EKG's

LEADS
 Inferior Leads:
 II, III, AvF

Lateral Leads:
 V4-V6, I, AvL

Anterior Leads:
 V2-V5

Septal Leads:

Junctional Leads:

Ischemia = ST depression

Recent Infarct = ST elevation

Old Infarct = Q waves

NORMALS
 PR < 0.2 sec (1 large block)
Small Q in I, AvR, AvL, V5 & V6
ST inverted R?
Normal R progression

RHYTHM
 Normal Sinus Rhythm:
 A P before every QRS
Rate = 60-100 bpm

Sinus Bradycardia:
 P before every QRS
Rate < 60

Sinus Tachycardia:
 P before every QRS
QRS normal
Rate > 100

SINUS ARRHYTHMIAS
 Ectopic Atrial Pacemaker:
 Abnormally shaped P's (e.g. inverted)
Change in PR interval

Miltifocal Atrial Tachy:
 Variable P morphology
Variable PR interval
(think pulm dz)

WPW:
 Delta waves
(predisposes to PSVT)

Atrial Flutter:
 Sawtooth baseline @ 300/min
X:1 conduction
Near regular R-R

Atrial Fibrillation:
 Tremulous baseline
Irregular RR
No P waves

ATRIAL ENLARGEMENT
 Left Atrial Enlargement:
 Notched p in II
Biphasic P in V1
Prolonged P with leftward axis

Right Atrial Hypertrophy:
 Tall P waves in II & III
Rightward axis

BLOCK
 RBBB:
 RSR' in V1 & V2
Deep S waves in I & AvL

RBBB with Left Anterior Hemiblock:
 RSR' in V1-V2
Deep S wave in II, III, AvF & V5-V6
Axis = 60o

LBBB:
 Wide QRS
ST & T changes balance QRS orientation
Leftward deviation

Left Anterior Hemiblock:
 Left axis at 60o
Normal QRS duration
Small Q wave in I
Small R in III

Left Posterior Hemiblock:
 Dramatic right axis deviation
No RVH
Normal QRS

1o AVB:
 Prolonged PR (>200 msec) Normal QRS
Normal T
Normal ST interval

2o AVB:
 Some P without QRS

Type I 2o AVB (Wenkenbach):
 PR interval increases until missed

Type II 2o AVB:
 Missed QRS
Regular PR intervals

Complete Block, 3o:
 No relation of P with irregular shaped QRS
Rate = 30

Ventricular Escape Rhythm:
 No Ps at all
HYPERTROPHY
 Left Ventricular Hypertrophy:
 Large voltage in I, AvL & V5-V6
T inversions in I, AvL & V5-V6
Widespread T inversion

RVH
 Right axis deviation
Large voltage in V1-V3
Increased S in V4-V6, I & L

ISCHEMIA
 Inferior Ischemia:
 ST depression in II, III & AvF

Anterior Ischemia:
 ST depression in V2-V4

Lateral Ischemia:
 ST depression in V5-V6 & AvL

ACUTE INFARCT
 Inferior Infarct:
 ST elevation II, III, AvF
Q waves in III & AvF

Inferiolateral Infarct, acute:
 ST elevation in II & AvF
Q in II

Lateral Infarct, Acute:
 ST elevation in AvL & V5-V6

Posterior Infarct, Acute:
 Large R in V1
ST depression in V1
Upright T

RECENT INFARCTS
 Inferior Infarct, Recent:
 ST elevation in II, III & AvF
Q waves in II, III & AvF
T inversion in II, III & AvF

Anterior Infrct, Recent:
 No R in V1 & V2
Q waves in V2-V5
ST elvation in V2-V5

Lateral Infarct, Recent:
 ST elevation in V5-V6, I & AvL
Terminal T inversion?

OLD INFARCTS
 Inferior MI, Old:
 Q waves in I, III & AvF
Q > 1/4 R

Inferolateral MI, Old:
 Q waves in V5-V6
Q waves in II, III & AvF

Anterior MI, Old:
 No R in V1 & V2
Small Q wave in V4

Anterolateral MI, Old:
 Decreasing R amplitude in anterior leads with Q waves

Lateral MI, Old:
 Q waves in V4, V5 & V6
Small Q waves in AvL

PERICARDITIS
 Acute Pericarditis:
 Widespread ST elevation

Chronic Pericarditis:
 Widespread T inversion

OTHER
 Digitalis:
 ST scooped
Septal Q waves

Hyperkalemia:
 Peaked T
Short PR interval

Early Repolarization:
 ST elevation in precordials
Upsloping ST
No Q waves?