chapter  18
Electrocardiographic Diagnoses
Pages 45

Systematic Evaluation of an ECG Tracing 1. Standardization and leads shown; review for

reversed leads, right chest leads, and 1/2 voltage standardization in left ventricular hypertrophy

2. Heart rate: determine separately for QRS and P waves if the rhythm is other than sinus

3. Heart rhythm 4. Cardiac axis 5. Configuration and duration of P, QRS, and T waves 6. Relationship of P wave to QRS complex

Stephen C. Hammill, MD

7. Intervals: PR, QRS, and QT 8. ECG diagnosis 9. Suggested clinical diagnosis

1. General Features

a. Normal ECG b. Borderline normal ECG or normal variant c. Incorrect electrode placement d. Artifact due to tremor

2. Atrial Rhythms

a. Sinus rhythm b. Sinus arrhythmia c. Sinus bradycardia (<60 beats/min) d. Sinus tachycardia (>100 beats/min) e. Sinus pause or arrest f. Sinoatrial exit block g. Ectopic atrial rhythm h. Wandering atrial pacemaker i. Atrial premature complexes,normally conducted j. Atrial premature complexes, nonconducted k. Atrial premature complexes with aberrant

intraventricular conduction l. Atrial tachycardia (regular, sustained, 1:1 con-

duction) m.Atrial tachycardia, repetitive (short paroxysms) n. Atrial tachycardia, multifocal (chaotic atrial

tachycardia) o. Atrial tachycardia with atrioventricular (AV)

block p. Supraventricular tachycardia, unspecified q. Supraventricular tachycardia, paroxysmal r. Atrial flutter s. Atrial fibrillation t. Retrograde atrial activation

3. AV Junctional Rhythms

a. AV junctional premature complexes b. AV junctional escape complexes c. AV junctional rhythm, accelerated d. AV junctional rhythm

4. Ventricular Rhythms

a. Ventricular premature complex(es), uniform, fixed coupling

b. Ventricular premature complex(es), uniform, nonfixed coupling

c. Ventricular premature complex(es), multiform d. Ventricular premature complexes, in pairs (2

consecutive) e. Ventricular parasystole f. Ventricular tachycardia (≥3 consecutive beats) g. Accelerated idioventricular rhythm h. Ventricular escape complexes or rhythm i. Ventricular fibrillation

5. Atrioventricular Interactions in Arrhythmias

a. Fusion complexes b. Reciprocal (echo) complexes c. Ventricular capture complexes d. AV dissociation e. Ventriculophasic sinus arrhythmia

6. AV Conduction Abnormalities

a. AV block, first degree b. AV block, second degree-Mobitz type I

(Wenckebach) c. AV block, second degree-Mobitz type II d. AV block, 2:1 e. AV block, third degree f. AV block, variable g. Short PR interval (with sinus rhythm and nor-

mal QRS duration) h. Wolff-Parkinson-White pattern

7. Intraventricular Conduction Disturbances

a. Right bundle branch block (RBBB), incomplete

b. RBBB, complete c. Left anterior fascicular block d. Left posterior fascicular block e. Left bundle branch block (LBBB), complete

with ST-T waves suggestive of acute myocardial injury or infarction

f. LBBB, complete

g. LBBB, intermittent h. Intraventricular conduction disturbance,

nonspecific type i. Aberrant intraventricular conduction with

supraventricular arrhythmia (specify rhythm)

8. P-Wave Abnormalities

a. Right atrial abnormality b. Left atrial abnormality c. Nonspecific atrial abnormality

9. Abnormalities of QRS Voltage or Axis

a. Low voltage, limb leads only b. Low voltage, limb and precordial leads c. Left-axis deviation (>−30°) d. Right-axis deviation (>+100°) e. Electrical alternans

10. Ventricular Hypertrophy

a. Left ventricular hypertrophy by voltage only b. Left ventricular hypertrophy by both voltage

and ST-T-segment abnormalities c. Right ventricular hypertrophy d. Combined ventricular hypertrophy

11. Transmural Myocardial Infarction

Probably acute Probably old or or recent age indeterminate

Anterolateral a. g. Anterior b. h. Anteroseptal c. i. Lateral or

high lateral d. j. Inferior

(diaphragmatic) e. k. Posterior f. l.