 ms
QT/QTc 306/460 ms
P-R-T axes 60 -13 12
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #5
I
Lateral
aVR
------------
V1 Septum
V4 Anterior
V4R Right Ventricle
II Inferior
aVL Lateral
V2 Septum
V5 Lateral
V5R Right Ventricle
III Inferior
aVF Inferior
V3 Anterior
V6 Lateral
V6R Right Ventricle
Baseline wander or artifact?
Yes  No 
ST-segment elevation?
Leads: _________
Underlying rhythm?
_________________
ST-segment depression?
Leads: _________
Pathologic Q waves?
Leads: __________
T-wave changes?
Leads: _________
Poor R-wave progression?
Leads: __________
Interpretation:
______________________________________
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #5
Baseline wander or
artifact?
None
Underlying rhythm?
Sinus rhythm
at 77 bpm
ST-segment
elevation?
None
ST-segment
depression?
None
T-wave changes?
None
Interpretation:
Sinus rhythm; low
voltage in aVL otherwise
normal ECG
PR interval 156 ms
QRS 80 ms
QT/QTc 356/402 ms
P-R-T axes 73 56 60
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #6
I
Lateral
aVR
------------
V1 Septum
V4 Anterior
V4R Right Ventricle
II Inferior
aVL Lateral
V2 Septum
V5 Lateral
V5R Right Ventricle
III Inferior
aVF Inferior
V3 Anterior
V6 Lateral
V6R Right Ventricle
Baseline wander or artifact?
Yes  No 
ST-segment elevation?
Leads: _________
Underlying rhythm?
_________________
ST-segment depression?
Leads: _________
Pathologic Q waves?
Leads: __________
T-wave changes?
Leads: _________
Poor R-wave progression?
Leads: __________
Interpretation:
______________________________________
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #6
Baseline wander or
artifact?
None
Underlying rhythm?
Sinus
bradycardia at
58 bpm
ST-segment
elevation?
None
ST-segment
depression?
None
T-wave changes?
None
Interpretation:
Sinus bradycardia,
otherwise normal ECG
PR interval 176 ms
QRS 86 ms
QT/QTc 420/412 ms
P-R-T axes 40 73 35
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #7
I
Lateral
aVR
------------
V1 Septum
V4 Anterior
V4R Right Ventricle
II Inferior
aVL Lateral
V2 Septum
V5 Lateral
V5R Right Ventricle
III Inferior
aVF Inferior
V3 Anterior
V6 Lateral
V6R Right Ventricle
Baseline wander or artifact?
Yes  No 
ST-segment elevation?
Leads: _________
Underlying rhythm?
_________________
ST-segment depression?
Leads: _________
Pathologic Q waves?
Leads: __________
T-wave changes?
Leads: _________
Poor R-wave progression?
Leads: __________
Interpretation:
______________________________________
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #7
Baseline wander or
artifact?
Some artifact in
most leads
Underlying rhythm?
Sinus rhythm at
75 bpm
ST-segment
elevation?
I, II, III, aVF,
V1-V6
T-wave changes?
Inverted in V1
Interpretation:
Anteroseptal infarct
with septal extension
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #8
I
Lateral
aVR
------------
V1 Septum
V4 Anterior
V4R Right Ventricle
II Inferior
aVL Lateral
V2 Septum
V5 Lateral
V5R Right Ventricle
III Inferior
aVF Inferior
V3 Anterior
V6 Lateral
V6R Right Ventricle
Baseline wander or artifact?
Yes  No 
ST-segment elevation?
Leads: _________
Underlying rhythm?
_________________
ST-segment depression?
Leads: _________
Pathologic Q waves?
Leads: __________
T-wave changes?
Leads: _________
Poor R-wave progression?
Leads: __________
Interpretation:
______________________________________
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #8
Baseline wander or
artifact?
Wander in I, II,
III, aVR
Underlying rhythm?
Sinus rhythm
at 69 bpm
ST-segment
elevation?
