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  1. Acute anterolateral stemi with ventricular extrasystoles [150 ECG]

    Acute anterolateral STEMI with ventricular extrasystoles
    This ECG was recorded from a 50-year-old man who had had severe chest pain for 1 h. What does it show and what would you do?



    ANSWER 93

    The ECG shows:
    • Sinus rhythm, rate 70/min, with ventricular extrasystoles
    • Normal axis
    • Q waves in leads V3–V5; small Q waves in leads VL and V6
    • Raised ST segments in ...
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  2. Normal ecg [150 ECG]

    Normal ECG
    This ECG was recorded from a 30-year-old man who complained of chest pain: the pain did not appear to be cardiac in origin, and the physical examination was normal. Can this man be allowed to hold a commercial driving licence?



    ANSWER 94

    The ECG shows:
    • Sinus rhythm, rate 62/min
    • Normal axis
    • Small Q waves, especially prominent in leads II, III, VF, V4–V6 ...
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  3. Atrial fibrillation and hypothermia [150 ECG]

    Atrial fibrillation and hypothermia
    This ECG was recorded from an 80-year-old woman who had been found unconscious with physical signs suggesting a stroke. Any comments?



    ANSWER 95

    The ECG shows:
    • Atrial fibrillation with a ventricular rate of about 55/min
    • QRS complex duration prolonged at 200 ms
    • Prominent ‘J’ waves, best seen in leads V3–V6
    • Widespread but ...
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  4. Right ventricular hypertrophy due to pulmonary embolism [150 ECG]

    Right ventricular hypertrophy due to pulmonary embolism
    A 32-year-old woman, who had had a normal pregnancy and delivery 3 months previously, was seen in the
    outpatient department complaining of severe breathlessness and dizziness on exertion. She had some chest pain on both sides, which sounded pleuritic. Does her ECG help with her diagnosis and treatment? A pulmonary ngiogram was performed as part of a series of investigations.
    ...
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  5. Left axis deviation and rbbb – bifascicular block [150 ECG]

    Left axis deviation and RBBB – bifascicular block
    This ECG was recorded from a fit 60-year-old man at a routine medical examination. What does it show and what would you recommend?



    ANSWER 97

    The ECG shows:
    • Sinus rhythm, rate 65/min
    • Normal PR interval
    • Left axis deviation – left anterior hemiblock
    • QRS complex duration just over 120 ms, with an RSR1 complex in ...
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  6. Probable hypertrophic cardiomyopathy [150 ECG]

    Probable hypertrophic cardiomyopathy
    This ECG was recorded as part of a routine examination of a healthy 25-year-old professional athlete. There were no abnormal physical findings. What does it show and what would you do?



    ANSWER 98

    The ECG shows:
    • Sinus rhythm, average rate 44/min
    • Normal axis
    • Normal QRS complexes, apart from narrow Q waves in lead VL
    ...
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  7. Accelerated idioventricular rhythm [150 ECG]

    Accelerated idioventricular rhythm
    This ECG was recorded from a 45-year-old man, who had been admitted to a coronary care unit with a myocardial infarction and who was recovering well. What is the rhythm, and what would you do?



    ANSWER 99

    The ECG shows:
    • Broad complex rhythm, rate 90/min
    • No P waves
    • Marked left axis deviation
    • QRS complex duration 160 ...
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  8. Normal ecg for an athlete [150 ECG]

    Normal ECG for an athlete
    This ECG was recorded from a 40-year-old man who had hypertension but was otherwise well and ran marathons. Despite showing four possible ‘abnormalities’, is the trace actually normal?



    ANSWER 100

    The ECG shows:
    • Sinus rhythm, average rate 39/min
    • Bifid P waves, best seen in the anterior chest leads
    • Normal axis
    • QRS complexes ...
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  9. Acute anterolateral stemi [150 ECG]

    Acute anterolateral STEMI



    ANSWER 101

    The ECG shows:
    • Sinus rhythm, rate 103/min
    • Normal axis
    • Normal QRS complexes
    • Raised ST segments in leads I, VL, V1–V6
    Clinical interpretation
    The ECG has the classic appearance of an acute anterolateral ST segment elevation myocardial infarction (STEMI).

    What to do
    Since this patient’s chest pain ...
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  10. Ventricular tachycardia [150 ECG]

    Ventricular tachycardia



    ANSWER 102

    The ECG shows:
    • Broad complex tachycardia at about 188/min
    • No P waves visible
    • Left axis deviation
    • QRS complex duration about 140 ms
    • Narrow fourth and fifth QRS complexes
    • QRS complexes that are probably concordant (in the chest leads all point upwards) though it is difficult to be certain
    Clinical interpretation ...
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