ATLAS OF CARDIAC ARRHYTHMIAS

Ary L. Goldberger

The electrocardiograms in this Atlas supplement those illustrated in Chaps. 15 and 16. The interpretations emphasize findings of specific teaching value.

All of the figures are adapted from cases in ECG Wave-Maven, Copyright 2003, Beth Israel Deaconess Medical Center, http://ecg.bidmc.harvard.edu.

The abbreviations used in this chapter are as follows:

AF—atrial fibrillation

AV—atrioventricular

AVRT—atrioventricular reentrant tachycardia

LBBB—left bundle branch block

LV—left ventricular

LVH—left ventricular hypertrophy

MI—myocardial infarction

NSR—normal sinus rhythm

RBBB—right bundle branch block

VT—ventricular tachycardia

WPW—Wolff-Parkinson-White

FIGURE 43-1
Respiratory sinus arrhythmia, a physiologic finding in a healthy young adult. The rate of the sinus pacemaker is relatively slow at the beginning of the strip during expiration, then accelerates during inspiration and slows again with expiration. Changes are due to cardiac vagal tone modulation with breathing.

FIGURE 43-2
Sinus tachycardia (110/min) with first-degree AV “block” (conduction delay) with PR interval = 0.28 s. The P wave is visible after the ST-T wave in V₁–V₃ and superimposed on the T wave in other leads. Atrial (nonsinus) tachycardias may produce a similar pattern, but the rate is usually faster.

FIGURE 43-3
Sinus rhythm (P wave rate about 60/min) with 2:1 AV (second-degree) block causing marked bradycardia (ventricular rate of about 30/min). LVH is also present.

FIGURE 43-4
Sinus rhythm (P wave rate about 60/min) with 2:1 (second-degree) AV block yielding a ventricular (pulse) rate of about 30/min. Left atrial abnormality. RBBB with left anterior fascicular block. Possible inferior MI.

FIGURE 43-5
Marked junctional bradycardia (25 beats/min). Rate is regular with a flat baseline between narrow QRS complexes, without evident P waves. Patient was on atenolol, with possible underlying sick sinus syndrome.

FIGURE 43-6
Sinus rhythm at a rate of 64/min (P wave rate) with third-degree (complete) AV block yielding an effective heart (pulse) rate of 40/min. The slow, narrow QRS complexes indicate an A-V junctional escape pacemaker. Left atrial abnormality.

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