II, III, aVF
T-wave changes?
Inverted in V1,
V2
Interpretation:
Inferior infarction;
right-sided chest leads
should be obtained
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #9
I
Lateral
aVR
------------
V1 Septum
V4 Anterior
V4R Right Ventricle
II Inferior
aVL Lateral
V2 Septum
V5 Lateral
V5R Right Ventricle
III Inferior
aVF Inferior
V3 Anterior
V6 Lateral
V6R Right Ventricle
Baseline wander or artifact?
Yes  No 
ST-segment elevation?
Leads: _________
Underlying rhythm?
_________________
ST-segment depression?
Leads: _________
Pathologic Q waves?
Leads: __________
T-wave changes?
Leads: _________
Poor R-wave progression?
Leads: __________
Interpretation:
______________________________________
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #9
Baseline wander or
artifact?
None
Underlying rhythm?
Sinus rhythm
at 80 bpm
ST-segment
depression?
I, aVL
ST-segment
elevation?
V3
T-wave changes?
Inverted in I,
aVL
Interpretation:
LBBB
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #10
I
Lateral
aVR
------------
V1 Septum
V4 Anterior
V4R Right Ventricle
II Inferior
aVL Lateral
V2 Septum
V5 Lateral
V5R Right Ventricle
III Inferior
aVF Inferior
V3 Anterior
V6 Lateral
V6R Right Ventricle
Baseline wander or artifact?
Yes  No 
ST-segment elevation?
Leads: _________
Underlying rhythm?
_________________
ST-segment depression?
Leads: _________
Pathologic Q waves?
Leads: __________
T-wave changes?
Leads: _________
Poor R-wave progression?
Leads: __________
Interpretation:
______________________________________
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #10
Baseline wander or
artifact?
None
Underlying rhythm?
Sinus rhythm
at 80 bpm
Pathologic Q waves?
II, III, aVF
Poor R-wave
progression?
V1
ST-segment
depression?
ST-segment
elevation?
I, aVL
T-wave changes?
Inverted in II,
III, aVF
Interpretation:
Inferolateral infarct; possible
right ventricular infarct
(ST segment elevation
greater in V1 than V2)
Low voltage V4 -V6
II, III, aVF, V1 ,
V2
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #11
I
Lateral
aVR
------------
V1 Septum
V4 Anterior
V4R Right Ventricle
II Inferior
aVL Lateral
V2 Septum
V5 Lateral
V5R Right Ventricle
III Inferior
aVF Inferior
V3 Anterior
V6 Lateral
V6R Right Ventricle
Baseline wander or artifact?
Yes  No 
ST-segment elevation?
Leads: _________
Underlying rhythm?
_________________
ST-segment depression?
Leads: _________
Pathologic Q waves?
Leads: __________
T-wave changes?
Leads: _________
Poor R-wave progression?
Leads: __________
Interpretation:
______________________________________
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #11
Baseline wander
or artifact?
Baseline wander I, II, III,
aVL
Underlying
rhythm?
Sinus rhythm at 95 bpm
Pathologic Q
waves?
I
Poor R-wave
progression?
V2, V3
ST-segment
depression?
I, aVL, V5?, V6
ST-segment
elevation?
aVL, V1, V2, V3
T-wave changes?
Peaked in II, III, aVF;
inverted in V2-V4; not
oppositely deflected from
QRS in V5, V6
Interpretation:
Anteroseptal infarct;
LBBB
Note how the T-waves
were not oppositely
deflected from the QRS
complex as expected in
BBB
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #12
I
Lateral
aVR
------------
V1 Septum
V4 Anterior
V4R Right Ventricle
II Inferior
aVL Lateral
V2 Septum
V5 Lateral
V5R Right Ventricle
III Inferior
aVF Inferior
V3 Anterior
V6 Lateral
V6R Right Ventricle
Baseline wander or artifact?
Yes  No 
ST-segment elevation?
