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·ELECTROCARDIOGRAPHIC TEST BOOK EDITOR TRAVIS WINSOR ADVISORY AND REVIEW PANEL RICHARD ASHMAN GW MANNING JOSEPH M BARKER WILLIAM R MILNOR S GILBERT BLOUNT GORDON B MYERS GERTRUDE NICOLSON HOWARD B BURCHELL J SCOTT BUTTERWORTH E GREY DIMOND EMANUEL GOLDBERGER ROBFRT P GRANT ASHTON GRAYBJEI HANS H HECHT FRANKLIN D JOHNSTON RENOR PORTER MYRON PRINZMETAL FRANCIS F ROSENBAUM ERNST SIMONSON SIDNEYS SOBIN MAURICE SOKOLOW CONGER WILLIAMS LOUIS WOLFF PAUL N YU ALBERT A LATTUS EUGENF LFPESCHKIN ROBERT T ZIEGLER RICHARD H LYONS ·TABLE OF CONTENTS VOLUME I Page 11 FOREWORD 111 PREFACE PART A Electrocardiograms PART B 120 Questions on Electrocardiographic Interpretation Arrhythmias 120 123 Artifacts 123 Conduction Defects 125 127 Disease States (Congenital and Acquired) Drugs and Electrolytes Electric Axis 128 129 Hypertrophy (Atrial and Ventricular) Intrinsicoid Deflection 130 130 Leads 133 Myocardial Infarction Myocardial Injury and Ischemia Pericarditis 135 135 136 Position of the Heart (Electrocardiographic) Pulmonary Infarction Theory 137 137 Waves Intervals Segments and S Point 140 PART C Appende Index 144 161 ·PART A ELECTROCARDIOGRAMS

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·70 YEAR OLD FEMALE
NO CHEST PRESSURE OR PAIN
CARDIAC CHECK UP NO DRUGS
II
V2
III
aVR
ار
aVL
ye
- www
V5
aVF
V6
V2
V
NI
The electric axis of the QRS complexes is
deviated somewhat to the
A left
B
right
The electrocardiographic position
of the heart is
A vertical
B semi vertical
с intermediate
D semihorizontal
honzontal
F indeterminate

·58 YEAR OLD FEMALE NO CARDIAC COMPLAINTS NO DRUGS
I
II
III
ave
aVL
aVe
16
V2
V6
Vi
The rhythm is
A sinus bradycardia
B nodal rhythm with retrograde conduction
с normal sinus rhythm
D sinus arrhythmia

·58 YEAR OLD MALE CHEST PAIN ON EFFORT TWO YEARS NO CARDIAC DRUGS
*********
II
BEN
V2
III
V3
aVR
aVi
V5
ave
AL
VO
V2
V2
V1
V6
The electrocardiogram is
A normal
B diagnostic of a myocardial infarct
C consistent with myocardial injury and/or ischemia
diagnostic of hypokalemia

·45 YEAR OLD MALE NO DRUGS
***
*****
+
V
II
II
III
III
avr
****
*********
av
avy
V6a
V2
V2
VO
The clectrocardiogram is
A entirely normal
B abnormal because of tall T waves in leads V2 and V3
с abnormal because of the notched P waves in lead V2
D abnormal because of sagging of the ST segments in lead av

·47 YEAR OLD MALE CHEST PAIN NO CARDIAC DRUGS
Vi
V₂
II
1
11
у;
VE
aVL
aVf
¡V2
V Vi
The tracing is
A entirely normal
B in keeping with postenor myocardial
injury or ischemia
с indicative of anterior myocardial
infarction
disenosis of left ventricular hypertrophy
n

·13 42 YEAR OLD MALE LEG PAINS ONE YEAR NO DRUGS I ttttttt Hot wy FitFTI 1 II *** III * avg NT ave ne V2 Vi 1 The QRS complexes are The electrocardiographic position of the heart is A horizontal B semi horizontal C intermediate D vertical E semi vertical F indeterminate A of normal width B abnormally narrow C abnormally wide ·13 YEAR OLD WHITE FEMALE LOUD HEART MURMUR SINCE BIRTH NO CARDIAC DRUGS LE AZAASSA V2 VR V4 VL V5 LLLL VF V6 V2 V2 EV1 V6 1 The following is present The neçams ST segment shifts in lead V4 are A A B с D sinus arrhythmia sinus tachycudinodal tachycardia atrın tachycardın dingnostic of dicie probabli second in to the rapid rate indiative of pencarditis C

·AR OLD WHITE MALE TEN MILE MARATHON RUNNER NO CARDIAC COMPLAINTS NO DRUGS
Vil
V21
III
V3
aVR
4
aVL
aVi
IR
V6
V2
V2 V1
The following is present
A normal sinus rhythm
B sinus bradycardia,
С sino-atral block
sinus arrest
The electrocardiographic position of
the heart is
A horizontal
intermediate
C vertical
8

·54 YEAR OLD MALE CHEST PAIN ONE YEAR NO CARDIAC DRUGS
ht
NA..
+
LE
ΠΛΑ.Λ.
int
*
.
LYCH
DEN
السام به اسم
WA
w
Vg
V6
V2
1
The tracing is
А normal
B suggestive of cardiac disease
C abnormal
The electrocardiographic position is
А horizontal
B semi horizontal
с intermediate
D vertical
E semi vertical
F indeterminate

·55 YEAR OLD FEMALE COMPLAINS OF YELLOW TUMORS OV EYELIDS
*****
+-+-+
SEB
V3
V4
V5
V6
V6
The waves in lead aVF are strongly suggestive of
А an old postenor myocardial infarct
strong counterclockwise rotation of the heart about the long
anus as cued from the apex
C
normal ventncular depolarization
pulmonary infarction
D
10

·55 YEAR OLD MALE CHECK UP SIX MONTHS AFTER ATTACK OF PULMONARY EDEMA
NO CARDIAC DRUGS
1
}
II
III
aVR
VA
aVz
a Ve
V6
V2
V2
V
The electrocardiogram is 1) pical of
A nght and left ventricular hypertrophy
B left ventricular hypertrophy
left bundle bench Lent

·SAR OLD WHITE FEMALE SUBSTERNAL PAIN RADIATING INTO JAWS, SIX HOURS NO DRUGS
V
Vz
VA
Vg
++++++
V6
V2
V6
The electrocardiogram
A is entirely normal
с
D
us strongly suggestive of chronic pencarditis
15 suggestive of subendocardial injury or ischemia
indicates abnormally late depolarization of the left ventricle
2
14

·57 YEAR OLD MALE CRUSHING PRECORDIAL PAIN FOR SIX HOURS TWELVE DAYS AGO
*****
ایم
CI
TI
NNN
VR
VL
Vs
VE
V
6
V2
V2
Vi
V6
The electrocardiogram
A indicates ischemia involving the subepicardial and anterolateral
aspect of the left ventricle along with a small anteroseptal infarct
B indicates anterior myocardial ischemia and rules out an anterior
infarct
с is typical of an acute subendocardial infarct

·58 YEAR OLD FEMALE CHEST PAIN ON EFFORT NO CARDIAC DRUGS
Vi
***
V2
V3
VA
Vs
TI!
V2
The voltages of the ORS complexes
in the standard leads
A tend to be lon
are near or are above average
с
are tall
The ORS complexes are
A of normal width
B
abnormally wide
C abnormally narrow
16

·50 YEAR OLD FEMALE PALPITATION THREE YEARS
V
ОЛСА
I
V2
TI
VR
VL
V6
The following is present
A left ventricular hypertrophy
B nght and left ventricular hypertrophy
с an incomplete left bundle branch block
D a false bundle branch block
The following is present
À
a ventncular ectopic beat
B
& nodal ectopic beat
с
premature contraction

·AR OLD MALE EPIGASTRIC DISTRESS ON LYING DOWN AND ON EFFORT NO CARDIAC DRUGS
Vi
V2
Vg
V2
V6
The iniened noves in leads V3 V4 and Vs are
А definite evidence of coronary artery disease
consistent with sschema of the anterolateral aspect of
the icit venincic
C diagnostic of a myocardial infarct
10

·41 YEAR OLD MALE HEART ATTACK TWELVE MONTHS AGO NO CARDIAC DRUGS
I
II
V2
III
VA
VR
VAM
EVL
IVF
V6
ΓΙΑ
V2
VI
V6
The electrocardiogram is
A normal and rules out cardiac disease
B normal however cardiac disease may be present
с abnormal

·6U YEAR OLD FEMALE STROKE TWO YEARS AGO HYPERTENSION TWENTY YEARS
G
BRANA V3
VA
Vs
V6
V2
6
The P waves in leads V2 through V are
A abnormally wide
B appear wide because of the presence of U waves
suggest the presence of mitral stenosis
D suggest right atrial enlargement
20

·30 YEAR OLD FEMALE MILD ASTHMA SINCE BIRTH V 1 HT JI V2 III ERICHTE V3 aVR aVL w VS 6 V2 V2 Vi 16 The 3 points (junction of end of QRS complexes with beginning of ST segments) in lead V2 are A indicative of cardiac disease B indicative of pericarditis C indicative of an electrolyte disturbance D probably normal

·71 YEAR OLD FEMALE HEADACHES FIVE YEARS NO CARDIAC DRUGS
V2
V3
V2
SA
V6
The voltage of the Rwaves in lead V4 is
A low
B normal
C high
The tracing suggests
Anght ventricular hypertrophy
B
left ventricular hypertrophy
с
no ventricular hypertrophy
22

·68 YEAR OLD MALE HYPERTENSION FOR YEARS NO SYMPTOMS DIGITALIS LEAF 02 GM DAILY
Vi
III
aVR
4
aVL
*
V6
ave
1
The tracing shows the following
A a lead us mounted upside down
B there was movement of the
clectrode on the skin
C there was a loose clectnc
connection
There is evidence of
А night and left ventncular
hypertrophy
right ventricular hypertrophy
с
left ventricular hypertrophy
23

·67 YEAR OLD WHITE FEMALE SINGER DYSPNEA EIGHT MONTHS NO DIGITALIS
V2
V3
Free
VA
V5
V
V6
The electrocardiogram is
А normal
B in keeping with left ventricular hypertrophy with or without
myocardial injury and ischemia
с strongly suggestive of pulmonary infarction
24

·48 YEAR OLD KOREAN MALE CHECK UP NO CARDIAC DRUGS
1
Vi
V2
I
w
HII
w
V3
aVR
V
a V
aVF
6
Vi
The following artifact is present in the standard leads
A
leads I and III were interchanged when mounted
B
the right and left arm lead wires were switched when applied to the patients limbs
с lead I is mounted upside down
25

·58 YEAR OLD MALE CHECK UP V1 V2 V3 R V4 Vs aVE V6 V2 V2 V6 The first portion of the QRS complexes The transitional zone (QRS complexes) in lead V6 IS 15 at lead 1 A B с large and positive isoelectric or slightly positive ncgatise A B с V D E V 4 Vs 26

·29 YEAR OLD MALE COLLAPSE FOLLOWING INTRAVENOUS INJECTION
1
LA
II
V2
AVR
V
A
WWW.LU
aVc
AN
wurden
wo
aVe
V6
V2
V6
The mean electric axis of the
QRS complexes is
A deviated abnormally to the right
B deviated abnormally to the left
within normal limits
The tracing 15
A definitely abnormal
B normal

·58 YEAR OLD FEMALE
V2
V₃
VA
V5
V6
F
2
V2
V6
A possible cause for the cardiac rhythm which is present is
anemia
B anxiety
C hyperthyroidism
infection
E cpinephrine
F reserpine
28

·48 YEAR OLD MALE ATTACKS OF RAPID HEART BEATING TAKING FOUR WHITE PILLS DAILY
1
Va
V3
V4
aVx
!
aVt
ave
V6
1
The electrocardiogram suggests the following select one)
A quinidine effect
B quinidinc effect and muscle tremor in the limbs
C quinidine effect muscle tremor in the limbs and a loose
conacction to the lamp circuit in the electrocardiograph machine
60 cycle alternatag current interference
11
The electrocardiographic position of the heart is
A. horizontal
B semihorizontal
C zotermediate
E
vertical
sem vertical
indeterminate
29

·48 YEAR OLD MALE CHEST PAIN TWO MONTHS AGO NO CARDIAC DRUGS
tit
TIN
***
.
TI
ht
test
+++++
V2
+
V
V6
VF
The following is present
A atrial premature contractions with aberration
B ventricular premature contractions
с nodal premature contractions without retrograde conduction
D nodal premature contractions with retrograde conduction
30

·50 YEAR OLD MALE CHEST PAIN, SEVERE, LASTING TWENTY FOUR HOURS NO CARDIAC DRUGS
I
V1
LU
11
AL
there
1
V2
III
V3
aVe
Ett
4
aVL
VS
1.H.ULUI.
ave
***
V6
V2
V2
V1
V6
The tracing is typical of
A acute pericarditis
B an extensive subacute myocardial infarct
C pulmonary infarction
D myocardial ischemia without infarction
31

·55 YEAR OLD MALE CHEST PAIN ONE WEEK AGO
V1
Anet
V2
aan
V3
man
HH
TIM
V4
R
M
Het
L
VO
If
VO
2
V2
V6
11
An anteroseptal myocardial infarct is
A probable
B improbable
ruled out
D
certain
32

·39 YEAR OLD MALE HEART ATTACK SEVEN YEARS AGO NO CARDIAC DRUGS
1114
JOTIRE
watan
I
V3
w
AVR
V
ave
V5
avf
V6
V2
V2
Inspiration
aVF
Expiration
The tracing is typical of
A
a high lateral myocardial infarct
B
an old antenor myocardial infarct
C an old posterior myocardial infarct
D
a normal intermediale electrocardiographic position
33

·5 YEAR OLD WHITE FEMALE NO CARDIAC COMPLAINTS NO CARDIAC DRUGS MAR IVAR VaR در بسیاری از V2 MALAM 11 1 The rhythm is А Sinus tachycardia B sinus arrhythmia sinus bradycardia nodal thythm with retrograde conduction The tracing А indicates night ventricular hypertrophy which is pathologic B 15 within normal limits с indicates myocardial ischemia because of the inverted T waves in the precordial leads The wandering base line seen in leads V2 and V3 suggests A a loose connection within the instrument or between a lead wise and the electrode movement of the electrode on the skin or polarization at an electrode 60 cycle interfening alternating current B

·63 YEAR OLD WHITE MALE CLERK HEADACHES ONE YEAR NO CHEST PAIN
TAKING RESERPINE O 25 MG DAILY NO DIGITALIS
I
V
I
V2
III
M
M
V3
aVR
VA
TARA
ti
NICE
ANTEN
aVL
Vg
VE
V2
V6
The following is present
A sinus bradycardia and a night complete bundle branch block
B
sinus bradycardia and a right incomplete bundle branch block
с
normal sinus rhythm and a right complete bundle branch block
D
a nght complete bundle branch block and an antenos infarct
35

·13 YEAR OLD FEMALE CARDIAC CHECK UP NO CARDIAC DRUGS
V2
V3
NI
V5
V6
The following artifact is present
А switching of the lead I wires when the electrodes were
applied to the right and left arms of the patient
switching of the lead II wires when the right arm and
left leg electrodes were applied to the patient
C switching of the lead II wires when the left arm and
left leg electrodes were applied to the patient
B

·50 YEAR OLD WHITE FEMALE NO CARDIAC COMPLAINTS NO CARDIAC DRUGS
I
V1
II
V2
V3
VA
aVx
اله
Vs
a VL
V6
avg
The following is present
А
no artifact
B definite evidence of a posterior myocardial infarct
с an artifact involving some of the unipolar leads (V leads)
D nodal rhythm
37

·58 YEAR OLD WHITE SALESMAN PALPITATION INTERMITTENTLY ONE YEAR NO DRUGS
JANA
V2
ΑΛΛΑ
V3
A
'R
1
S
wamy
وی باہ
V6
The folloning is present
A atrial premature contractions with aberration
of the QRS complexes
B multiple ventricular premature contractions
multifocal ventricular premature contractions
a paroxysmal left bundle branch block in the
absence of premature atrial contractions
38

