ATLAS OF ELECTROCARDIOGRAPHY

Ary L. Goldberger

The electrocardiograms (ECGs) in this Atlas supplement those illustrated in Chap. 11. The interpretations emphasize findings of specific teaching value.

All of the figures are from 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

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

FIGURE 41-1
Anterior wall ischemia (deep T-wave inversions and ST-segment depressions in I, aVL, V₃ V₆) in a patient with LVH (increased voltage in V₂–V₅).

FIGURE 41-2
Acute anterolateral wall ischemia with ST elevations in V₄–V₆. Probable prior inferior MI with Q waves in leads II, III, and aVF.

FIGURE 41-3
Acute lateral ischemia with ST elevations in I and aVL with probable reciprocal ST depressions inferiorly (II, III, and aVF). Ischemic ST depressions also in V₃ and V₄. Left atrial abnormality.

FIGURE 41-4
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.

FIGURE 41-5
Acute, extensive anterior MI with marked ST elevations in I, aVL, V₁–V₆ and small pathologic Q waves in V₃ – V₆. Marked reciprocal ST-segment depressions in III and aVF.

FIGURE 41-6
Acute anterior wall MI with ST elevations and Q waves in V₁–V₄ and aVL and reciprocal inferior ST depressions.

FIGURE 41-7
NSR with premature atrial complexes. RBBB; pathologic Q waves and ST elevation due to acute anterior/septal MI in V₁–V₃.

FIGURE 41-8
Acute anteroseptal MI (Q waves and ST elevations in V₁–V₄) with RBBB (note terminal R waves in V₁).

FIGURE 41-9
Extensive prior MI involving inferior-posterior-lateral wall (Q waves in leads II, III, aVF, tall R waves in V₁, V₂, and Q waves in V₅, V₆). T-wave abnormalities in leads I and aVL, V₅, and V₆.

FIGURE 41-10
NSR with PR prolongation (“1st-degree AV block”), left atrial abnormality, LVH, and RBBB. Pathologic Q waves in V₁–V₅ and aVL with ST elevations (a chronic finding in this patient). Findings compatible with prior anterolateral MI and LV aneurysm.

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