Leads: _________
Underlying rhythm?
_________________
ST-segment depression?
Leads: _________
Pathologic Q waves?
Leads: __________
T-wave changes?
Leads: _________
Poor R-wave progression?
Leads: __________
Interpretation:
______________________________________
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #12
Baseline wander or
artifact?
V1
Underlying rhythm?
Sinus bradycardia at
approximately 54 bpm
Pathologic Q
waves?
II?, III?, aVF?
Poor R-wave
progression?
V2, V3
ST-segment
depression?
I, aVL
ST-segment
elevation?
II, III, aVF
T-wave changes?
Inverted in I, aVL, V2,
V3, V4; tall/peaked in III,
aVF; flattened in V5, V6
Interpretation:
Inferior infarct.
Possible posterior
wall infarct. Possible
previous anteroseptal
infarct (poor R-wave
progression).
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #13
I
Lateral
aVR
------------
V1 Septum
V4 Anterior
V4R Right Ventricle
II Inferior
aVL Lateral
V2 Septum
V5 Lateral
V5R Right Ventricle
III Inferior
aVF Inferior
V3 Anterior
V6 Lateral
V6R Right Ventricle
Baseline wander or artifact?
Yes  No 
ST-segment elevation?
Leads: _________
Underlying rhythm?
_________________
ST-segment depression?
Leads: _________
Pathologic Q waves?
Leads: __________
T-wave changes?
Leads: _________
Poor R-wave progression?
Leads: __________
Interpretation:
______________________________________
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #13
Baseline wander or
artifact?
V1
Underlying rhythm?
Sinus bradycardia
at approximately 30
bpm
Pathologic Q waves?
II, III, V2, V3
Poor R-wave
progression?
V2
ST-segment
depression?
I, aVL
ST-segment elevation?
II, III, aVF
T-wave changes?
Inverted in aVL, V2;
tall/peaked in II, III,
aVF, V3-V6
Interpretation:
Inferior infarct
extending to the apex
(boundary of the
anterior and inferior
walls).
RSR’ pattern in V1,
QRS duration < 12
ms, therefore no BBB
is present. This is
often referred to as
incomplete BBB.
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #14
I
Lateral
aVR
------------
V1 Septum
V4 Anterior
V4R Right Ventricle
II Inferior
aVL Lateral
V2 Septum
V5 Lateral
V5R Right Ventricle
III Inferior
aVF Inferior
V3 Anterior
V6 Lateral
V6R Right Ventricle
Baseline wander or artifact?
Yes  No 
ST-segment elevation?
Leads: _________
Underlying rhythm?
_________________
ST-segment depression?
Leads: _________
Pathologic Q waves?
Leads: __________
T-wave changes?
Leads: _________
Poor R-wave progression?
Leads: __________
Interpretation:
______________________________________
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #14
Underlying rhythm? Sinus rhythm at
approximately 85
bpm
Interpretation:
Normal ECG
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #15
I
Lateral
aVR
------------
V1 Septum
V4 Anterior
V4R Right Ventricle
II Inferior
aVL Lateral
V2 Septum
V5 Lateral
V5R Right Ventricle
III Inferior
aVF Inferior
V3 Anterior
V6 Lateral
V6R Right Ventricle
Baseline wander or artifact?
Yes  No 
ST-segment elevation?
Leads: _________
Underlying rhythm?
_________________
ST-segment depression?
Leads: _________
Pathologic Q waves?
Leads: __________
T-wave changes?
Leads: _________
Poor R-wave progression?
Leads: __________
Interpretation:
______________________________________
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #15
Baseline wander or
artifact?
V6
Underlying rhythm?
Sinus rhythm at
approximately 85
bpm
ST-segment
depression?
I, aVL
ST-segment elevation?
V2-V5
T-wave changes?