·45 YEAR OLD FEMALE CHEST PAIN NINE MONTHS AGO NO CARDIAC DRUGS
I
Wonin
II
V2
III
V₃
aVR
aV
Vs
LISLLLLLLLL
ave
m
V6
V2
V2
Vi
V6
The electrocardiogram
А is diagnostic of a myocardial infarct
B rules out a myocardial infarct
с is in keeping with a diagnosis of a myocardial infarct
39

·58 YEAR OLD MALE FULL FEELING IN HEAD FOR EIGHT MONTHS NO CARDIAC DRUGS
V1
V2
V3
V4
A
PL
15
w
F
V6
V2
V2
Vi
16
The fracing is in keeping with
А a complete right bundle branch block
B an incomplete right bundle branch block
с
no cardiac disease
an incomplete left bundle branch block
40

·49 YEAR OLD WHITE MALE EXECUTIVE SEVERE SUBSTERNAL PAIN OF TWO DAYS DURATION
I
II
w
V2
III
aVR
VA
a VL
Vs
aVF
V6
V2
V2
V1
V6
The following is present
A a right incomplete bundle branch block
B a night complete bundle branch block and a
myocardial infarct
с a nght complete bundle branch block and
left ventricular hypertrophy
D a night complete bundle branch black and
night ventricular hypertrophy
41

·62 YEAR OLD WHITE MALE SALESMAN DYSPNEA ON SLIGHT EXERTION
V1
اری باردار
V2
رہی ہے
V5
.
.
V6
met
tu
11
The P waye picture is that of
А P mitrale
B P pulmonale
C normal atria
The clinical condinions which produce
tracings of this sort are
A
acute cor pulmonale
B
chronic cor pulmonale
C
mitral stenosis
42

·56 YEAR OLD FEMALE MITRAL COMMISSUROTOMY ONE YEAR AGO DIGITALIS LEAF 0 1 GM DAILY
I
V1
HET.IT
II
AA
V2
III
V3
aVR
aVL
Vs
aVe
V2
V2
V1
V6
The tracing
A
B
с
rules out rheumatic mitral stenosis
is in keeping with a digitalis effect
suggests pencarditis
43

·43 YEAR OLD MALE CHEST PAIN SEVEN WEEKS AGO
ASA
V2
V3
Www
nevy
V4
V5
V
6
The tracing has the characteristics of
А an acute (few hours) anterolateral myocardial infarct
B a subacute or chronic anteroseptal myocardial infarct
C anterior myocardial ischemia without infarction
D an anterior and posterior myocardial infarct

·55 YEAR OLD FEMALE PALPITATION SIX MONTHS TAKING DIGITALIS DAILY
_
I
II
IU
V3
RT
aVR
a VI
V5
a VF
V6
V2
V2
The tracing is most consistent with heart disease due to
A hyperthyroidism
B syphilis
с ventricular septal defect
D hypothyroidism
45

·55 YEAR OLD MALE ATTACKS OF WEAKNESS, SWEATING AND PRECORDIAL PAIN INTERMITTENTLY
FOR ONE YEAR ALL TRACINGS ARE LEAD II
A
V
B
C
A
E
F
The cardiac rhythm shown in tracing A S
А ventricular fibrillation
B ventricular flutter
с ventricular tachycardia
D anomalous atrioventricular conduction
(Wolff Parkinson White)
17
Tracing F shows a normal sinus rhythm and suggests
A digitalis effect
hyperkalemia
с hypercalcemia
quinidine
46

·42 YEAR OLD WHITE MALE BOOKKEEPER LEFT CHEST PAIN ON EFFORT FOR TWENTY FIVE YEARS
I
V2
11
3
ava
4
aVL
aVF
6
V2
V
2
V1
6
The electrocardiogram is
А within normal limits
B diagnostic of coronary artery disease
C strongly suggestive of pulmonary embolus
D consistent with chronic adhesive or constrictive pencarditis
47

·40 YEAR OLD WHITE FEMALE BLACK OUT SPELLS AND SHORTNESS OF BREATH
TAKING DIGITALIS, RESERPINE AND QUINIDINE RHEUMATIC FEVER AND CHOREA AS A CHILD
I
II
III
ETII
RA
tweet
a Va
aVL
aVF
V2
5
V3
V6
The tracing shows the effect of
A quinidine
B digitalis
The tracing shows
А periods of sinus arrest
B nodal bradycardia
C slow atnal fibnllation
D
Wenckebach phenomena
48

·54 YEAR OLD MALE WITH ACUTE CHEST PAIN STARTING TWO DAYS AGO WHICH LASTED 24 HOURS
I
II
2
V3
III
A
aVe
V5
aVL
V6
av
The following is present
A an incomplete AV block without dropped beats (first degree)
without other abnormalities
B an incomplete AV block without dropped beats with an acute
posterior myocardial infarct but without ventricular hypertrophy
an incomplete AV block without dropped beats with an acute
postenor myocardial infarct with left ventricular hypertrophy
49

·69 YEAR OLD FEMALE SHORTNESS OF BREATH ON EXERTION DIGITALIS LEAF 01 GM DAILY AND QUINIDINE 02 GM THREE TIMES DAILY TI ******** V1 Fitri T! V2 11 V3 VR VL Vs VE V6 V2 V2 Vi V6 I/ The rhythm is A atrial fibrillation B atral flutter C a complete AV block with nodal rhythm D strial premature contractions The tracing suggests A quinidine administration B digitalis administration с myocardial infarction D night ventricular hypertrophy 50

·71 YEAR OLD FEMALE DIABETES MELLITUS CHEST PAIN ON EFFORT NO CARDIAC DRUGS
I
III
ave
aVL
aVF
V1
V2
ШЛЕ ЈАСЫЛ
w
V3
6
The cardiac irregularity is
A atrial premature contractions
B nodal premature contractions
C septal ectopic beats
D ventricular extrasystoles
The tracing is most consistent with
A
left ventricular hypertrophy
B
right ventricular hypertrophy
51

·54 YEAR OLD WHITE MALE TAKING HEART PILLS BECAUSE OF PALPITATION FOR FIVE YEARS
I
II
aVR
V
aV.
11
aVe
ve
6
The electrocardiogram is
А normal
B suggestive of quinidine procaine amide administration or hypocalcemia
с typical of digitalis administration
D typical of hyperpotassemia
52

·5 YEAR OLD BOY CYANOSIS SINCE BIRTH HEART OPERATION FOUR YEARS AGO
I
II
V2
IIL
V3
aVR
V4
aVL
V5
aVF
V6
The electrocardiogram suggests
A nght ventricular hypertrophy
B no cardiac hypertrophy
с a complete right bundle branch block
D an acute pulmonary embolism
53

·38 YEAR OLD FEMALE HEART MURMUR FOR YEARS NO CARDIAC DRUGS
++++
WE
II
IN
w
aVR
aVL
aVF
ЛЦАН
WAAA
V2
АЛЛЕл.
V4
Vs
The tracing indicates the presence of
А a complete left bundle branch block
B a complete and incomplete left bundle branch block
C an incomplete left bundle branch block
D
an anomalous atrioventricular conduction (Wolff Parkinson White)
54

·48 YEAR OLD ATTORNEY CRUSHING CHEST PAIN ONE YEAR AGO NO CARDIAC DRUGS بولما I ++++++ Vi + THE tut TITUT АСАДА II V2 III V aVR 4 aVL V5 aVF V6 V2 V2 ave avy Expiration Normal Breathing aVf Inspiration The electrocardiogram A has a normal vertical electrocardiographic position B rules out a posterior infarct C is in keeping with a posterior infarct D has a normal semivertical ele. 55

·37 YEAR OLD MALE CHEST PAIN ON EFFORT, THREE MONTHS
PE
STIILIT
VE
V2
Vi
II
The electrocardiographic position is
A vertical
B semivertical
C intermediate
D semihorizontal
E horizontal
F indeterminate
The tracing suggests
A
anteroseptal myocardial ischemia
B
posterior myocardial ischemia
C
posterior myocardial infarct
D
septal infarct

·48 YEAR OLD WHITE MALE CHEST PAIN OCCASIONALLY AT REST OR ON EXERCISE
NO CARDIAC DRUGS
I
II
ESTA
SI
LEN
LAR
LORE
V2
III
V3
AVR
aVi
V4
aVF
S
Vz
V6
V2
V6
The following lead lines have been switched
А
lead I (right arm and left arm) wires when attached to the arms
B
lead II (night arm and left leg) wires when attached to the right arm and left leg
lead III (left arm and left leg) wires when attached to the left am and left leg
57

·72 YEAR OLD WHITE MALE PHYSICIAN MINIMAL CHEST PAIN LASTING THREE MINUTES
NO CARDIAC DPUGS
VA
.
V
VE
V6
V2
V2
Vi
The electrocardiogram is suggestive of
A ischemia involving the anterior wall of the left ventrcle
ischemia involving the posterior wall of the left ventncie
с ischemia involving the posterior and anterior wall of the left ventricle
58

·41 YEAR OLD MALE CHEST PAIN TWO YEARS AGO
V1
II
V2
III
V3
V4
aVR
དམ་
aVL
V5
a Ve
V6
V2
V2
V1
WATT
The tracing indicates the presence of
A an incomplete left bundle branch block
в an anterior and a posterior myocardial infarct
с an intraventricular block without a myocardial infarct
an acute anterior and an acute posterior myocardial infarct
59

·73 YEAR OLD MALE SEVERE CHEST PAIN SEVEN WEEKS AGO NO CARDIAC DRUGS
+
fi
FIL
*
KR
V2
II
V3
avg
aV.
V5
aVF
V2
V6
The tracıng indicates the presence of
A anterior myocardial ischemia without myocardial infarction
B anterolateral myocardial infarction without other abnormalities
с
anterolateral myocardial infarction with atral premature contractions
left ventricular hypertrophy
60

·65 YEAR OLD MALE PALPITATION FIVE DAYS I II V2 shut betul- III V3 TTTTTT LLLLLLL LILIT aVR aVL Vs 11 avg V6 The rhythm is А atrial fibrillation B atrial flutter с interference dissociation D Dodal tachycardia 61

·58 YEAR OLD MALE NO CARDIAC DRUGS CHEST PAIN ON EFFORT
SASE
1
1
V2
M
V3
aVR
VA
aVL
VS
aVF
V6
V2
V2
Vi
V6
NI
Other abnormalities are
The electric axis of the QRS complexes is
A deviated to the right
B deviated to the left
within normal limits
A
B
not present
present
62

·56 YEAR OLD MALE MERCHANT SEVERE PRECORDIAL PAIN WITH SYNCOPE FOUR MONTHS AGO
I
Vi
II
V2
III
V3
aVR
VA
aVL
VS
aVF
V6
V2
V2
aVF
aVF
Inspiration
Expiration
The tracing indicates the presence of
A
an old (more than a month) posterior infarct with posterolateral myocardial ischemia
B a pulmonary infarct
с nght ventricular hypertrophy
D a night incomplete bundle branch block
63

·62 YEAR OLD MALE SUBSTERNAL PAIN ON EFFORT TEN YEARS DIGITALIS LEAF 01 GM DAILY
LI
V
V2
JI
V3
VA
EVR
V5
V6
aVe
The rhythm is
A a 2 1 sino-atral block
B atrial premature contractions with an AV block
с a 21 AV block
D a complete AV block
The following is present
A
Jeft ventricular hypertrophy in the presence of a semivertical heart
B
left ventricular hypertrophy in the presence of an intermediate heart
с no evidence of left ventricufar hypertrophy
64

·60 YEAR OLD MALE SUBSTERNAL PAIN TWO DAYS AGO WHICH LASTED SIX HOURS
I
Vi
II
V2
ET
III
FA
V3
سلام با اسید
aVR
- SYA
VA
aVL
VS
+
ave
V6
If this tracing were to remain essentially unchanged for three months
the following diagnosis would be likely
A chronic pericarditis
B aortic aneurysm
с ventncular aneurysm
63

·55 YEAR OLD MALE CHEST PAIN ON EFFORT PENTAERYTHRITOL TETRANITRATE 400 MG DAILY
I
LILLE
II
MI
VR
aVi
Vs
است مراسما
ave
17
1
The rhythm is
A sinus bradycardia
B normal sinus rhythm
с sinus arrhythmia
D nodal bradycardia
The following is present
A a right incomplete bundle branch block
B a right complete bundle branch block
с a left incomplete bundle branch block
D
a left complete bundle branch block
III
The electrocardiographic position of the heart is
A horizontal
B intermediate
с vertical
66

·40 YEAR OLD MALE NO CARDIAC DRUGS CHEST PAIN
-JAA
I
II
V2
III
V3
aVR
V
aVL
Vg
ave
V6
V2
V2
Vi
V6
The tracing is
A normal
B abnormal because of the positive
segment shifts in lead V2
с abnormal because of the Q waves
in leads II III and aVe
The electrocardiographic position is
А semihorizontal
B horizontal
с semivertical
67

·71 YEAR OLD MALE DYSPNEA FOR YEARS PALPITATION TEN DAYS NO CARDIAC DRUGS
I
Vi
w
II
10
III
ES
V3
aVR
V5
aVL
ta
V6
aVF
The rhythm is
A sinus tachycardia
B incomplete AV block without dropped beats (first degree)
VC incomplete AV block with dropped beats (second degree)
IT
The P waves are
А entirely normal
B in keeping with chronic pulmonary disease
с typical of mitral stenosis
68

·62 YEAR OLD MALE CHEST PAIN ON EXERTION SIX MONTHS AGO ACETYL DIGITOXIN O 3 MGM DAILY
I
Vi
II
V2
V3
aVR
aVL
V5
aVe
V6
The tracing is typical of
A a left complete bundle branch block
B an incomplete left bundle branch block
с anomalous atrioventricular conduction (Wolff Parkinson White)
D ventricular tachycardia

·8 YEAR OLD BOY SHORTNESS OF BREATH SINCE BIRTH NO DRUGS
(Half Standardization in Precordial Leads)
V1
V2
LUTA
V3
VA
aVL
Vs
aVF
ww
V6
II
The electrocardiogram suggests the presence of
A left atrial enlargement
B nght ventricular hypertrophy
с a right incomplete bundle branch block
D right and left ventricular hypertrophy
The rhythm is
A
sinus tachycardia
B
sinus bradycardia
с sino atrial block
D
sinus arrhythmia
70

·19 YEAR OLD FEMALE SHORTNESS OF BREATH TEN YEARS TAKING DIGITALIS
*****
I
II
V2
INI
V3
VA
aVR
V5
aVL
NE
ave
V6
V2
V2
V1
V6
The electrocardiogram is consistent with
А diastolic overload of the right ventricle
B left ventricular hypertrophy
с an incomplete left bundle branch block
D anomalous atnoventricular conduction (Wolff Parkinson White)

·36 YEAR OLD MALE ATHLETE NO COMPLAINTS
V1
A
V2
V3
VA
Vg
F
The rhythm is
A sinus bradycardia
B sinus tachycardia
с normal sinus rhythm
sino-atrial block
72

·46 YEAR OLD FEMALE SHORTNESS OF BREATH ON EXERTION FIFTEEN YEARS DIGITALIS LEAP 01 GM DAILY I V1 II V2 III TE V3 aVR aV Vs aVF V6 11 The U waves are 1 The following is present A atrial fibrillation and left ventncular hypertrophy B atrial fibrillation and nght ventricular hypertrophy atrial futter and left ventricular hypertrophy D atrial flutter and nght ventricular hypertrophy A B с D normal size abnormally large abnormally small absent 73

·62 YEAR OLD RETIRED MALE SEVERE DYSPNEA ON SLIGHT EXERTION FIFTEEN YEARS
NO ORTHOPNEA
V
The tracing suggests
A atrial enlargement only
B
ventricular hypertrophy only
с atrial enlargement and night sentricular hypertrophy.
D
ventricular aneurysm
74

·60 YEAR OLD FEMALE SHORTNESS OF BREATH EIGHT YEARS
I
۷
II
سيارات
V2
در راه با
بله
III
موريتا
V
بار بار بار بار
VA
aVR
۷5
aVL
76
دارای
aVF
The electrocardiogram suggests the following
A right ventricular hypertrophy only
atrial enlargement left ventricular hypertrophy and quinidine effect
C atral enlargement left ventricular hypertrophy and digitalis effect.
digitalis effect and left ventricular hypertrophy without atrial enlargement
B
D
5

