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CHAPTER e28 Atlas of Electrocardiography

CHAPTER e28

Atlas of Electrocardiography

Ary L. Goldberger

The electrocardiograms (ECGs) in this Atlas supplement those illustrated in Chap. 228. The interpretations emphasize findings of specific teaching value.

All of the figures are from ECG Wave-Maven, Copyright 2003, Beth Israel Deaconess Medical Center, .

The abbreviations used in this chapter are as follows:

AF--atrial fibrillation HCM--hypertrophic cardiomyopathy LVH--left ventricular hypertrophy MI--myocardial infarction NSR--normal sinus rhythm RBBB--right bundle branch block RV--right ventricular RVH--right ventricular hypertrophy

MYOCARDIAL ISCHEMIA AND INFARCTION

I

aVR

V1

V4

II

aVL

V2

V5

III

aVF

V3

V6

II

Figure e28-1 Anterior wall ischemia (deep T-wave inversions and ST-segment depressions in I, aVL, V -V ) in a patient with LVH (increased voltage in 3 6

V -V ). 2 5

Copyright ? 2012 The McGraw-Hill Companies, Inc. All rights reserved.

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PART 10 Disorders of the Cardiovascular System

I

aVR

V1

V4

II

aVL

V2

V5

III

aVF

V3

V6

II

Figure e28-2 Acute anterolateral wall ischemia with ST elevations in V -V . Probable prior inferior MI with Q waves in leads II, III, and aVF. 4 6

I

aVR

V1

V4

II

aVL

V2

V5

III

aVF

V3

V6

II

Figure e28-3 Acute lateral ischemia with ST elevations in I and aVL with probable reciprocal ST depressions inferiorly (II, III, and aVF). Ischemic ST depres-

sions also in V and V . Left atrial abnormality.

3

4

28-2

Copyright ? 2012 The McGraw-Hill Companies, Inc. All rights reserved.

CHAPTER e28 Atlas of Electrocardiography

I

aVR

V1

V4

II

aVL

V2

V5

III

aVF

V6

V3

II

Figure e28-4 Sinus tachycardia. Marked ischemic ST-segment elevations in inferior limb leads (II, III, aVF) and laterally (V6) suggestive of acute inferolateral MI, and prominent ST-segment depressions with upright T waves in V1-V4 are consistent with associated acute posterior MI.

I

aVR

V1

V4

II

aVL

V2

V5

III

aVF

V3

V6

II

Figure e28-5 Acute, extensive anterior MI with marked ST elevations in I, aVL, V -V and small pathologic Q waves in V -V . Marked reciprocal

1 6

3 6

ST-segment depressions in III and aVF.

Copyright ? 2012 The McGraw-Hill Companies, Inc. All rights reserved.

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PART 10 Disorders of the Cardiovascular System

I

aVR

V1

V4

II

aVL

V2

V5

III

aVF

V3

V6

II

Figure e28-6 Acute anterior wall MI with ST elevations and Q waves in V -V and aVL and reciprocal inferior ST depressions. 1 4

I

aVR

V1

V4

II

aVL

V2

V5

III

aVF

V3

V6

II

Figure e28-7 NSR with premature atrial complexes. RBBB; pathologic Q waves and ST elevation due to acute anterior/septal MI in V -V . 1 3

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Copyright ? 2012 The McGraw-Hill Companies, Inc. All rights reserved.

CHAPTER e28 Atlas of Electrocardiography

I

aVR

V1

V4

II

aVL

V2

V5

III

aVF

V3

V6

II

Figure e28-8 Acute anteroseptal MI (Q waves and ST elevations in V -V ) with RBBB (note terminal R waves in V ).

1 4

1

I

aVR

V1

V4

II

aVL

V2

V5

III

aVF

V3

V6

II

Figure e28-9 Extensive prior MI involving inferior-posterior-lateral wall (Q waves in leads II, III, aVF, tall R waves in V , V , and Q waves in V , V ).

1 2

5 6

T-wave abnormalities in leads I and aVL, V5, and V6.

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