Chapters Archive – Page 18 of 23 – The Cardiovascular

ECG non-specific nonspecific intraventricular conduction delay

Nonspecific intraventricular conduction delay (defect)

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Figure 1. Electrical alternans in patient with cardiac tamponade. The ECG shows varying QRS and T-wave amplitudes.

Eletrical alternans: the ECG in pericardial effusion & cardiac tamponade

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Figure 3. Chest leads of patient with acute pericarditis. Note the ST segment elevations, concave ST segments.

Pericarditis, myocarditis & perimyocarditis: ECG, criteria & treatment

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Figure 1. Early repolarization pattern on ECG. Note the end-QRS notches and slurs, as well as the ST segment elevations.

Early repolarization pattern on ECG (early repolarization syndrome)

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Figure 1. Echocardiogram showing takotsubo cardiomyopathy in acute phase (A) and resolution phase (B). Note the apical ballooning of the apical portion fo the left ventricle (A).

Takotsubo cardiomyopathy (broken heart syndrome, stress induced cardiomyopathy)

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Figure 1. Osborn wave (J wave). These waves occur due to hypothermia, hypercalcemia, early repolarization and Brugada syndrome.

ECG J wave syndromes: hypothermia, early repolarization, hypercalcemia & Brugada syndrome

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Figure 1. The ECG contour of the normal P-wave, P mitrale (left atrial enlargement) and P pulmonale (right atrial enlargement)

Left atrial enlargement (P mitrale) & right atrial enlargement (P pulmonale) on ECG

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Figure 2. Two ECGs showing left and right ventricular hypertrophy.

Biventricular hypertrophy ECG and clinical characteristics

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Atrial and ventricular enlargement: hypertrophy and dilatation on ECG

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Figure 1. These ECGs show the difference between normal conduction, left bundle branch block (LBBB) and right bundle branch block (RBBB). As evident from these ECGs, the cardinal difference between normal conduction and bundle branch blocks is the QRS duration: bundle branch blocks are caused by dysfunctional bundle branches, which results in slow (and abnormal) activation of ventricular myocardium and thus prolonged QRS duration. A QRS duration of 120 ms (0.12 s) is required to diagnose bundle branch block. Also note that both left bundle branch block (LBBB) and right bundle branch block (RBBB) cause marked ST-T changes, including ST elevations, ST depressions and inverted (negative) T-waves. These ST-T changes are due to abnormal repolarization and they are expected to occur in both LBBB and RBBB. Finally, note that there are marked difference in the ECG pattern between LBBB and RBBB. These ECGs are printed at paperspeed 50 mm/s.

Left bundle branch block (LBBB): ECG criteria, causes, management

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