·30 YEAR OLD FEMALE SHORTNESS OF BREATH TWELVE YEARS TAKING DIGITALIS
I
II
INI
A
V3
4
MET
aVx
V 5
aV2
aVE
V2
V2
V1
The electrocardiogram suggests
A right ventricular hypertrophy
B a right bundle branch block
C pericarditis
D pulmonary infarction
76

·30 YEAR OLD FEMALE HEART MURMUR SINCE BIRTH I V1 wa II ESKALA V2 LUL III ** aVR VA aVL VS aVF V6 E V2 Vi V6 The mean electric axis of the QRS complexes А is deviated to the right B is deviated to the left shows no unusual deviation The following us present A a posterolateral myocardial infarct B an incomplete right bundle branch block с a complete right bundle branch block 77

·54 YEAR OLD MALE PALPITATION DIGITALIS LEAP 01 GM DAILY
I
Vnuw
V1
I
V2
AANV
III
VA
vya
aVx
aVL
VV
vaan
V6
aVe
II
The following is present
А normal sinus rhythm
B sinus arrhythmia
с
nodal rhythm
supraventricular tachycardia
The following is present
A left ventricular hypertrophy
B an old posterior infarct
с right ventricular hypertrophy
a left complete bundle branch block
78

·30 YEAR OLD COLORED FEMALE ULCERS OF ANKLES ONE YEAR NO CARDIAC DRUGS
I
Vi
IT
BERSEE
II
III
V3
VA
ava
Vs
aVL
TERAN
aVe
V6
ter
V2
V2
Vi
16
The electrocardiogram
A is normal
B indicates coronary artery disease
с is consistent with an abnormal myocardium
D is diagnostic of hypertensive heart disease
79

·29 YEAR OLD FEMALE
I
جیمیهن
تیم
۷
III
۷3
aVR
aVL
المراهقه
به هم
تتوقی
به می باشد
سیر له مالمیرا
avr
PETE
HTTL
هيها
76
V2
72
v,
6
The tracing is suggestive but not diagnostic of
A tricuspid stenosis
B mitral stenosis
C coarctation of the aorta
D patent ductus arteriosus
E right aortic arch
80

·42 YEAR OLD FEMALE PALPITATION FOUR DAYS DIGITALIS LEAF 01 GM DAILY ht I RETTE V2 II V3 III MAAT aVR HEALTH Vs aVL 16 aVe V2 V6 Vi The rhythm is A atrial flutter with block or atrial tachycardia with block B parasystole C incomplete interference dissociation There is A suggestive evidence of nght ventricular hypertrophy B suggestive evidence of left ventricular hypertrophy 81

·50 YEAR OLD MALE TAKING DIGITALIS CHEST PAIN THREE YEARS AGO
I
V1
II
V2
III
*****
aVL
my
Vs
I det
HTTTTT
aVF
V6
V2
V2
II
1
The time of onset of the intrinsicoid
deflection in lead V6 IS
A delayed
B normal
C
short
The following is likely
A a myocardial infarct with ventricular ectopic beats
B ventricular ectopic beats and anomalous atrioventricular
conduction (Wolff Parkinson White)
82

·50 YEAR OLD MALE PALPITATION FOR YEARS NO CARDIAC DRUGS
++++++
+++
ht
II
III
V3
aVR
VA
ft.EE
aVz
Vg
a VF
V6
V2
V2
V6
The tracing indicates the following
A a true left bundle branch block
B
anomalous atrioventricular excitation (Wolff Parkinson White)
C
Jeft ventricular hypertrophy
D
night ventncular hypertrophy

·13 YEAR OLD BOY JOINT PAINS TWO YEARS AGO NO CARDIAC DRUGS
II
III
AVR
Vs
aVL
aVF
V6
The electrocardiogram is
А normal
B in keeping with a diagnosis of left and right ventricular hypertrophy
с excludes rheumatic heart disease
is diagnostic of pencarditis
84

·56 YEAR OLD WHITE MALE MINIMAL CHEST PAIN ON EXERTION SIX TIMES IN THE PAST YEAR
NO CARDIAC DRUGS
LA
I
HULUMTHILLITE!
II
VAATA
V2
3
III
وار
VA
aVR
Vg
با ما
aVL
aVF
V6
V2
2
V
V6
The tracing shows
A a right complete bundle branch block
B a night incomplete bundle branch block
с a night complete bundle branch block with an anterior myocardial infarct
85

·36 YEAR OLD MALE SHORTNESS OF BREATH TEN YEARS NO CARDIAC DRUGS
1
II
von
M
V
aVR
Л.Л.
aV2
AA
Vg
aVF
16
The tracing indicates the presence of
A left ventricular hypertrophy without right ventricular hypertrophy
B a complete right bundle branch block
с hypertrophy of the right ventricle
D an incomplete left bundle branch block
86

·28 YEAR OLD MALE THREE DAYS POST-OPERATIVE NO DRUGS
Before Treatment
After Treatment
V1
II
II
V2
III
V3
III
V
aVR
aVR
VL
Vs
aVL
HE
aVF
VO
a V
The tracing taken before treatment indicates
A hyperkalemia
B hypokalemia
с hypercalmemia
D hypematremia
87

·68 YEAR OLD MALE CHEST PAIN LASTING TWO HOURS THREE DAYS AGO ON DIGITALIS
1
+++
11
III
a VR
aVL
Vs
1
TOP
+41 to
المه
aVe
V2
Vi
V6
The conduction defects which are present (select more than one if necessary) are
A an incomplete AV block without dropped beats (first degree)
B a left complete bundle branch block
с a nght complete bundle branch block
D an incomplete AV block with dropped beats (second degree)
E a complete AV block
88

·58 YEAR OLD FEMALE CHEST PAIN EIGHTEEN HOURS DURATION ONE YEAR AGO
I
V1
II
V2
III
V3
VA
aVR
aVi
Vg
aVF
16
V2
V2
Att
aVp
ave
Inspiration
Expiration
The tracing is
A diagnostic of a posterior infarct
B consistent with but not diagnostic of a posterior myocardial infarct
с entirely normal
D suggestive of an acute pulmonary infarct
89

·49 YEAR OLD FEMALE SHORTNESS OF BREATH SIX MONTHS
V2
III
V3
aVe
VA
V5
aVe
V6
The tracing is indicative of
А an acute lateral myocardial infarct
an acute injury to the subepicardial surface of the left ventricle
C coronary insufficiency
D
coronary arteriosclerosis
90

·61 YEAR OLD MALE CHEST PAIN FIVE YEARS AGO DIGITALIS LEAF 01 GM DAILY
KILAFELL TILL
e
1
HIE
BENE
*****
tttt
1
V1
witware
II
V2
III
hinn
aVx
Vg
all
tet
st
V6
aVE
The following is present
A a false bundle branch block (Wolff Parkinson White)
В an incomplete left bundle branch block with digitalis effect
& posterior peri infarction block
D a complete night bundle branch block
91

·62 YEAR OLD MALE DIABETES 20 YEARS NO INSULIN NO CHEST PAIN OR DRUGS
Vi
II
V2
(II
Ve
aVL
Vs
V6
The electrocardiogram
А is within normal limits
B is diagnostic of an electrolyte disturbance
C
represents a transmural anterior myocardial infarct
D is suggestive of left ventncular hypertrophy and/or myocardial ischemia
92

·68 YEAR OLD WHITE DENTIST SEVERE DYSPNEA WHEN SUPINE AND ON EXERCISE
DIGITOXIN 02 MG DAILY
1.
V1
1
-
VR
VA
VL
Vs
اس دی ۔
V6
The electrocardiogram shons
А a complete left bundle branch block
B a complete left bundle branch block with ventricular ectopic beats
с an incomplete left bundle branch block
D an incomplete left bundle branch block with ventricular eotanir heats
93

·61 YEAR OLD MALE CHEST PAIN INTERMITTENTLY FOR FIVE YEARS DIGITALIS 01 GM DAILY
th
I
V1
II
V2
III
V3
aVR
+ht
wilt
VA
aVL
15
aVe
V2
V2
V1
V6
А
The rhythm is
normal sinus rhythm
B sinus bradycardia
C nodal rhythm with retrograde conduction
nodal rhythm without retrograde conduction
nodal rhythm with retrograde conduction with abnormalities of the ST segments
94

·30 YEAR OLD MALE SUDDEN PAIN IN CHEST, SWEATING WEAKNESS AND SHORTNESS OF BREATH
MA
+++++
+
HO
[
V1
I
BE
www
II
V3
VR
V5
VL
VF
V6
V2
V2
Vi
V6
The electrocardiogram is
A indicative of a myocardial infarct involving the lateral wall of the left ventricle
B consistent with but not diagnostic of a left pneumothorax
с indicative of rheumatic mitral stenosis
95

·69 YEAR OLD WHITE MALE FAINTING SPELLS ONE DAY NO CARDIAC DRUGS
I
II
III
aVR
aVL
aVF
V3
V 6
u
The cardiac rhythm is
A sino atrial block
B sinus bradycardia
с sinus arrest
D intraventricular block
The following is present
А a nodal escape beat without
retrograde conduction
B a ventricular escape beat
с a nodal escape beat with
retrograde conduction
96

·70 YEAR OLD FEMALE UNABLE TO BREATHE WHEN SUPINE TAKING DIGITALIS LEAF 0 1 GM DAILY
I
Vi
THE
II
V2
V₃
AVR
VA
aVL
Vs
aVe
V6
I
The following artifact is present
A muscle tremor
B interfering alternating current
and incorrect standardization
с loose filaments in vacuum tube
The rhythm is
A atnal fibrillation
B atrial fibrillation and multifocal
ventricular ectopic beats
с
atrial fibrillation and ventncular
and atrial premature contractions
97

·54 YEAR OLD MALE MECHANIC CHEST PAIN LASTING ONE HOUR EIGHT MONTHS PRIOR TO
THIS TRACING NO DRUGS
V2
A
V3
VR
VA
VL
V.
VF
V6
V2
V2
V1
V6
The tracing indicates the presence of
A an old postenor myocardial infarct with peri infarction block
B a left typical complete bundle branch block
с
a false bundle branch block (Wolff Parkinson White)
D a recent posterior myocardial infarct
98

·55 YEAR OLD MALE SUBSTERNAL PAIN RADIATING TO BACK TEN MONTHS AGO
HANDS STIFF FOR EIGHT MONTHS
I
II
V2
III
V3
ܝܝܪܳ
aVR
LI
aVL
aVF
The tracing is suggestive of
A anterior myocardial ischemia
B anterior myocardial infarct
с posterior myocardial ischemia with a posterolateral myocardial infarct
D no heart disease
99 >

·58 YEAR OLD MALE CHEST PAIN SIX MONTHS AGO
A
V2
+
V3
+
V4
L
.
Ve
The following is present
А a posterior infarct without other abnormalities
B a posterior infarct and ventricular ectopic beats without other abnormalities
с a posterior infarct with ventricular ectopic beats and local intraventricular block
D anomalous atrioventricular conduction (Wolff Parkinson White)
100

·65 YEAR OLD MALE CHEST PAIN FOUR MONTHS AGO NO CARDIAC DRUGS
1
Vi
II
V2
III
V₃
aVR
aVL
Vg
aVF
V2
V2
V1
V6
The tracing suggests
А ischemua involving the anteroseptal lateral and posterolateral
aspect of the left ventricle
в necrosis of a large part of the anteroseptal lateral and posterolateral
aspects of the left ventricle
с necrosis or myocardial death of the anteroseptal portion of the
left ventricle with anteroseptal lateral and posterolateral myocardial ischemia

·30 YEAR OLD FEMALE SHORTNESS OF BREATH FIFTEEN YCARS NO DIGITALIS
II
MAN
V2
III
محامين
titt
V3
aVx
VA
aVL
بعد سے
V5
ave
V6
The tracing suggests
A right ventricular hypertrophy without left ventricular hypertrophy
B left ventricular hypertropby without right ventricular hypertrophy
C right and left ventricular hypertrophy
102

·8 YEAR OLD BOY SHORTNESS OF BREATH ON EXERTION NO CARDIAC DRUGS
I
V
انا اب میرا امر ما بيw//
MAAN
V2
II
NI
MMM
VA
avg
V5
aVL
aVf
V6
V2
V1
V6
The electrocardiogram is in keeping with the following disease state
A uncomplicated ventricular septal defect
B Ebsteins syndrome
с tricuspid stenosis
D aortic valve disease
103
103

·58 YEAR OLD FEMALE CHEST PAIN AT REST AND ON EFFORT
Vi
1
V2
II
V3
Ne
VA
av
Vs
a VF
V2
V
V1
V
6
The tracing us typical of
A an acute (few hours) anterolateral myocardial infarct
B a subacute or chronic (weeks or months) anterolateral myocardial infarct
с anteroseptal myocardial ischemia without infarction
D an incomplete left bundle branch block
104

·33 YEAR OLD MALE GENERAL CHECK UP NO DRUGS
I
II
V2
III
Уз
سالار
aVR
aVL
aVF
The inverted I wases in lead aVi are
A indicative of ischemia of the lateral wall of the left ventricle
B indicative of a lateral myocardial infarct
с within normal limits
II
The electrocardiographic position is
А horizontal
B semihorizontal
с intermediate
D indeterminate
E vertical
105

·32 YEAR OLD FEMALE SHORTNESS OF BREATH TEN YEARS NO CARDIAC DRUGS
1
w
II
SINGEN
V2
II
UR
FR
V3
4
VR
VL
V5
.
ett
IVF
V6
SO
V2
V2
Vi
The tracing is most consistent with the follow ing condition
A dextrocardia not associated with other cardiac abnormalities
B severe pulmonary valvular stenosis
C acute cor pulmonale
D aortic valve disease
106

·15 YEAR OLD PEMALE HEIGHT 68 INCHES WEIGHT 75 POUNDS CARDIAC CHECK UP
LT1
STRE
1
V1
II
ܚܚܬܐ
i
III
V4
ave
aVL
aVF
V6
The following is present
A an incomplete right bundle branch block without other abnormalities
B
an incomplete right bundle branch block and right
ventricular hypertrophy without other abnormalities
an incomplete night bundle branch block right ventricular
hypertrophy and a ventricular ectopic beat

·+++
15 YEAR OLD MALE CARDIAC CHECK UP
.
1
V1
II
wwwind
V2
III
Ft
V3
VA
a VR
Vg
aVL
V6
ave
The tracing is consistent with but not diagnostic of
А
left ventricular hypertrophy
B right ventricular hypertrophy
с
Jeft and right ventricular hypertrophy
D
a left incomplete bundle branch block
108

·13 YEAR OLD GIRL SHORTNESS OF BREATH SINCE BIRTH HEIGHT 52 INCHES WEIGHT 85 POUNDS
I
Vi
بنایا
II
V2
III
V3
aVR
Vs
aVL
tre
V6
aVe
V2
V2
Vi
The fracing suggests
A a false bundle branch block (Wolff Parkinson White)
B an incomplete night bundle branch block
a left bundle branch block
D a partial atrioventricular block

·67 YEAR OLD FEMALE WEIGHT 160 POUNDS DIGITALIS LFAF 0 I GM DAILY FOR ONE YEAR
***
***
1
tul
++++++++++
11
III
aVR
aVL
Vs
ave
V2
ty
16
The ST segments are characteristic of
A hyperkalemia
B hypocalcemia
.C digitalis in subtherapeutic doses without myocardial injury and ischemia
procaine amide
E therapeutic or excessive doses of digitalis and miocardial injury and ischemia

·49 YEAR OLD FEMALE SHORTNESS OF BREATH DIGITALIS 02 GM DAILY
I
V1
wa
II
V2
III
MA.
aVR
VA
aVL
a VF
Vs
The electrocardiogram is consistent with the following clinical states
А mitral stenosis and insufficiency
B subaortic stenosis
patent ductus arteriosus without other abnormalities
113

·72 YEAR OLD MALE PHYSICIAN CHEST PAIN FOR SEVEN DAYS NO CARDIAC DRUGS
ERAEUS
I
TA
II
V2
BE
-
TNT
AN
IIL
SEA
V3
aVe
aVL
V5
aVF
V6
The following is present
A dextrocardia
B right ventricular hypertrophy
C switching of the lead I wires when applied to the patients arms
D a right complete bundle branch block
114

·68 YEAR OLD FEMALE CHEST PAIN ON EFFORT ONE YEAR NO DIGITALIS
I
V1
II
V2
III
AGASM
V3
AVR
Vs
aVL
a VF
V6
The tracing suggests the following (select more than one if desired)
a complete left bundle branch block
an incomplete left bundle branch block
C a partial AV block without dropped beats
nodal premature contractions
E ventricular premature contractions
115

·60 YEAR OLD MALE CHEST PAIN TWO DAYS
w
II
V2.
VA
ava
A
aVL
The tracing is suggesture of
A a left typical complete uncomplicated bundle branch block
B a right complete uncomplicated bundle branch block
C an intraventricular block associated possibly with a dying heart or with hyperkalemia
severe hypokalemia v
113

·HALALTH
V2
small ventricular septal defect
13 YEAR OLD JAPANESE SCHOOLBOY CARDIAC MURMUR SINCE BIRTH NO DRUGS
I
II
III
av
aVF
A
dextrocardia
The tracing is in keeping with a diagnosis of
B
Ebsteins syndrome
D
E
large atrial septal defere
ava
Vs
دربار
V6
C uncomplicated tetralogy of Fallot
117

·28 YEAR OLD WHITE MALE WEAKNESS OF TWO MONTHS DURATION NO CARDIAC COMPLAINTS
I
Il
III
V2
!
Vz
aVR
WHIS
HILLLLLLL
VA
aVL
ww
aVe
.
Vs
The tracing suggests
A anterior subepicardial ischemia
B hypokalemia
Chyperkalemia
D hypocalcemia
E hypercalcemia
118

·45 YEAR OLD MALE SLOW PULSE RATE FIRST DISCOVERED AT AGE 8
I
Vi
ma
II
V2
III
V3
V4
aVR
Vs
aVi
ave
V6
The following is present
A sino atrial block
B interference dissociation
с complete AV block with idioventricular rhythm
D a nght incomplete bundle branch block
E a right complete bundle branch block
F a complete AV block with nodal rhythm
119

·No text on this page.