Inverted in I, aVL
Interpretation:
Anterior infarction
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #16
I
Lateral
aVR
------------
V1 Septum
V4 Anterior
V4R Right Ventricle
II Inferior
aVL Lateral
V2 Septum
V5 Lateral
V5R Right Ventricle
III Inferior
aVF Inferior
V3 Anterior
V6 Lateral
V6R Right Ventricle
Baseline wander or artifact?
Yes  No 
ST-segment elevation?
Leads: _________
Underlying rhythm?
_________________
ST-segment depression?
Leads: _________
Pathologic Q waves?
Leads: __________
T-wave changes?
Leads: _________
Poor R-wave progression?
Leads: __________
Interpretation:
______________________________________
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #16
Pathologic Q waves?
aVF
Poor R-wave
progression?
V3
ST-segment
depression?
I, aVL
ST-segment
elevation?
III, aVF
T-wave changes?
Inverted III, aVF;
biphasic V2, V3
Interpretation:
Inferior infarct;
right-sided chest
leads should be
obtained
Possible previous
anterior infarct
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #17
I
Lateral
aVR
------------
V1 Septum
V4 Anterior
V4R Right Ventricle
II Inferior
aVL Lateral
V2 Septum
V5 Lateral
V5R Right Ventricle
III Inferior
aVF Inferior
V3 Anterior
V6 Lateral
V6R Right Ventricle
Baseline wander or artifact?
Yes  No 
ST-segment elevation?
Leads: _________
Underlying rhythm?
_________________
ST-segment depression?
Leads: _________
Pathologic Q waves?
Leads: __________
T-wave changes?
Leads: _________
Poor R-wave progression?
Leads: __________
Interpretation:
______________________________________
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #17
Baseline wander or Artifact in I, II, III, aVL
artifact?
ST-segment
elevation?
V3, V4
T-wave changes?
Peaked II, III; inverted
aVL; tall/peaked V4,
V5; flat I
Interpretation:
Anterior infarction;
low voltage II, III,
aVF
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #18
I
Lateral
aVR
------------
V1 Septum
V4 Anterior
V4R Right Ventricle
II Inferior
aVL Lateral
V2 Septum
V5 Lateral
V5R Right Ventricle
III Inferior
aVF Inferior
V3 Anterior
V6 Lateral
V6R Right Ventricle
Baseline wander or artifact?
Yes  No 
ST-segment elevation?
Leads: _________
Underlying rhythm?
_________________
ST-segment depression?
Leads: _________
Pathologic Q waves?
Leads: __________
T-wave changes?
Leads: _________
Poor R-wave progression?
Leads: __________
Interpretation:
______________________________________
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #18
Underlying
rhythm?
Sinus tachycardia
at 109 bpm with
occasional PVCs
ST-segment
depression?
I, aVL, V2
ST-segment
elevation?
II, III, aVF
T-wave
changes?
Inverted in I, aVL
Interpretation:
Possible inferior
infarct; right-sided
chest leads should be
obtained
PR interval 152 ms
QRS 100 ms
QT/QTc 316/380 ms
P-R-T axes 75 83 108
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #19
I
Lateral
aVR
------------
V1 Septum
V4 Anterior
V4R Right Ventricle
II Inferior
aVL Lateral
V2 Septum
V5 Lateral
V5R Right Ventricle
III Inferior
aVF Inferior
V3 Anterior
V6 Lateral
V6R Right Ventricle
Baseline wander or artifact?
Yes  No 
ST-segment elevation?
Leads: _________
Underlying rhythm?
_________________
ST-segment depression?
Leads: _________
Pathologic Q waves?
Leads: __________
T-wave changes?
Leads: _________
Poor R-wave progression?
Leads: __________
Interpretation:
______________________________________
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #19
Baseline wander
or artifact?
Artifact II, III, aVL, aVF
Underlying
rhythm?
Sinus rhythm at
100 bpm
Pathologic Q
waves?
III (initial R-wave vs.
artifact), V2, V3
Poor R-wave
progression?
V3, V4
ST-segment
depression?