·PART B
QUESTIONS ON
ELECTROCARDIOGRAPHIC INTERPRETATION

·ARRHYTHMIAS 1 Atrial fibrillation is characterized by A the absence of clearly distinguishable P waves and irregular R R intervals B RR intervals which show phasic variations with respiration с clearly defined P waves of similar configuration with variable P R intervals 2 Atrial fibrillation usually has an atrial rate A which exceeds 300 beats per minute B is less than 200 beats per minute с is less than 100 beats per minute 3 Atrial fibrillation or flutter usually but not invariably is associated with demonstrable disease in the heart or somewhere in the body А True B False 4 Atrial fibrillation is A usually accompanied by an irregular ventricular rhythm B seldom accompanied by an irregular rhythm 5 Atrial flutter when untreated commonly has a rate of A 450 beats per minute B 300 beats per minute 150 beats per minute D 100 beats per minute 6 Atrial tachycardia is characterized by A a rapid atrial rate often with nearly regular P P intervals absolute irregularity of atrial contraction с a gradual slowing of atrial contractions following breath holding or deep breathing B 7 When atrial tachycardia changes to sinus rhythm the conversion usually takes place A gradually B abruptly 8 Paroxysmal atrial tachycardia with block frequently results from A epinephrine injection B extreme physical exertion C digitalis intoxication Dhyperthyroidism 9 Paroxysmal atrial tachycardia is A pathognomonic of organic cardiac disease B good evidence of organic cardiac disease C not in itself indicative of organic cardiac disease 10 Paroxysmal tachycardia may be atrial nodal or ventricular A True B False Electric alternation always accompanies pulsus alternanse A True B False 120 ·12 A nodal escape occurs commonly with sinus arrest when the atrioventricular node assumes control for one or more beats B describes slow rhythms of ventricular origin when retrograde conduction into the atria Occurs с describes a nodal rhythm where QRS precedes an inverted P wave AV nodal rhythm with retrograde conduction is character,ed typically by А positive P waves in lead II B inverted P waves in lead av с positive P waves in leads I and aVe 13 14 Nodal rhythm is caused by a periodic discharge from the А Sinus node B atrioventricular node 15 16 With nodal rhythm with retrograde conduction the P Waves A always precede the ORS complexes. B always follow the QRS complexes с always fall within the QRS complexes D may precede, fall within or follow the QRS complexes Nodal tachycardia with retrograde conduction is characteried by A rapid regular atrial contractions occurring at a rate greater than 100 beats per minute with inverted P waves in leads II III and a Ve an atrial rate between 60 and 100 beats per minute with inverted P waves in leads 11 III and aVe с an atrial rate over 100 beats per minute with positive P waves in lead aVe Nodal rhythm is A always accompanied by retrograde conduction through the atria not always accompanied by retrograde conduction through the atria Wuh parasystole the interval in seconds between any ino complexes produced by the ectopic pacemaker will be divisible by a common denominator and results in a whole number as a quotient A True B False 17 B 18 19 Sinus arrest usually is A a functional arrhythmia characterized by temporary cessation of activity of the sinus node B produced by organic disease of the sino atrial node and is associated with long periods of atrial standstill 20 Phasic sinus arrhythmia is present when the cardiac rate varies with A respiration and the pacemaker is in the sinus node B exercise when the pacemaker is outside the sinus node 21 Phasic sinus arrhythmia is in itself A diagnostic of cardiac disease B not diagnostic of cardiac disease 22 Sintes bradycardia is diagnosed when the cardiac rate is A less than 60 beats per minute and the pacemaker is in the sinus node between 60 and 100 beats per minute and the pacemaker ss in the sinus node less than 60 beats per minute with the pacemaker in the atrioventricular node 121 ·23 The cardiac rate normally varies A inversely with age from birth to adulthood (the older the age the slower the rate) B directly with age from birth to adulthood 24 Normal sinus rhythm is diagnosed when the pacemaker is A in the sinus node and the cardiac rate is from 60 to 100 beats per minute B in the atrioventricular node and the cardiac rate us from 60 to 100 beats per minute с in the sinus node and the cardiac rate exceeds 100 beats per minute 25 Sinus tachycardia as a general rule A does not exceed 160 beats per minute B often exceeds 180 beats per minute с falls between 60 and 100 beats per minute 26 Sinus tachycardia is diagnostic of hyperthyroidism B suggestive of hypothyroidism consistent with a normal heart as well as with cardiac and other disease states 27 Supraventricular tachycardia includes A sinus atrial or nodal tachycardia and atrial fibrillation or flutter B atrial fibrillation or atrial flutter only с sinus atrial or nodal tachycardia only 28 Ventricular fibrillation is characterized by A irregular RR intervals and wide QRS complexes which are irregular in amplitude and duration and which are not regularly preceded by P waves B regular wide QRS complexes preceded by P waves с QRS complexes of normal width and configuration ✓ 29 Multiple ventricular ectopic beats are diagnosed when two or more ventricular ectopic beats of similar sıze configuration and polarity are present A True B False 30 Multfocal ventricular ectopic beats are diagnosed when in a lead two or more ventricular ectopic beats A differ from each other in size configuration or polarity are similar in size configuration and polarity B 31 Ventricular premature contractions characteristically are A preceded by P waves B not preceded by P waves 32 Ventricular premature contractions recorded with the subject at rest are A diagnostic of organic myocardial disease. B not in themselves diagnostic of organic myocardial disease 33 Ventricular ectopic beats arising from the base of the heart are in the three standard leads predominately A negative B positive C biphasic 122 ·V 34 Bigeminy is character.ed by groups of two beats consisting of A a normal beat and a ventricular ectopic beat B a normal beat and an atrial premature beat C any combination of coupled beats 35 Premature beats of ventricular origin A always indicates myocardial disease B frequenly occur in the absence of demonstrable cardiac disease 36 37 Ventricular fachycardia is usually regular but at times may show slight irregularity of the RR intervals A True B False the requirements for ventricular tachycardia is А a pacemaker in a ventricle which sends out a series of successive ventricular contractions B ventricular ectopic beats which show retrograde conduction с ventricular ectopic beats which fail to show retrograde conduction One of ARTIFACTS 38 When the right arm and left arm lead wires have been attached incorrectly to the arms (lead / lines interchanged) the three standard leads can be corrected by viewing A lead I as its mirror image and interchanging leads II and III B lead Ill as the mirror image and interchanging leads I and II When the left arm and left leg wires have been attached incorrectly to these limbs while form ing the lead III connection (lead uires interchanged) the standard leads can be corrected by viewing А lead III as its mirror image and interchanging leads I and II lead II as its mirror image and interchanging leads I and III 39 B 40 41 When the right arm and left leg lead wires have been attached incorrectly to these limbs when forming the connections for lead II (lead wires interchanged) the standard leads can be cor rected by viewing А all leads as their mirror images and interchanging leads I and III B lead II as the mirror image and by interchanging leads I and III Negative P QRS and T waves in lead I with P waves preceding and T waves following QRS complexes suggests A typical right bundle branch block B typical right ventricular enlargement C dextrocardia or reversal of the right arm and left arm lead wires when making the lead I connection D a lead mounted upside down CONDUCTION DEFECTS 42 A first degree AV block is A diagnostic of rheumatic heart disease B diagnostic of ischemia of the AV node с not diagnostic of any specific state 123 ·43 A first degree block (prolonged P R interval) usually indicates changes in the A sinus node B atrioventricular node с bundle of His 44 a complete atrioventricular block is characterized by QRS complexes which A are never wider than 0 12 second B are always wider than 0 12 second с may be of normal duration or prolonged 45 A complete AV block with idioventricular rhythm indicates the presence of a block in the А sinus pode B atrioventricular node. C bundle of His 46 The Wenckebach phenomenon is a type of А complete AV block B incomplete AV block with dropped beats с incomplete AV block without dropped beats 47 The Wenckebach phenomenon is A progressive lengthening of P R interval with eventual dropping of a ventricular beat B excessive sinus arrhythmia not respiratory in orgin с progressive lengthening of P R with dropping of a ventricular beat after every second D cyclic variations in P R without dropping of beats wave 48 Anomalous atrioventricular conduction (Wolf Parkinson White) A is never associated with organic cardiac disease B is always associated with organic cardiac disease с may or may not be associated with organic cardiac disease 49 Anomalous atrioventricular conduction (Wolf Parkinson White) is characterized by A short P R intervals and wide QRS complexes B prolonged P R intervals and QRS complexes of short duration с long P R intervals and slurring of QRS complexes Which of the following is most consistent with typical complete left bundle branch block? A Q waves in lead I QRS complexes which measure from 0 10 to 0 12 second C QS waves in leads V1 and V2 with QRS complexes which are greater than 0 12 second in duration 50 B 57 52 In the presence of a left bundle branch block es waves in leads Vs and V 6 A suggest a myocardial infarct B rule out a myocardial infarct с suggest left ventricular hypertrophy In typical left bundle branch block the J paint ST segments and T waves are usually concordant with the major deflections of the QRS complexes discordant with the major deflections of the QRS complexes A right bundle branch block may be a congenital abnormality True B False A B 53 A 124 ·54 An incomplete right bundle branch block in the electrocardiogram suggests interruption of some of the fibers of the right bundle of His A True B False 55 In the presence of a night bundle branch block large ( wares in leads V3 V4 and Vs suggest A an anterior myocardial infarct a posterior myocardial infarct C right ventricular hypertrophy B 56 In the presence of a right bundle branch block elevated J points and coved ST segments with inverted T waves in leads V3 V4 and Vs which persist for 24 hours or more suggest an anterior myocardial infarct or pericarditis posterior myocardial ischemia C pulmonary infarction А B 57 The prognosis with a complete night bundle branch block generally is A more favorable than with a complete left bundle branch bloche B less favorable than with a left bundle branch block 58 Incomplete right bundle branch block is common when lead V3R or V1 shows an rSR prime wave with the onset of the intrinsicold deflection of the R prime wave from A 0 035 to 0 05 second B 005 to 0 075 second с 008 second or greater 59 A right bundle branch block makes it impossible to diagnose a large postero inferior myocardial infarct A True B False 60 Sino auricular block may be due to A epinephrine B atropine с digitalis D theophylline DISEASE STATES+ (CONGENITAL AND ACQUIRED) 61 The electrocardiogram is diagnostic of at least one of the following types of congenital heart diseases A Tetralogy of Fallot B Eisenmengers complex с Dextrocardia D Interatrial septal defect Uncomplicated atrial septal defects of significant size generally are characterized by electro cardiographic evidence of right ventricular hypertrophy or right bundle branch block left ventricular hypertrophy с left bundle branch block 62 A B 125 ·63 Ventricular septal defects uncomplicated by other congenital abnormalities produce no ab normalities in the tracing of the defect is small however if it is large there may be evidence of left or right or left and right ventricular hypertrophy A True B False 64 Large or many pulmonary veins emptying into the right atrum generally result in the electro cardiographic picture of A left ventricular hypertrophy B right ventricular hypertrophy с left bundle branch block 65 Transposition of the great vessels results in the electrocardiographic picture of pure left ven tricular hypertrophy without right ventricular hypertrophy A True False B 66 The electrocardiogram of Ebsteins syndrome suggests А right atrial and left ventricular hypertrophy left atrial hypertrophy in the absence of right ventricular hypertrophy C right atrial hypertrophy and right complete bundle branch block or intraventricular block B 67 The electrocardiogram from a patient with a patent ductus arteriosus which is uncomplicated by other abnormalities typically A is normal or shows evidence of left ventricular hypertrophy shows evidence of right ventricular hypertrophy without left ventricular hypertrophy B 68 Coarctation of the aorta in the adult shows usually A a left ventricular hypertrophy pattern or occasionally a normal electrocardiogram Bright bundle branch block right ventricular hypertrophy 69 Tricuspid atresia with a nonfunctioning right venircle and an interatnal septal defect charac teristically produces А a right ventricular hypertrophy pattern a left ventricular hypertrophy pattern с a normal electrocardiogram B 70 Truncus arteriosus existing as an uncomplicated entity is associated with a left ventricular hypertrophy pattern A True B False 71 The tetralogy of Fallot without a ductus arteriosus or other additional abnormalities charac teristically shows A a left ventricular hypertrophy pattern B a left bundle branch block с a right ventricular hypertrophy pattern 72 Pulmonary stenosis with intact atral and ventricular septa shows characteristically right ventricular hypertrophy or occasionally a normal electrocardiogram left ventricular hypertrophy right and left ventricular hypertrophy A с 126 ·73 Rheumatic mitral stenosis frequently shows a vertical electrocardiographic position of the heart with wide notched P waves in leads I and II or atrial fibrillation A True B False 74 Aotic stenosis and insufficiency usually are characterized by A left ventricular hypertrophy B right ventricular hypertrophy с no ventricular hypertrophy The electrocardiogram is always abnormal with disseminated lupus erythematosus A True B False 75 76 P waves in pulmonary emphysema often are A wide and notched in leads I II and a VL B wide and notched in leads II III and aVf tall and pointed in leads II III and aVF D tall and pointed in leads I II and aVL Severe hyperthyroidism produces often А complete atrioventricular block B sinus bradycardia C atrial fibrillation or atrial futter 77 78 Severe hypothyroidism produces often A complete atrioventricular block B sinus bradycardia с atrial fibrillation or atrial flutter DRUGS AND ELECTROLYTES 79 Digitalis in digitalızıng doses typically produces A short QT intervals B no change in QT intervals с long QT intervals 80 81 Digitalis therapy may result in A prolongation of P R interval but not in higher degrees of AV block B a complete AV block an intraventricular conduction delay Digitalis usually slows the ventricular rate significantly in patients with А atrial fibrillation B tachycardia due to toxic states or infections if congestive heart failure is not present Digitalis shifts the point in most leads opposite to the major deflections of the QRS complexes in the same direction as the major deflections of the QRS complexes Quinidine characteristically A shortens QT intervals B lengthens QT intervals с does not alter QT intervals 82 83 127 ·84 Quinidine characteristically A converts atrial fibrillation to sinus rhythm B produces sinus arrhythmia shortens the duration of QRS complexes Quinidine increases the ventricular rate in certain patients with atrial flutter A True False 8S 86 Hypocalcemia of severe degree produces A short QT intervals R long QT intervals C no change in QT intervals 87 88 In itypokalemia A QT intervals are prolonged and U waves are prominent 8 T waves are generally tall and upright C Q T untervals are shortened QRS increases in length Hyperkalemia is associated with A tall peaked T waves B decreased durauon of QRS complexes Clong QT or long Q U intervals Large U saves are a common finding with A hyperkalemia B hypokalemia C rapid cardiac rates hypernatremia The electrocardiogram is a highly reliable ander of the blood potassium level under all cir cumstances True B False 89 90 9/ ELECTRIC AXIS The mean electric axis of the QRS complexes is normally A less positive in infants than in children B more positive in infants than in children C essentially the same in infants and children Right aris derration of the QRS complexes greater than 90 degrees is found commonlı on partenes with dextrocardia tetralogy of Fallot Ersenmengers complex significant pulmonary stenosis significant atrial septal defect or Lute mbacher s syndrome A True B False 92 93 Left axis deviation or a tendency to left ars devanon of the QRS compleres is present charac teristically in adults » 1th significant coarctanon of the aorta and in parents with hypogenesis of the right sonircle or with tricuspid stenosis associated with arnal septal detect A True B False 94 Normall the mean electric aris of the T wales А is opposite to the mean electric aus of the QRS complexes follows in general that of the mean electric axis of the QRS compleres 128 ·HYPERTROPHY (ATRIAL AND VENTRICULAR) 95 Left atrial hypertrophy is characterized often by A narrow tall peaked unnotched P waves of similar configuration in leads II and III B wide notched P waves in leads I and II с inverted P waves in leads II III and aVe 96 Right alrial hypertrophy is characterized often by A broad notched P waves in leads 1 and Il B narrow tall peaked P waves of similar configuration in leads II and III с inverted P waves in leads II III and a VF 97 Left ventricular hypertrophy is characterized by high voltage of the R waves in lead aVl muth points ST segements and T waves which are opposite to the major deflections of the QRS com plexes A True B False 98 The average of the electric forces present during ventricular depolarization in a subject with left ventricular hypertrophy is often from the AV node toward the A left shoulder and back of the body B right shoulder and back left shoulder and front 99 The R waves in lead VA with left ventricular hypertrophy characteristically are A tall and often exceed 27 0 mm short B 100 The time of onset of the intrinsicold deflections in lead Vonith left ventricular hypertrophy is often A as long as 0 06 second B longer than 0 12 second C longer than 0 16 second 101 and V2 Right ventricular hypertrophy is characterized by A tall R waves in leads V3 V4 and Vs B tall R waves in leads V and V2 с deep S waves in leads V1 Left ventricular hypertrophy always causes a shift of the mean QRS axis to the left B is recognizable with a normal mean electric axis of the QRS complexes с is a frequent cause of a right axis deviation of QRS complexes 102 А 1 103 All of the following criteria are keeping with right ventricular hypertrophy a QR pattern in lead V3R or V1 2 Rwaves in lead Viwhich exceed 7 0 mm in amplitude 3 R/S ralios in lead V1 greater than 10 ventricular activation times in lead V1 of 0 035 to 0 05 second True False 4 А B 129 ·. 104 In right ventricular hypertrophy the transitional zone in the o precodial leads characteristically is shifted A to the right B to the left • 105 Right ventricular hypertrophy in the presence of a right complete bundle branch block produces large R prime waves in lead V1 B does not influence the height of the R prime waves in lead V1 INTRINSICOID DEFLECTION 106 A delayed onset of the intrinsicoid deflections in lead Vs indicates often A left bundle branch block and excludes delayed intraventricular conduction delayed intraventricular conduction and excludes left bundle branch block C left bundle branch block or delayed intraventricular conduction B 107 The intrinsicoid deflections are read generally from A the standard leads B unipolar chest leads с unipolar extremity leads 108 The intrinsicold deflections recorded from the precordium over the left ventricle normally occur A earlier than those recorded from the precordium over the right ventricle B later than those recorded from the precordium over the right ventricle 109 In a left bundle branch block and in left ventricular hypertrophy the time of onset of the in Irinsicoid deflections in lead Vois A delayed B shortened с normal 110 In right bundle branch block and right ventricular hypertrophy the time of onset of the intrin sicoid deflections in lead V1 characteristically is А delayed B shortened с normal LEADS Lead I measures the differences in potential between А the left and right arm B Tight arm and left leg с left arm and left leg 112 Lead II measures the differences in potential between the А right arm and left arm B left leg and right arm C left arm and left leg 130 ·113 Lead III measures the differences in potential between the A right arm and left arm B right arm and left leg C left leg and left arm 115 116 An upright deflection is written in lead / when the potential at the left arm is relatively A positive compared with that at the right arm B negative as compared with that of the right arm с positive as compared to the left leg An upright deflection is nritten in lead II when the potential A at the right arm is positive with respect to that at the left leg B at the right arm is negative with respect to that of the left leg с at the left arm is positive with respect to the left leg An upright deflection written in lead III when the potential A at the left arm is positive with respect to the left leg B at the left arm is negative with respect to the left leg C at the right arm is negative with respect to the left leg An upright deflection is written in a central terminal lead when the exploring electrode is A positive with respect to the central terminal negative with respect to the central terminal C nearly zero with respect to the central terminal The limb leads ava aVL and aVf record differences in potential between one lead which is nearly zero potential throughout the heart cycle and another lead placed on a limb which usually has a significant variable potential throughout the heart cycle A True B False 117 B 118 119 nd II are often referred to as The standard leads / II A unipolar leads B bipolar leads 120 Lead V 3 is located 121 A on a horizontal line midway between Vi and V2 B on a horizontal line midway between Vs and V6 C on a slanting line midway between leads V zandv The precordial lead V2 is located at the junction of the A 4th intercostal space and the night sternal border B 4th intercostal space and the left sternal border C Sth intercostal space and the left sternal border D mid clavicular line and the 4th intercostal space If the heart is positioned normally in the chest (intermediate position) the V6 electrode usually lies over the A anterior aspect of the left ventricle B posterolateral aspect of the left ventricle с over the right ventricle 122 123 The V4R electrode is placed on the right side of the chest but in the same relative position as the standard V4 electrode on the right leg с above the V4electrode B 131 ·124 The esophageal lead is of practical value in differentiating A atrial fibrillation from atrial tachycardia B right from left bundle branch block C right from left ventricular hypertrophy 125 When the esophageal lead is placed at the atrioventricular groove and atrial depolarization occurs in a normal fashion the P waves are predominantly A negative B positive с diphastic 126 Einthovens equation states that at a guen instant the sum of the amplitude of the waves is as follows A I plus III equals II B II plus III equals 1 с I plus II equals III 127 The unipolar limb lead law states that at a given instant the amplitude of similar waves from the right arm left arm and foot equals zero (VR + V1 + VF = 0) right arm left arm and back equals a large positive value (Vx + V1 + VB = a large positive value) right arm left arm and precordium equals a large negative value (VR + V1 +. Vp - a large negative value) A B с 128 129 The augmented unipolar limb lead law states that at a given instant she sum of the amplitude of similar waves in leads AaVR aVL and aVf equals zero B 1 II and ill equals zero C Vi V4 and V6 equals zero The standard leads may be derived from unipolar leads from amplitudes of similar waves using following formulas A Vf minus VL equals lead I B VF minus VI equals lead II C VF minus VL equals lead III The augmented unipolar limb leads may be derived from the standard leads using the amplitudes of similar waves with the following formulas А aVR equals III minus I 2 B aVL equals II minus III 2 C aVf equals II plus III 2 130 131 A The unipolar limb leads may be derived from the amplitude of waves of the standard leads using the formula VR equals II minus III 3 B VL equals I minus III 3 C VF equals II plus I 132 ·MYOCARDIAL INFARCTION 132 A typical anterior transmural myocardial infarct is characterized in the leads overlying the infarct by QS waves and A isoelectric S T segements B positive ST segments с negative S T segments 133 A typical subacute transmural anterior myocardial infarct is charactered in the leads pierling the infarct by QS waves and A ST segments near the isoelectric line and deeply inverted T waves which change in amplı tude with time B large positive S T segments which become more positive with time с isoelectric T waves which do not change with time 134 A typical chronic transmural anterior myocardial infarct is charactered in the leads overlying the infarct by OS waves and А essentially isoelectric S T segments and T waves which do not change in amplitude sig nificantly with time B positive S T segments which change from day to day с negative S T segments which change from day to day 135 An old anterior myocardial infarct often does not show diagnostic changes when A a left bundle branch block is present B a right bundle branch block is present с anterior myocardial ischemia is present 136 A strictly anterior myocardial infarct often does not produce diagnostic changes in the three standard and unipolar limb leads A True B False 137 A transmural myocardial infarct involving the anterolateral aspect of the left ventricle is char acteri.ed by OS naves in the leads which face the anterolateral wall of the left ventricle A True B False 138 A typical acute anterolateral myocardial infarct is characteri.ed in lead V463 S T segment shifts and QRS complexes whose directions with respect to each other are A discordant concordant B 139 R waves in lead V are recorded often in the presence of an anterolateral infarct of the infarcı involves only A a thin layer of the epicardium leaving the endocardium intact a thin layer of the endocardium leaving the epicardium intact B 140 An anteroseptal mycardial infarct is one which produces significant changes of the QRS com plexes in lead A B с 133 ·141 A small left ventricular intramural infarct characteristically produces A short QT intervals very little change in the QRS complexes с QS waves in leads which overlie the infarct 142 A precordial lead directly overlying a transmural anterior infarct characteristically shows A QR waves B QS waves. с RS waves 143 An infarct involving the lateral wall of the left ventricle А often increases the height of the R waves in lead Vi B produces QS waves in lead Vi с does not change the standard 12 lead electrocardiogram 144 A myocardial infarct which involves the lateral wall of the left ventricle usually shows character istic changes in leads A Vsor av B с II or III II or aVF 145 An acute large typical posterior myocardial infarct is characterized in lead a VF by A relatively deep Q waves and elevated S T segments B relatively deep Q waves and isoelectric S T segments 146 A large subacute posterior myocardial infarct is characterized in lead aVp by А relatively deep Q waves ST segments which are near the isoelectric line and deeply in verted T waves which change in amplitude in serial tracings B large R waves without Q waves and isoelectric S T segments с inverted T waves with isoelectric S T segments 147 148 An old posterior myocardial infarct is characterized in lead avę by А T waves which change in amplitude from day to day B elevated S T segments which change in amplitude from day to day с relatively deep Q waves with isoeletric S T segments and T waves which do not change in amplitude in serial tracings A typical large acute posterior myocardial infarct is characterized in lead aVF by ) points and ST segments which are A concordant with the initial deflection of the ORS complexes B discordant with the initial deflections of the QRS complexes The electric potentials at the foot lead a Vg which are present during early ventricular depoları zation (first 0 04 second) in posterior myocardial infarction are usually relatively A negative positive 149 B 150 A posterior myocardial infarct may exist in the presence of a normal 12 lead electrocardiogram True False A B 151 A posterior myocardial infarct high at the base of the left ventricle consistently produces diag nostic changes in the electrocardiogram А True B False 134 ·152 A thin acute subendocardial infarct with the precordial leads overlying the infarct characteristic ally alters the A ST segments B QRS complexes с U waves 153 A large subendocardial infarct may reduce the amplitude of the R naves in leads overlying the infarct if it involves A the subendocardium only and does not penetrate deeply into the myocardium B the subendocardium and most of the thickness of the myocardium MYOCARDIAL INJURY AND ISCHEMIA 154 Large transient negative S T segments which appear in lead V4 after exercises are strongly suggestive of A subendocardial ischemia and injury B subepicardial ischemia and injury 155 Insufficiency of the coronary arteries may exist in the presence of a normal electrocardiogram taken with the patient at rest A True B False 156 During severe attacks of angina pectoris lead V4 often shows A transient negative S T segments B shortening of QT intervals 157 Ischemia involving certain portions of the posterior wall of the left ventricle may produce tall positive T waves in the precordial leads A True B False 158 Transmural infarction of the anterior wall of the left ventricle produces inverted T waves in the precordial leads which are adjacent to the infarct А True B False PERICARDITIS 159 Acute severe diffuse pericarditis is characterized in leads I II and V4 by ST segments which are А B elevated depressed isoelectric 160 The electrocardiographic changes in diffuse acute pericarditis are due to involvement of the A pericardium B subepicardium с subendocardium 1 135 ·161 Subacute diffuse pericarditis is characterized by А inverted T waves in leads I II and V B tall positive T waves in lead I II and V C widening of the QRS complexes 4 162 Chronic pericarditis due to tuberculosis is a cause of low voltage of the QRS complexes А True B False POSITIONS OF THE HEART (ELECTROCARDIOGRAPH) 163 The electrocardiographic position shows an excellent correlation with anatomic position of the heart in health and disease A True B False 164 The horizontal electrocardiograph position of the heart is associated often with А clockwise rotation about the long axis as viewed from the apex B counterclockwise rotation of the heart about the long axis as viewed from the apex 165 The horizontal electrocardiographic position is present nhen the ventricular complexes of lead aVL resemble those of leads Vs and Vand the ventricular complexes of lead a Vg resemble those of leads V1 and V2 A True False B 166 The semihonzontal electrocardiographic position is present when the ventricular complexes of lead aVų resemble those of leads Vs and V and the ventricular complexes of lead aVf are small True False A B 167 The intermediate electrocardiographic position is present when the ventricular compleres of leads aVį and aVs are similar in form and size and like those of leads Vs and V6 A True False B 168 The semivertical electrocardiographic position is present when the ventricular complexes of lead aVg resemble those of leads Vs and V6 and the ventricular complexes of lead aVL are small A True В. False 169 The vertical electrocardiographic position is present when the ventricular compleres in lead aVL resemble those of leads Vị and V2 and the ventricular complexes of lead a VE resemble those leads Vs and V 6 A True B False 136 ·170 A 171 In the normal heart the horizontal electrocardiographic position is associated often with counterclockwise rotation about the axis as viewed from the apex B clockwise rotation around the long axis as viewed from the apex The indeterminate electrocardiographic position as described by F N Wilson is said to be pres ent when there is no obvious similarities between the ventricular complexes of the unipolar limb leads and the precordial leads A True B False PULMONARY INFARCTION 172 A large acute pulmonary infarct typically produces A S waves in lead I Q waves elevated S T segments and inverted T waves in leads III and aV B S waves in lead I and in lead III Q waves elevated S T segments and inverted T waves с tall R waves in lead I and in lead III Q waves elevated S T segments and inverted T waves 173 A small subacute pulmonary infarct almost always produces S waves in lead I and in lead IIIQ waves elevated S T segments and inverted T waves A True B False THEORY 174 Theoretically the QRS compleres are isoelectric in lead III and are posible and of equal ampli tude in leads I and II when the ventricular depolarization process mores away from the right arm perpendicular to a line connecting the left ar and left leg electrodes A True B False 175 Lead VB of connected properly shows the largest QRS complexes when the ventricular depol anization process is perpendicular to A the frontal plane of the body B the saggital plane of the body Ventricular depolarızation results in the writing of the A P waves atrial T waves с QRS complexes D ventricular T waves 176 B 177 Atrial repolarization results in the uniting of the A P waves B atrial T waves с QRS complexes D U waves 178 A The repolarized state of the ventricles is indicated in the electrocardiogram by the ST intervals B ST segments C time interval between the end of the U waves and the beginning of the ORS complexes 137 ·179 The transitional one of the QRS complexes in the wr precordial kadu refers to that lead position In lunch the QRS completes are А of equal amplitude B predominately positive с predominately negative 180 Normall the endocardium of the contricles is acinated carl during the ventricular de polariza 110n process A True B False 187 Theorin all the QRS compk tas ant Noelectric in lead I and are large and positive and of equal amplitude m kads II and III fun the scultricula de polarranon process moves fouard the four alf an anik with a lme connectin ilu kad I ckctrodes of A 90 degrees B 70 degrees с 60 degrees 182 The QRS complexes are sınall in lead II and are tall and positive in lead I when the venircular depoları anton process moves toward the left arm perpendicular 10 a line connecting the right arm and left foot electrodes A True B False 183 An electromone force generated perpendicular to the frontal plane of the body results in lead Tin A B tall positive deflections deep negative deflections the smallest deflections 184 Inhibition of the ventricular depolarization process sometimes is called defecte intraventricu lar conduction A True False 185 The electric potentials of the heart as detected at the surface of the body are inversely proportional to the square of the distance between the heart and the electrode inversely proportional to the cube of the distance between the heart and the electrode directly proportional to the cube of the distance between the heart and the electrode А B с 186 A vector quantits is often represented A as a point on a graph B as an arrow with the length of the arrow representing magnitude and position and the arrow head representing direction 187 A scalar quantin is often represented A as a point on a graph B as an arrow with the length representing magnitude and the position of the arrow and the arrowhead representing direction 188 The sector sum of the instantaneous QRS ares is equal to the mean electric QRS aris А True B False 138 ·189 The ventricular gradient is derned from A the QRS complexes and T waves B P waves and auricular P waves C QRS complexes and P Waves 190 Potassium chloride in adequate concentration when applied locally to a portion of a cell mem brane produces a current of injury A True B False 191 The direction of the mean electric axis of the QRS compleres normally is from the A apex of the heart to the valvular orifices (base of the heart) B valvular orifices to the apex of the heart 192 The vectorcardiogram represents as a series of vectors many of the instantaneous electric forces which are associated with cardiac activity A True B False 193 A homogenous volume conductor is a medium which permiſs the conduction of a current equally in all directions A B True False 194 The quart: fiber of a string galvanometer moves because the current from the parlent flowing over the fiber produces an electromagnetic field which interacts with a magnetic field produced by a fixed magnet A True False B 195 One of Kirchoffs laws states that the algebraic sum of all electric forces flowing to a single point in a netu ork is zero A B True False 196 The smallest squares on the background graph of the standard electrocardiogram measure A 100 microvolts tall and 0 02 second in duration B 10 microvolts tall and 0 2 second in duration с 100 microvolts tall and 0 04 second in duration 197 The string galvanometer for electrocardiography was described first by А Waller in 1887 B Einthoven in 1903 C Wilson in 1906 198 The sive and direction of the ventricular defiections in any lead depend upon A the proximity of the lead to the ventricular myocardium only the proximity of the lead to the ventricular myocardium the thickness of ventricular myocardium and the direction in which the electromolive forces are directed with respect to the position of the electrodes B 139 ·WAVES, INTERVALS, SEGMENTS AND POINT 199 Broad and notched Pwaves in leads 1 and 1 A suggests cor pulmonale are diagnostic of atrial infarction C are seen often in mitral stenosis 200 Notching of the Puaves without abnormalities of height or duration is A diagnostic of cardiac disease B not diagnostic of cardiac disease 201 Phares typical of chronic cor pulmonale are А wide ard notched leads I II and all B wide and notched in leads I II and avę C tal) and peaked sa leads II III and aVe 202 The upper limit of normal for duration of P wales in adults is A 0 06 second 8 008 second 011 second 203 Wide noiched Pabes in leads I and II are suggestie of enlargement of the A left atrium B right atrium 204 The amplitude of the Phares in lead Il for most adults normally does not exceed A 100 microvolts B 250 microvolts C 250 microvolts 205 Prolonged PR intervals are А diagnostic of rheumatic heart disease B not ss themselves diagnostic of rheumatic heart disease 206 Prolonged PR intervals during a febrile illness are A pathognomonic of theumatic fever B not pathognomonic of theumatıc fever 207 The PR interval measures the time required for A sino atrial conduction only B conduction through the atria and through the atrioventricular node C conduction through the Purkinje system In measuring the P R interval it is advisable to make the measurement in a lead in which the p kares are wide and there are prominent waves or wide QRS complexes True B False 208 209 @naves in lead avę which measure 004 second from the beginning of the wave to the nadır indicate often a posterior myocardial infarcı A True B False 140 ·210 Q uaves in lead aV; which are more than 28 percent of the height of the R waves when the amplitude of the QRS complexes is greater than 50 mm indicate usually a posterior myocardial infarct A True B False 211 Relatnely deep Q uaves (up to 0 6 milinolt) in lead II A are diagnostic of a posterior myocardial infarct B are often normal C rule out a posterior infarct 212 Septal waves often are seen in lead I and generally are less than 0 03 second in duration and less than 30 mm deep А True B False 213 Os waves in lead aVR A indicate infarction of the right ventricle B reflect potential variations of the normally activated endocardium of the heart с are diagnostic of right ventricular enlargement Normally the ventricular depolariation process occurs first from the left to the right side of the septum (Q waves) nerr from the endocardium to the apex and lateral portion of the left ventricle (R waves) and lastly toward the posterior portion of the heart (S uaves) A True B False 214 215 The QRS complexes of some of the precordial V leads are wider than those of the unipolar limb leads A True B False 216 Wide M shaped QRS complexes which are preceded by Praves in leads V and V 2 suggest A a right bundle branch block B a left bundle branch block с myocardial infarction 217 Vg and V suggest Hide M shaped QRS complexes which are preceded by Pwaves in leads y A a right bundle branch block B a left bundle branch block с myocardial infarction 218 Splintering of the ORS complexes is common normally in А lead III B lead II lead I 219 The width of the QRS complexes in the tracings of most normal adult inden iduals does not erceed 0 10 second in the standard and unipolar limb leads A True B False 220 Low voltage of the QRS complexes in the standard and unipolar limb leads is good evidence of myocardial disease True A False 141 ·221 Wide QRS complexes exceeding 0 12 second A are common with a complete left bundle branch block do not occur with hyperkalemia с do not occur with quinidine intoxication B 222 The IT intervals A do not vary with the heart rate B show a linear relation to the heart rate C vary approximately with the square root of the heart rate 223 Short QT intervals occur in A hypothyroidism B hyperparathyroidism C hypoparathyroidism After large doses of digitalis the QT intervals are characteristically A prolonged B shortened с unchanged 224 225 Normally the QT intervals are longer for women than for men and children A True B False 226 I ong QT intervals in the presence of a normal blood calcium are diagnostic of organic myocardial disease A True B False 227 228 229 QTc represents the QT intervals corrected for A temperature B heart rate C area of the body D amplitude of QRS complexes In lead V 3 positive S T segments which measure 0 2 millivolt above the isoelectric line are А diagnostic of anterior myocardial injury B diagnostic of pericarditis с sometimes encountered normally Abnormally large positive ST segment shifts in lead aVF which persist for 24 hours or longer usually indicate A a posterior myocardial infarct B an anterior myocardial infarct Ab nal S T segment shifts and abnormally inverted T waves in lead V4 may occur in patients with rheumatic myocarditis A True B False With normal QRS complexes and T waves an elevation of the R T junctions in leads V2 and V3 of 0 2 mi A are diagnostic of an anteroseptal infarct B suggest acute diffuse subendocardial injury с are diagnostic of pericarditis D may be normal 230 231 142 ·232 The point is the point of junction beineen A the QRS complexes and the ST segments B the P R segment and the QRS complexes 233 Inversion of T waves in leads Vsand Vg in the presence of a complete left bundle branch block is diagnostic of ischemia of the left ventricle in addition to a defect in the left bundle of His B may be secondary effect associated with large QRS complexes A 234 Coved and inverted T waves with normal QRS complexes in lead V are diagnostic of myocardial ischemia A True B False 235 Negalne T waves in lead I in the presence of clearly positive QRS complexes in this lead are often evidence of cardiac disease A True B False 236 Primary T wave changes are always associated with increased areas under the QRS complexes True A B False 237 I waves in lead III nhich are more negative than minus 4 0 mm (with normal standardization) generally are А abnormal B normal 143