V5, V6; slight in I, II
ST-segment
elevation?
V1-V3
Interpretation:
Anteroseptal
infarct; low
voltage in II, aVF
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #20
I
Lateral
aVR
------------
V1 Septum
V4 Anterior
V4R Right Ventricle
II Inferior
aVL Lateral
V2 Septum
V5 Lateral
V5R Right Ventricle
III Inferior
aVF Inferior
V3 Anterior
V6 Lateral
V6R Right Ventricle
Baseline wander or artifact?
Yes  No 
ST-segment elevation?
Leads: _________
Underlying rhythm?
_________________
ST-segment depression?
Leads: _________
Pathologic Q waves?
Leads: __________
T-wave changes?
Leads: _________
Poor R-wave progression?
Leads: __________
Interpretation:
______________________________________
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #20
Baseline wander
or artifact?
Underlying
rhythm?
Poor R-wave
progression?
Artifact I, aVL
Interpretation:
Inferior infarct,
reciprocal changes;
Sinus rhythm at 85 bpm possible posterior
infarct; right-sided
chest leads should
V2-V6
be obtained
ST-segment
depression?
I, aVL, V2 -V6
ST-segment
elevation?
II, III, aVF
T-wave changes?
Tall/peaked in II, III,
aVF; inverted in aVL,
V2-V6
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #21
I
Lateral
aVR
------------
V1 Septum
V4 Anterior
V4R Right Ventricle
II Inferior
aVL Lateral
V2 Septum
V5 Lateral
V5R Right Ventricle
III Inferior
aVF Inferior
V3 Anterior
V6 Lateral
V6R Right Ventricle
Baseline wander or artifact?
Yes  No 
ST-segment elevation?
Leads: _________
Underlying rhythm?
_________________
ST-segment depression?
Leads: _________
Pathologic Q waves?
Leads: __________
T-wave changes?
Leads: _________
Poor R-wave progression?
Leads: __________
Interpretation:
______________________________________
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #21
Baseline wander or
artifact?
Artifact I, II, III, aVL, aVF,
V5, V6
Underlying rhythm?
Sinus rhythm at 60 bpm
Poor R-wave
progression?
V2-V3
ST-segment
depression?
aVL
ST-segment
elevation?
II, III, aVF
T-wave changes?
Tall/peaked in II, III, aVF,
V3-V5; inverted in aVL
Interpretation:
Inferoapical
infarct,
right-sided chest
leads should be
obtained
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #22
I
Lateral
aVR
------------
V1 Septum
V4 Anterior
V4R Right Ventricle
II Inferior
aVL Lateral
V2 Septum
V5 Lateral
V5R Right Ventricle
III Inferior
aVF Inferior
V3 Anterior
V6 Lateral
V6R Right Ventricle
Baseline wander or artifact?
Yes  No 
ST-segment elevation?
Leads: _________
Underlying rhythm?
_________________
ST-segment depression?
Leads: _________
Pathologic Q waves?
Leads: __________
T-wave changes?
Leads: _________
Poor R-wave progression?
Leads: __________
Interpretation:
______________________________________
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #22
Underlying
rhythm?
Sinus rhythm at 80
bpm
ST-segment
depression?
I, aVL, V1-V4
ST-segment
elevation?
II, III, aVF
T-wave changes?
Tall/peaked in II, III,
aVF; inverted in aVL,
V1-V4
Interpretation:
Inferior infarct;
right-sided chest leads
should be obtained;
nonspecific intraventricular
conduction delay
PR interval 196 ms
QRS 112 ms
QT/QTc 376/412 ms
P-R-T axes 71 75 93
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #23
I
Lateral
aVR
------------
V1 Septum
V4 Anterior
V4R Right Ventricle
II Inferior
aVL Lateral
V2 Septum
V5 Lateral
V5R Right Ventricle
III Inferior
aVF Inferior
V3 Anterior
V6 Lateral
V6R Right Ventricle
Baseline wander or artifact?