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·PART C APPENDIX ·DETERMINING HEART RATE (Beats per minute) mm Rate mm* Rate mm Rate mm* Rate mm Rate mm. Rate 1-1500 2 --- 750 3 --500 4 375 5 -- 300 6--250 7-214 8 - 187 9 -- 167 10 - 150 11 - 136 12125 13 115 14 - 107 15 100 16 94 1788 1883 1979 20 75 2171 2268 23 -65 24 - 63 25 - 60 2658 27-56 2854 29-52 30-50 3148 3247 33-45 34 --44 3543 36-42 37-41 38-40 39 - 39 4038 41 -- 37 42 - 36 43-35 44 - 34 45-33 46 - 33 47 - 32 48 - 31 49 - 31 50-30 S1-30 52-29 53 - 28 54 28 55 - 27 56 - 27 57-26 58 — 26 59 - 25 60-25 61 - 25 62 -24 63 -24 64 - 23 65-23 66 23 6722 68 22 69 -22 7021 71 ---21 72-21 7320 74 20 75 ---20 *Number of millimeters (004 sec per mm) beineen recurring complexes REFERENCES 1 Winsor T Unpublished data AGE AND HEART AGE HEART RATE (Beats per minute) AGE HEART RATE (Beats per minute) Cases Mean Range Cases Mean Range 0-24 hrs 14 125 88 to 166 8-10 yrs 16 81 0-2 yrs 16 127 107 156 62 to 142 55 126 11-14 15 81 24 16 99 72 125 Adults 1000 64 38 100* 5-7 37 88 71 109 *Three udults in this series had heart rates greater than 100 the highest being 110 REFERENCES 1 Graybiet A et al Analysis of the electrocardiograms obtained from 1000 young healthy aviators Am Heart J 27 524 549 (April) 1944 2 Yu PNG Joos HA and Katsampes CP Unipolar electrocardiogram in normal infants and children Am Heart J 41 91 104 (Jan) 1951 3 Ziegler R F Electrocardiographic Studies in Normal Infants and Children Springfield Iu Charles C Thomas 1951 144 ·P WAVES AMPLITUDE (mm) LIMB LEADS PRECORDIAL LEADS Lead Age # Cases Mean Range Lead Age # Cases Mean Range 1 08 1 2 24 hrs 1-3 yrs 3-5 548 12-16 Adults 32 57 53 90 68 500 00 to 15 05 25 05 20 05 20 00 20 0 1 13 24 hrs 1-3 yrs 345 5--8 12-16 Adults 41 36 28 44 45 121 01 08 10 09 04 06 00 to 20 -10 20 00 25 00 25 00 IS -08 16 11 09 07 II 25 V2 00 00 05 11 14 30 24 hrs 1-3 yrs 3-5 5-8 12-16 Adults 12 32 57 53 90 68 500 15 17 17 17 16 14 24 hrs 1-3 yrs 3-5 548 12—16 Adults 00 00 00 00 30 30 41 36 28 44 45 121 20 20 15 20 20 16 05 10 13 11 08 10 03 00 25 02 III V3 24 hrs 1-3 yrs 3-5 548 12-16 Adults 32 57 53 90 68 500 06 07 06 07 07 07 -10 -15 -10 -10 05 -05 20 15 20 20 20 19 24 hrs 1-3 yrs 34-5 5--8 12--16 Adults 41 36 28 44 45 121 17 12 11 11 10 06 10 00 10 05 05 00 30 20 15 15 15 18 aVe V4 24 hrs 02 yrs 3—5 610 12-16 Adults 32 16 16 53 15 15 -09 -08 -09 -08 -08 -08 -20 -15 -12 -15 -15 01 15 -10 --05 -02 03 -10 24 hrs 1-3 yrs 24 5—10 11-14 Adults 41 36 28 44 45 121 11 11 10 0 1 10 06 05 05 OS 00 03 01 20 15 IS 15 15 23 aVL 15 Vs 24 hrs 1-3 yrs 24 hrs 0-2 yrs 3-5 6--10 12-16 Adults 32 16 16 53 15 15 01 0 1 02 03 02 01 -15 -01 -OS -05 01 -05 08 10 20 06 08 2-4 5-10 11-14 Adults 41 36 28 44 45 121 13 01 09 08 09 06 10 05 05 00 03 00 20 15 10 15 10 24 aVe V6 24 hrs 1-3 yrs 24 hrs 02 yrs 3-5 6-10 12-16 Adults 32 16 16 53 15 15 11 08 06 06 05 08 -10 02 00 02 00 03 20 IS 15 20 15 15 41 36 28 44 45 121 20 15 10 244 5-10 11-14 Adults 09 08 08 08 07 06 00 05 05 00 03 00 15 10 14 REFERENCES 1 Battro A and Mendy JC Precordial leads in children Arch Int Med. 78 31-41 (July) 1946 2 Lepeschkin E Modern Electrocardiography vol 1 The PQRST U Complex Baltimore Williams & Wilkins Co 1951 3 Stewart CB and Manning GW A detailed analysis of the electrocardiograms of 500 RCAF air crew Am Heart J 27 502 523 (Apnl) 1944 4 Yu PNG Joos HA and katsampes CP Unipolar electrocardiogram in normal infants and children Am Heart J 41 91 104 (Jan) 1951 s Ziegler R F Electrocardiographic Studies in Normal Infants and Children Springfield II Charles C Thomas 1951 6 Sokolow M and Lyon TPVentricular complete in left ventricular hypertrophy as obtained by unipolar precordial and limb leads Am. Heart J 37 161 186 (Feb ) 1949 7 Winsor T Unpublished data 145 ·P WAVES DURATION* (Seconds) AGE NO CASES MEAN RANGE 0-24 hrs 14 OOS 004 to 006 1-3 yrs 57 006 005 0 09 35 53 007 004 O 10 010 5-8 90 005 007 008 812 88 005 0 10 1216 68 0 08 0 06 010 Adults 100 0 08 006 011 * Widest P waves of the 6 limb and 6 precordial leads usually Vor V REFERENCES 1 Ziegler R F. Electrocardiographic Studies in Normal Infants and Children Springfield Ill Charles C Thomas 1951 2 Ashman Rand Hull E Essentials of Electrocardiography 2nd ed NY Macmillan Company 1941 146 ·Q WAVES AMPLITUDE (mm ) LIMB LEADS PRECORDIAL LEADS Lead Age # Cases Mean Range Lead Age # Cases Mean Range I 24 hrs Vi 24 hrs 0-2 yrs 0-2 yrs 10 32 72 72 72 68 500 05 07 01 02 0 1 09 00 to 05 00 20 00 00 20 00 30 00 40 3-5 610 12-16 Adults 41 72 72 72 49 121 00 00 00 00 00 00 00 to 00 00 00 00 00 00 00 00 00 00 00 II 3—5 6--10 12-16 Adults 24 hrs 0-2 yrs 3-5 6-10 12-16 Adults 24 hrs 50 30 V2 0-2 yrs 20 32 72 72 72 68 500 15 13 03 OS 12 11 345 6--10 12-16 Adults 41 72 72 72 49 121 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 III V3 00 00 00 00 00 05 00 00 00 00 00 24 hrs 0-2 yrs 3-5 6-10 12-16 Adults 00 00 32 72 72 72 68 500 30 25 40 90 40 30 30 50 60 25 16 14 06 16 14 00 24 hrs 0-2 yrs 345 6-10 12--16 Adults 41 72 72 72 49 121 00 00 00 04 10 07 05 aVR V4 24 hrs 0-2 yrs 345 24 hrs 0-2 yrs 2-4 5-10 11-14 Adults 24 hrs 32 16 16 53 15 151 24 16 29 14 10 20 00 00 00 00 00 00 40 105 100 100 80 80 41 72 72 72 49 121 13 01 03 02 01 01 610 10—15 Adults OOOOOOOOOOOOOOOOOOOO 15 10 25 15 24 16 aVL Vs 24 hrs 55 0--2 yrs 0-2 yrs 2-4 5-10 11—14 Adults 32 16 16 53 15 151 00 00 00 00 00 00 41 72 72 72 49 121 13 01 02 0 1 01 02 18 12 13 05 04 05 22 08 08 06 03 05 35 6-10 10—15 Adults 24 hrs 20 05 10 10 05 35 60 40 40 30 20 30 60 30 40 21 21 aVF 24 hrs V6 0-2 yrs 0-2 yrs 24.4 5-10 11-14 Adults 32 16 16 53 15 151 00 00 00 00 00 00 3-5 6-10 10-15 Adults 41 72 72 72 49 121 13 11 07 04 05 04 00 00 00 00 00 00 20 30 25 30 17 27 REFERENCES 1 Lepeschkon E Modern Electrocardiography vol 1 The PQRSTU Complex Baltimore Williams & Wilkins Co 1951 2 Stewart CB and Manning GW A detailed analysis of the electrocardiograms of 500 RCAF air crew Am Heart 1 27 502 523 (April) 1944 3 Yu PNG Joos H A and katsampes C P Unipolar electrocardiogram in normal infants and children am Heart 41 91 104 (lan) 1951 4 Ziegler R F Electrocardiographic Studies in Normal Infants and Children Springfield in Charles C Thomas 1951 $ Sokolow Mand Lyon TP Ventricular complex in left ventricular hypertrophy as obtained by unipolar precordial and limb leads Am Heart J 37 161 186 (Feb ) 1949 6 Winsor T Unpublished data 7 Battro A and Mendy SC Precordial leads in children Arch Int Med 78 31-41 (ufv1016 147 3 ·R WAVES AMPLITUDE (mm) LIMB LEADS PRECORDIAL LEADS Lead Age # Cases Mean Range Lead Age # Cases Mcan Range 1 24 hrs V1 24 hrs 0-2 yrs 0-2 yrs 3--5 610 10-15 Adults 32 72 72 72 49 121 26 42 50 50 48 53 00 to 55 00 100 20 100 20 90 13 114 07 113 2-4 8-10 11-14 Adults 41 16 16 16 15 151 167 70 75 36 S1 23 30 to 230 10 14 5 20 14 0 10 90 05 15 5 00 70 II 210 V2 30 24 hrs 0-2 yrs 3-5 6--10 10-15 Adults 32 72 72 72 49 55 57 76 72 91 71 10 00 30 30 37 18 140 120 130 16 0 168 24 hrs 02 yrs 2-4 8-10 11-14 Adults 41 16 16 16 15 151 210 13 0 127 78 83 S9 45 50 20 15 00 410 220 25 0 14 5 23 5 160 121 III V3 24 hrs 02 yrs 35 610 10-15 Adults 32 72 72 72 49 121 88 56 56 42 60 38 20 10 20 05 07 03 210 110 100 130 158 13 1 24 hrs 0-2 yrs 2-4 810 11-14 Adults 41 16 16 16 15 151 200 140 13 4 84 92 89 140 30 60 50 30 15 28 0 24 0 25 0 12 5 220 260 avr 14 24 hrs 2 yrs 24 hrs 0-2 yrs 2-4 8-10 11-14 Adults 32 16 16 16 15 151 37 10 13 12 12 08 00 05 00 05 05 00 90 40 30 60 80 50 2-4 8-10 11-14 Adults 41 16 16 16 15 151 190 200 18 5 149 172 142 30 35 90 40 70 40 32 0 350 300 30 0 28 0 27 0 aVL 24 hrs 21 40 10 05 Vs 0-2 yrs 31 2-4 8-10 11-14 Adults 32 16 16 16 15 151 60 80 70 88 60 100 OOOOO 24 hrs 0-2 yrs 2.4 8-10 11-14 Adults 12 16 21 41 16 16 16 15 151 120 16 0 18 4 174 164 12 1 4 5 25 10 0 60 60 40 21 0 25 0 26 0 28 0 29 0 26 0 ave 20 V6 05 24 hrs 0-2 yrs 2-4 8--10 11--14 Adults 32 16 16 16 15 151 66 88 95 85 10 S 13 05 35 50 00 200 160 195 14 0 210 200 24 hrs 0-2 yrs 2-4 8-10 11-14 Adults 41 16 16 16 15 151 45 120 14 6 12 5 135 92 00 20 80 SO 40 40 110 200 23 0 19 1 25 0 220 REFERENCES 1 Battro A and Mendy JC Precordial leads in children Arch Int Med 78 31 41 (July) 1946 2 Lepeschkin E Modern Electrocardiography Vol 1 The P Q R S-T U Complex Baltimore Williams & Wilkins Co 1951 3 Yu PNG Joos H A and Katsampes CP Unipolar electrocardiogram in normal infants and children Am Heart 41 91 104 (Jan) 1951 4 Ziegler R F Electrocardiographic Studies in Normal Infants and Children Springfield 111 Charles Thomas 1951 5 Sokotow Mand Lyon T, P., Ventricular complex in left ventricular hypertrophy as obtained by unipolar precordial and limb leads Am Heart J 37 161 186 (Feb ) 1949 148 ·S WAVES AMPLITUDE (mm) LIMB LEADS I RECORDIAL I HAIS Lead ACC # Cires Mein Ringe Led Age #C Men Ringe 24 hrs 0-2 yrs 24 hrs 02 yrs 2-5 6-10 10-15 Adults 32 72 72 72 49 121 63 39 2.5 16 18 10 0 0 to 150 00 70 00 60 00 30 00 68 00 36 41 16 16 16 30 2-4 8--10 11-14 Adults 100 48 86 86 116 86 0 0 to 28 0 OS 140 160 30 160 00 200 20 250 151 V2 24 hrs 24 hrs 0-2 yrs 2-5 6/10 10—15 Adults 0-2 уг» 2-4 32 72 72 72 49 121 32 27 16 14 16 12 00 00 00 00 00 00 70 SO 40 35 49 49 41 16 16 16 IS 151 8-10 11—14 Adults 220 93 160 168 20 8 127 10 US 85 80 70 00 420 210 300 300 36 0 29 0 111 24 hrs بیا 0-2 yrs 25 6-10 10-15 Adults 32 72 72 72 49 121 23 11 08 07 09 12 00 00 00 00 00 30 3 S 50 40 53 24 hrs 0-2 yrs 2-4 810 11-14 Adults 41 16 16 16 15 151 264 102 127 163 148 88 00 OS 35 80 10 00 39 0 230 210 270 300 25 0 00 55 a VR V4 23 0 102 24 hrs 0-2 yrs 2-4 8-10 11-14 Adults 32 16 16 16 15 151 39 63 59 49 83 43 00 00 00 00 00 00 95 140 140 100 170 130 24 hrs 2 yrs 2-4 8—10 11-14 Adults 90 41 16 16 16 15 151 00 20 00 40 10 0 112 80 S2 420 220 200 170 160 200 aVL Vs 24 hrs 0-2 yrs 24 hrs 0-2 yrs 2-4 8-10 11—14 Adults 32 16 16 16 15 151 66 34 27 32 31 04 00 00 00 00 00 00 160 70 60 70 90 180 2- 4 8-10 11-14 Adults 41 16 16 16 15 151 120 61 4.4 57 15 10 00 05 OS 00 300 130 I10 120 80 60 37 15 aVF 24 hrs V6 24 hrs 0-2 yrs 0-2 yrs 32 16 16 16 15 151 2-4 8-10 11—14 Adults 30 07 21 07 08 02 00 00 00 00 00 00 75 25 140 20 25 80 45 25 16 24 8—10 11-14 Adults 41 16 16 16 15 151 00 00 05 00 00 00 130 75 50 40 20 70 09 06 3 REFERENCES Battro A and Mendy J C Precordial leads in children Arch Int Med 78 31-41 (July) 1946 2 Lepeschkin F Modern Electrocardiography vol 1 The PQRSTU Complex Baltimore Willams & Wilkins Co 1951 Yu PNG Joos H A and Katsampes CP Un polar electrocardiogram in normal infants and ch Idren Am Heart J 41 91 104 (Jan) 1951 A Ziegler R F Electrocard ographic Studies in Normal Infants and Children Springfield Ill Charles C Thomas 1951 S Sokotow Mand Lyon TP Ventncular complex in left ventracular hypertrophy as obtained by unipolar precordial and limb leads Am. Heart J 37 161 186 (Feb ) 1949 149 ·T WAVES AMPLITUDE (mm) LIMB LFADS PRECORDIAL LEADS Led AGL # Cis Me in Ringe Led Age # Cires Mein Ring 24 hrs 0-2 yrs 3-5 6-10 10-15 Adults 41 72 72 72 49 500 03 26 17 20 26 30 -20 to 30 05 SO 00 40 OS 40 11 50 10 50 24 hrs 02 yrs 2—4 8-10 11-14 Adults 32 16 16 16 15 151 13 -23 -22 -17 -13 02 40 to 60 45 OS -55 -10 -30 IS 35 40 40 02 II 24 hrs V2 0-2 yrs 3—5 6--10 10-15 Adults 41 72 72 72 49 12 24 18 21 30 38 00 10 05 05 09 10 30 40 40 SO 65 66 24 hrs 0-2 yrs 24 8--10 11-14 Adults 32 16 16 16 15 151 13 -24 -26 00 07 55 -75 -60 -70 -35 -5 -30 90 04 30 50 35 18 0 500 111 V₃ 24 hrs 0-2 yrs 3-5 6-10 10-15 Adults 41 72 72 72 49 500 10 02 02 01 04 08 -10 00 00 00 -19 -14 30 30 15 10 31 34 24 hrs 0-2 yrs 2-4 8--10 11-14 Adults 32 16 16 16 15 151 -04 -07 -07 18 17 54 -70 -50 -50 -20 00 -20 40 45 50 45 50 16 0 AVR 24 hrs V4 24 hrs 06 0-2 yrs 0--2 yrs 24 8--10 11-14 Adults 41 16 16 16 15 151 -04 -20 -25 -20 -22 -2 3 -30 -30 -50 -35 40 -50 20 05 -15 -02 -15 IS 24 8—10 11-14 Adults 32 16 16 16 15 151 17 24 32 33 48 -70 -25 00 00 00 00 30 SO 110 90 70 170 1VL 24 hrs Vs 24 hrs 0-2 yrs 02 yrs 41 16 16 16 15 151 0 1 07 14 07 08 05 2—4 8-10 11—14 Adults 13 26 34 -15 05 -05 -10 05 -40 20 20 30 25 20 60 32 16 16 16 15 151 2-4 8-10 11-14 Adults _40 1 2 00 OS 10 00 41 SO 55 70 11 0 SO 90 31 34 aVF 24 hrs Vo 24 hrs 0-2 yrs 02 yrs 2-4 8-10 11-14 Adults 41 16 16 16 15 151 09 16 18 14 13 17 -10 08 -02 -02 00 -05 30 35 40 30 3 5 50 2-4 8-10 11-14 Adults 32 16 16 16 15 151 12 22 32 31 23 24 -30 05 15 00 10 -05 60 40 50 80 40 50 REFERENCES Battro And Mendy SC Precordial lends in children Arch Int Med 78 31-41 (July) 1946 2 lepeschkin E Modern Electrocardiography vol i The PQRSTU Complex Baltimore Williams & Wilkins Co 1951 3 Stewart CB and Manning GW A detailed analysis of the electrocardiograms of 500 R CAF a crew Am Heart 1 27 507 573 (April) 1944 + Yu PNG Joos HA and Katsampes CP Unipolar electrocardiogram in normal infants and children Am Heart j 41 91 104 (Jan) 1951 $ Ziegler R F Electrocardiographic Studies in Normal Infants and Children Springfield in Charles C Thomas 1951 6 Sokolow Mand Lyon TP Ventricular complex in left ventncufar hypertrophy as obtained by unipolar precordial and limb feads Am Heart 37 161 186 (Feb ) 1949 150 ·QRS COMPLEXES DURATION* (Seconds) Age # Cases Mean Range 24 hrs 14 006 004 to 0 10 0-2 yrs 16 006 005 008 2-4 16 007 005 0 08 5-7 35 007 006 0 08 8-10 16 007 005 008 11-14 14 007 006 008 Adults 100 008 006 0 10 *Widest QRS complex of the 6 limb and 6 precordial leads usually V V or , REFERENCES 1 Yu PNG Joos HA and Katsampes CP Unipolar electrocardiogram in normal infants and children Am Heartſ 41 91 104 (Jan) 1951 2 Ziegler RF Electrocardiographic Studies in Normal Infants and Children Spring field Ill Charles C Thomas 1951 3 Ashman Rand Hull E Essentials of Electrocardiography 2nd ed N Y Mac millan Company 1941 131 ·RATIOS OF WAVES* (Amplitudes) Aduits LEAD QIR R/S R/T Mean Range Mean Range Mean Range 4 97 00 to 140 00 00 to 01 00 00 to 00 a VR aVL aVF 0 24 00 075 15 00 80 26 01 100 0 10 00 028 24 00 160 46 03 140 03 00 10 03 70 02 01 130 14 02 120 V2 V3 14 01 101 19 03 130 V4 004 00 0 10 41 02 190 31 03 90 007 00 0 16 73 10 Vs V6 24 35 10 90 0 09 00 021 90 23 220 41 17 100 16 to 151 cases REFERENCES 1 Sokolow M and Lyon T P Ventricular complex in left ventricular hypertrophy as obrained by unipolar precordial and limb leads Am Heart I 37 161 186 (Feb ) 1949 152 ·INTRINSICOID DEFLECTIONS FOR VARIOUS AGES (V1 and V6)* V1 V6 Age # Cases Mean Range Mean Range 1—7 weeks 0012 0 005 to 0 025 0 020 0010 to 0028 2-12 months 0013 0005 0 026 0 024 0018 0 036 1-2 years 0016 0 004 0 026 O 028 0018 0036 26 0017 0 004 0 026 0 030 0 020 0 040 6--13 0018 0 004 0 026 0 030 0 020 0040 Adults 100 0017 0 000 0 030 0 039 0016 O 052 REFERENCES Myers G B et al Normal variations in multiple precordial feads Am Heart J 34 785 808 (Dec ) 1947 2 Nicolson G Clinical Electrocardiography in Children N Y Macmillan Company 1953 3 Winsor T Unpublished data INTRINSICOID DEFLECTIONS (Leads V1 through V6)* # Cases Sex Age Lead Mean Min Max Stand Dev 100 M 10 to 20 0 020 0 000 0031 00043 V1 V2 0 022 0012 0030 00039 0026 0014 0044 V3 VA 0 0050 0 029 0015 O OS2 0 0061 0 037 0022 0053 00066 Vs V6 0037 0 024 0050 0 0063 Measured from beginning of QRS complex to peak of R waves in seconds REFERENCES Sodi Pallares D et al La deflexion intrinseca en casos pormales y en hipertrofias ventriculares Arch Inst Cardiol Mexico 16 397-4 O (Oct 31) 1946 153 ·PR INTERVAL FOR VARIOUS AGES AND HEART RATES* UPPER LIMIT OF NORMAL (Seconds) HEART RATE (Beats per Minute) Age Years Below 70 71 90 91 110 111 130 Over 130 015 016 015 0 15 0 14 0 13 15—6 017 0 17 0 16 0 15 0 14 7 — 13 018 017 016 015 014 14 - 17 0 19 0 18 017 0 16 0 15 Small adults 0 20 0 19 018 0 17 0 16 Large adults 021 0 20 019 0 18 017 *PR interval (seconds) measured in the standard lead with the tallest P REFERENCES Ashman Rand Hull E Essentials of Electrocardiography 2nd ed N Y Macmillan Company 1941 154 ·ST SEGMENTS (Elevation or Depression in mm) Newborn to 1 year 185 cases 1 to 10 yrs 227 cases Adults+ 100 cases Lead Min Max Min Max Mean Min Max 1 01 -10 09 01 02 -01 -02 10 20 10 011 021 004 03 -10 06 III 02 -10 08 a VR -01 01 -10 10 0 55 06 06 aVL -01 01 -10 10 028 05 03 aVe OOS 02 -10 10 -032 -06 10 V 02 01 -10 20 021 -01 08 V2 -02 02 -10 25 047 00 15 V. -02 0 25 00 25 0 58 00 20 V. :01 02 00 20 033 -01 20 V, 02 -10 12 014 -05 06 V. 01 -10 10 004 05 05 *Measurements were made from the base line in front of the P waves Unipolar limb and chest lead measurements (93 cases) include all electrocardiographic positions except vertical REFERENCES 1 Kossmann, CE The normal electrocardiogram Circulation 8 920 936 (Dec ) 1953 2 Winsor T Unpublished data ST SEGMENTS IN VERTICAL ELECTROCARDIOGRAPHIC POSITION (Elevation or Depression in mm ) 7 cases Lead Mean Min Max 1 II III 007 0 16 0 17 -03 15 -04 02 07 09 ave av, 028 029 00 -03 -04 05 02 02 10 3 a Vy V, V2 V, VA V, 011 051 0 66 0 43 0 16 0 17 00 01 01 01 00 00 05 08 20 14 07 18 *Measurements made from the base line in front of the P waves REFERENCES 1 Winsor T Unpublished data. 155 ·OT INTERVAL NORMAL RANGE FOR VARIOUS HEART RATES AND CYCLE LENGTHS Lepeschkin Mean (Seconds) Cycle Length (R R Interval) (Sec ) Heart Rate (Min) Ashman Upper Limit of Normal (Sec ) Men & Women Child Lower Limit of Normal (Sec ) Men & Child Women 40 1 50 042 045 046 049 0 50 43 1 40 0 39 044 045 048 049 46 1 30 0 38 0 43 044 047 048 48 1 25 0 37 0 42 043 0 46 047 SO 1 20 0 36 041 043 045 0 46 S2 1 15 035 041 42 045 46 5S 1 10 0 34 0 40 041 0 44 045 57 1 05 0 34 0 39 040 0 43 044 60 100 0 33 39 040 042 043 63 095 0 32 0 38 0 39 041 0 42 67 090 0 31 0 37 0 38 040 0 41 71 085 0 31 036 037 038 041 75 80 030 35 036 038 0 39 80 075 029 0 34 035 0 37 0 38 86 070 0 28 033 0 34 0 36 037 93 065 0 28 0 32 0 33 0 35 0 36 100 0 60 027 031 0 32 0 34 0 35 109 OSS 0 26 0 30 0 31 0 33 0 33 120 050 025 0 28 0 29 0 31 0 32 133 045 0 24 027 028 029 0 30 150 040 023 0 25 0 26 028 0 28 172 0 35 22 023 024 0 26 0 26 REFERENCES 1 Lepc.chkin E Modern Electrocardiography vol 1 The PQRSTU Complex Baltimore Williams & Wilkins Co 1981 2 Ashman Rand Hull E Essentials of Electrocardiography 2nd ed N Y Macmillan Company 1941 156 ·SQUARE ROOT TABLE FOR CORRECTING QT INTERVAL FOR HEART RATE Bazett Formula QTc QT (seconds) RR (seconds) (Intervals) RR RR RR ✓RR RR RR RR RR 040 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 0 63 64 64 65 66 67 67 68 69 70 70 71 72 72 73 74 74 75 76 76 77 0 61 62 63 64 65 66 67 68 69 70 71 73 74 75 76 77 78 79 80 81 82 078 78 79 80 80 81 81 82 83 83 84 85 86 86 87 87 88 88 89 90 90 083 84 85 86 87 88 89 90 91 92 93 95 96 97 98 99 1 00 1 00 1 10 1 02 1 03 091 91 92 92 93 93 94 94 95 95 96 97 97 98 98 99 1 00 100 1 00 1 00 104 1 05 1 06 107 1 08 1 09 110 111 1 12 1 13 1 14 1 16 117 1 18 I 19 1 20 121 1 22 1 23 1 24 1 01 1 02 1 02 1 03 1 03 104 104 105 1 OS 1 06 1 06 1 07 1 08 1 08 1 09 1 09 1 10 1 10 1 10 111 1 01 NORMAL VALUES OF CORRECTED QT INTERVALS FOR VARIOUS AGES Age # Cases Mean Range 0-24 hrs 32 0 42 0 37 to 0 53 0-2 yrs 16 040 0 37 042 2-4 16 040 0 38 042 8 — 10 16 041 0 39 042 11-14 15 041 040 042 Adults 0 38 0 35 044 REFERENCES 1 Yu PNG Joos Hand Katsampes CP Unipolar electrocardiogram in normal infants and children Am Heart | 41 91 104 (Jan) 1951 2 Ziegler. R Electrocardiographie Studies in Normal Infants and Children Spring 3 Winsor T Unpublished data 157