Yes  No 
ST-segment elevation?
Leads: _________
Underlying rhythm?
_________________
ST-segment depression?
Leads: _________
Pathologic Q waves?
Leads: __________
T-wave changes?
Leads: _________
Poor R-wave progression?
Leads: __________
Interpretation:
______________________________________
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #23
Underlying
rhythm?
Junctional tachycardia
(?) at 110 bpm
Interpretation:
Anteroseptal infarction,
left axis deviation
ST-segment
depression?
II, III, aVF; slight in V5,
V6
ST-segment
elevation?
V1, V2, V3, V4
PR interval None
QRS 92 ms
QT/QTc 296/361 ms
P-R-T axes 999 -69 52
T-wave changes?
Tall/peaked in V2-V4
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #24
I
Lateral
aVR
------------
V1 Septum
V4 Anterior
V4R Right Ventricle
II Inferior
aVL Lateral
V2 Septum
V5 Lateral
V5R Right Ventricle
III Inferior
aVF Inferior
V3 Anterior
V6 Lateral
V6R Right Ventricle
Baseline wander or artifact?
Yes  No 
ST-segment elevation?
Leads: _________
Underlying rhythm?
_________________
ST-segment depression?
Leads: _________
Pathologic Q waves?
Leads: __________
T-wave changes?
Leads: _________
Poor R-wave progression?
Leads: __________
Interpretation:
______________________________________
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #24
Underlying
rhythm?
Sinus rhythm at 80 bpm
Interpretation:
Normal ECG
PR interval 148 ms
QRS 80 ms
QT/QTc 356/409 ms
P-R-T axes 72 75 50
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #25
I
Lateral
aVR
------------
V1 Septum
V4 Anterior
V4R Right Ventricle
II Inferior
aVL Lateral
V2 Septum
V5 Lateral
V5R Right Ventricle
III Inferior
aVF Inferior
V3 Anterior
V6 Lateral
V6R Right Ventricle
Baseline wander or artifact?
Yes  No 
ST-segment elevation?
Leads: _________
Underlying rhythm?
_________________
ST-segment depression?
Leads: _________
Pathologic Q waves?
Leads: __________
T-wave changes?
Leads: _________
Poor R-wave progression?
Leads: __________
Interpretation:
______________________________________
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #25
Underlying
rhythm?
Sinus bradycardia at
56 bpm with short PR
interval
ST-segment
depression?
II, III, aVF, V6
ST-segment
elevation?
V1, V2, V3, V4; slight
in V5
T-wave changes?
Tall/peaked in V2-V4
Interpretation:
Anteroseptal infarction
PR interval 116 ms
QRS 100 ms
QT/QTc 456/447 ms
P-R-T axes 44 75 16
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #26
I
Lateral
aVR
------------
V1 Septum
V4 Anterior
V4R Right Ventricle
II Inferior
aVL Lateral
V2 Septum
V5 Lateral
V5R Right Ventricle
III Inferior
aVF Inferior
V3 Anterior
V6 Lateral
V6R Right Ventricle
Baseline wander or artifact?
Yes  No 
ST-segment elevation?
Leads: _________
Underlying rhythm?
_________________
ST-segment depression?
Leads: _________
Pathologic Q waves?
Leads: __________
T-wave changes?
Leads: _________
Poor R-wave progression?
Leads: __________
Interpretation:
______________________________________
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #26
Underlying
rhythm?
Sinus tachycardia at
117 bpm
Interpretation:
Sinus tachycardia,
otherwise normal ECG
PR interval 174 ms
QRS 96 ms
QT/QTc 304/424 ms
P-R-T axes 39 20 53
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #27
I
Lateral
aVR
------------
V1 Septum
V4 Anterior
V4R Right Ventricle
II Inferior
aVL Lateral
V2 Septum
V5 Lateral
V5R Right Ventricle
III Inferior
aVF Inferior
V3 Anterior
V6 Lateral
V6R Right Ventricle
Baseline wander or artifact?
Yes  No 
ST-segment elevation?
Leads: _________
Underlying rhythm?
_________________
ST-segment depression?
Leads: _________
Pathologic Q waves?
Leads: __________
T-wave changes?
Leads: _________
Poor R-wave progression?
Leads: __________
Interpretation:
______________________________________
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #27
Underlying
rhythm?
Sinus rhythm at 83
Interpretation:
Sinus rhythm, left axis
deviation
PR interval 176 ms
QRS 92 ms
QT/QTc 408/479 ms
P-R-T axes 62 -39 70
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #28
I
Lateral
aVR
------------
V1 Septum
V4 Anterior
V4R Right Ventricle
II Inferior
aVL Lateral
V2 Septum
V5 Lateral
V5R Right Ventricle
III Inferior
aVF Inferior
V3 Anterior
V6 Lateral
V6R Right Ventricle
Baseline wander or artifact?
Yes  No 
ST-segment elevation?
Leads: _________
Underlying rhythm?
_________________
ST-segment depression?
Leads: _________
Pathologic Q waves?
Leads: __________
T-wave changes?
Leads: _________
Poor R-wave progression?
Leads: __________
Interpretation:
______________________________________
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #28
Baseline wander
or artifact?
Artifact in I, II, III;
wander in V5
Underlying
rhythm?
Sinus rhythm at 72 bpm
with first-degree AV block
ST-segment
depression?
II, aVF, V5, V6
ST-segment
elevation?
V2, V3; slight in V1, V4
T-wave changes?
Inverted in aVL
Interpretation:
Possible anteroseptal
infarct
PR interval 208 ms
QRS 76 ms
QT/QTc 380/405 ms
P-R-T axes 83 -29 77
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #29
I
Lateral
aVR
------------
V1 Septum
V4 Anterior
V4R Right Ventricle
II Inferior
aVL Lateral
V2 Septum
V5 Lateral
V5R Right Ventricle
III Inferior
aVF Inferior
V3 Anterior
V6 Lateral
V6R Right Ventricle
Baseline wander or artifact?
Yes  No 
ST-segment elevation?
Leads: _________
Underlying rhythm?
_________________
ST-segment depression?
Leads: _________
Pathologic Q waves?
Leads: __________
T-wave changes?
Leads: _________
Poor R-wave progression?
Leads: __________
Interpretation:
______________________________________
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #29
Underlying
rhythm?
Atrial fibrillation at
99 bpm
Interpretation:
Atrial fibrillation, left axis
deviation
PR interval None
QRS 88 ms
QT/QTc 324/415 ms
P-R-T axes None -34 33
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #30
I
Lateral
aVR
------------
V1 Septum
V4 Anterior
V4R Right Ventricle
II Inferior
aVL Lateral
V2 Septum
V5 Lateral
V5R Right Ventricle
III Inferior
aVF Inferior
V3 Anterior
V6 Lateral
V6R Right Ventricle
Baseline wander or artifact?
Yes  No 
ST-segment elevation?
Leads: _________
Underlying rhythm?
_________________
ST-segment depression?
Leads: _________
Pathologic Q waves?
Leads: __________
T-wave changes?
Leads: _________
Poor R-wave progression?
Leads: __________
Interpretation:
______________________________________
Copyright © 2006 by Mosby Inc. All rights reserved.
12-Lead Review #30
Underlying
rhythm?
Sinus rhythm at 92 bpm
ST-segment
depression?
I, aVL, V1-V3, V6; slight
in V5
ST-segment
elevation?
II, III, aVF
T-wave changes?
Tall/peaked in II, III, aVF;
inverted in I, aVL, V1-V3,
V6
Interpretation:
Inferior infarct,
right-sided chest
leads should be
obtained; possible
left atrial enlargement
(-0.1 mV P-wave in
V1/V2)
Copyright © 2006 by Mosby Inc. All rights reserved.