·NORMAL VALUES FOR ELECTRIC AXES*
(Degrees)
Waves or
Complexes
Mean
Range
р
510
0 0 to 900
QRS
540
-30 0 1020
T
39 0
-110
760
*Derived from amplitude of waves of leads I and III using tables 44 males and 35 females
average age 35 years (range 15 to 50)
REFERENCES
Winsor T Unpublished data
158

·DE G OS 06 st ES ZE ZE Z$ CC 2C 11 BE LE ST LS ZS 6C BE ES 99 09 TE 65 40 90 29 POSITIVE ::::: 08 EL 6+ $t 99 : 60 90 TL 59 09 49 LEAD EL 89 $8 69 50 99 03 99 09 95 98 19 09 99 19 ZB 69 99 09 $9 19 09 9L and Winsor T Aids for determining magtutude and direction of electric axes of the LEAD I POSITIVE 00 0-3 10 IS20 2-0 3-0 35 40 45 50 60 7-0 6-0 90 100 110 12-0 BO HO 10-0 200 0-0 30 30 30 30 o 30 30 30 30 30 10 30 30 30 30 6 70 60 * 39 37 35 34 33 33 32 32 32 31 10 90 71 60 53 49 46 44 42 41 40 39 37 36 35 35 34 34 34 33 1-3 90 76 67 55 52 49 47 45 44 43 39 30 37 36 36 36 35 35 3 20 90 79 71 65 60 56 53 51 47 46 AZ 41 40 39 36 37 36 26 90 64 54 51 19 47 45 45 42 4 40 19 36 30 70 62 76 71 67 60 57 S5 52 49 47 45 44 43 12 40 39 39 37 38 90 76 73 63 sa 56 54 31 49 47 16 H 43 42 12 11 40 79 75 71 68 65 60 56 53 51 67 45 43 42 39 48 90 76 69 67 64 62 63 58 55 53 51 4. 47 45 4 43 43 40 80 90 21 77 74 71 68 64 62 60 57 55 52 51 47 46 15 11 OZ 79 76 73 69 67 65 57 55 53 52 50 49 47 46 43 7090 87 23 81 76 75 73 71 67 85 63 60 56 56 54 $3 51 50 40 60 90 87 84 32 19 77 75 72 69 65 62 60 58 56 55 53 SZ SO 46 90 90 87 82 80 70 76 74 73 71 67 64 62 60 58 57 55 54 53 52 48 10-090 BB 81 79 77 76 74 72 71 61 60 58 57 56 $4 53 19 11-090 4 62 73 77 75 73 72 70 67 65 62 59 $7 55 50 120 90 36 84 82 79 70 76 75 73 71 69 67 65 63 59 57 56 52 13-090 86 86 84 81 80 78 77 76 74 72 TO 68 64 63 60 59 58 53 140 90 87 65 83 BO 79 78 77 75 73 71 67 64 63 61 59 55 1. O 90 30 37 84 32 21 80 78 77 76 74 72 70 68 67 65 62 55 20-0 90 89 UB 87 85 84 32 al 80 79 77 74 72 71 70 65 65 60 LEAD I POSITIVE 00 08 10 15 20 25 30 35 40 45 50 60 70 80 90 100 110 120 130 140 150 200 30 30 30 30 30 30 30 30 JO 30 30 30 30 30 30 30 30 30 0-6 90 30 11 16 19 23 22 23 24 25 26 26 27 27 27 28 28 21 28 20 29 1090 30 11 0 7 11 14 26 18 19 22 22 23 24 25 2$ 26 26 26 27 27 190 30 16 7 5 7 11 13 16 20 21 22 23 2) 24 24 25 26 2 0 90 76 60 44 19 5 4 7 12 14 18 19 20 21 22 22 23 23 26 90 79 67 53 30 21 14 0 9 12 14 16 17 20 zo 21 23 81 71 60 39 30 ZZ 7 0 5 . 11 13 13 11 10 22 38 90 AZ 74 46 36 30 23 10 13 6 D 7 10 12 24 17 21 VO 90 83 76 52 37 SO 24 19 11 5 7 9 11 13 14 40 90 84 76 71 64 56 49 -42 36 30 9 1 O 6 0 10 IZ 13 6790 85 79 73 67 60 41 35 30 21 14 4 O 3 $ 11 6-0 70 76 11 66 60 54 49 . 39 30 22 16 11 7 3 3 7 13 70 90 86 SZ 70 76 65 $$ 51 46 30 30 18 23 0 lo 76 72 64 60 37 30 15 11 5 2 7 90 90 T 70 74 71 67 64 $6 09 36 30 25 20 37 05 79 T6 70 67 13 60 53 -47 JS 25 21 17 11.0 40 10 80 17 TS T2 69 63 $7 51 43 -47 30 26 22 at 23 16 76 $0 -44 19 34 1320 90 77 75 73 70 SY 32 -T ною M 76 76 14 72 $9 SS SL 15 o 40 67 $$ 33 #2 79 73 71 67 30 53 -49 $5 20.0 0 17 J6 35 76 76 70 37 REFERENCES 1 Jackson CE electrocardiogram Circulation 1 975 981 (Apnl) 1950 OO OG OC OC ° O 09 0 11 DG 0 1 61 30 90 91 TE 61 59 $1 91 99 09 0 NEGATIVE $1 SZ 91 5 1 6 90 10 69 09 EZ 6 9 C ? 10 0 0 90 95 ZS LEAD 61 1 10 09 31 6 7 3 CL 10090 25 14 21 O $ (1 99 SC it - 15 120 40 ::: 14 * OC 26 12 19 7 96 21 08 19 34 30 26 23 01 90 zt + 30 34 10 27 ( 00 -40 3) OC 21 67 16 OS 17 - 30 159 ·LEAD I NEGATIVE 0-0 06 10 15 20 25 30 35 40 45 60 60 70 80 90 100 110 120 130 HO 15 0 200 150 150 150 150 150 150 150 150 150 150 150 150 150 150 150 150 150 150 150 150 350 150 OO 90 120 131 136 139 141 142 144 145 146 146 147 147 147 148 149 148 10 109 90 120 127 134 136 138 139 140 142 143 145 145 146 146 146 147 15 104 113 90 120 125 128 131 135 136 131 139 141 142 142 145 145 114 147 20 90 101 109 115 120 124 127 129 131 133 134 136 138 139 140 141 142 142 113 145 143 106 28 90 112 99 116 120 123 126 12B 129 DJI 133 135 137 138 141 139 142 140 142 30 90 90 104 109 113 117 120 123 125 127 128 131 333 135 136 137 118 139 140 141 38 90 97 102 107 111 114 117 120 IZZ 124 I24 129 131 134 136 137 133 136 139 140 142 40 90 96 TOI 103 109 312 115 118 120 122 124 127 129 131 133 134 135 136 137 138 138 NEGATIVE 141 90 -95 100 104 107 111 113 116 118 120 122 125 127 129 131 132 133 135 136 137 137 140 90 95 80 99 103 106 109 IIZ 114 116 133 120 123 125 126 129 131 132 133 134 136 135 139 90 94 96 101 104 107 109 112 113 115 117 120 123 125 127 128 130 131 132 133 60 134 177 90 93 97 99 102 105 107 109 111 119 115 117 120 122 124 126 127 129 130 131 132 70 336 LEAD 80 90 93 96 98 101 103 JOS 107 109 111 112 115 11 120 122 IZ4 125 127 123 129 130 131 90 90 93 95 98 100 102 104 106 107 109 111 133 116 110 120 122 123 125 126 127 128 132 100 90 92 95 97 99 101 103 104 106 109 109 112 116 110 120 122 123 124 126 127 131 90 92 94 96 JOO JOZ JD3 3D5 107 108 ID 113 135 117 8 120 121 123 220 J25 130 120 0 92 94 96 98 99 101 102 104 105 107 109 111 11) 115 117 119 120 121 123 124 128 130 90 92 96 97 99 100 102 103 104 106 108 10 112 114 116 119 120 121 122 121 14 0 90 92 95 97 93 200 101 102 203 205 107 209 222 113 114 126 117 119 120 32: 325 15 O 90 92 93 9$ 96 98 99 IDO 102 103 104 106 108 110 112 115 116 119 120 123 20-0 90 91 92 93 95 96 97 98 99 100 101 103 104 306 108 109 110 112 113 -115 115 120 O 003 10 150 150 OO 05 90 150 180 10 90 120 150 15 90 109 131 20 90 104 120 2 5 90 101 113 166 164 JO 90 99 109 33 90 98 106 90 97 104 POSITIVE 4-0 43 90 96 102 80 90 95 101 LEAD 1 NEGATIVE 15 20 25 30 35 40 45 50 60 70 80 90 100 110 120 130 140 15 O 200 150 150 150 150 150 150 150 150 150 150 150 150 150 150 150 150 150 150 150 149 164 161 159 158 151 156 155 154 154 153 153 153 152 152 152 152 152 152 169 IBO 573 169 166 164 162 161 159 158 157 256 155 155 154 154 154 153 153 150 164 173 180 175 172 169 167 162 160 159 158 157 157 156 156 155 154 136 150 361 169 175 180 176 173 169 166 164 162 161 160 159 358 156 157 ISS 127 139 150 159 166 172 176 180 174 171 168 163 161 160 160 159 157 120 131 141 150 158 164 169 173 180 175 172 169 167 165 164 163 162 161 158 115 125 134 142 150 157 162 167 174 180 176 173 170 168 166 165 164 163 159 112 120 128 136 143 150 156 161 169 175 180 176 173 171 169 167 166 165 161 109 116 124 131 138 150 155 164 171 176 180 177 114 172 170 168 167 262 107 113 120 127 133 139 145 150 159 166 172 176 180 117 174 172 171 169 164 104 109 114 120 126 131 136 141 150 15a 164 169 173 177 180 177 175 173 167 102 106 111 115 IZO 125 129 134 142 150 157 162 167 171 174 177 180 178 170 100 104 10B 112 116 120 124 128 136 143 150 156 161 165 169 172 175 176 173 99 102 106 109 113 116 120 124 131 138 144 150 155 160 164 167 171 173 177 98 101 304 107 110 113 117 120 327 133 339 345 150 155 159 163 166 169 180 97 100 103 105 108 111 117 123 129 135 140 145 150 154 158 162 165 177 97 99 101 104 106 109 112 114 120 126 131 136 141 146 150 154 15. 161 17) 96 98 100 103 105 101 110 112 117 123 126 133 137 142 146 150 154 157 170 96 90 100 102 10s 106 166 115 120 125 129 134 138 142 146 150 153 167 95 97 99 101 103 103 107 109 U. 122 127 131 135 139 143 147 150 164 94 98 101 IOZ 104 107 110 113 117 IZO 123 127 130 133 136 ISO 90 94 99 60 70 90 94 90 93 97 80 90 07 no 90 93 96 10 90 93 95 Io 90 92 95 90 94 120 13 O 90 92 94 14 0 90 92 94 90 92 93 150 20-0 90 91 93 REFERENCES 1 Jackson CE and Winsor T Aids for determining magnitude and direction of electric axes of the electrocardiogram Circulation 1 975 981 (Apru) 1950 1 160 ·PART D INDEX

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·INDEX This Index includes only electrocardiographic findings and interpretations found in Electrocardioams Part A Volume I (Pages 1 119) and answers to Questions on Electrocardiograms Part B olume II (Pages 1 119) Page numbers in the Index apply to both correspondingly numbered pages 1 Volume I and Volume II Questions and Answers on Electrocardiographic Interpretation are nor indexed but are listed in ppropriate categories in the Table of Contents in both Volume I and Volume II Tables of normal values found in the Appendix Part C Volume I are included in the Index A Aberration of QRS 38 Acute posterior myocardial infarct 49 Age and heart rate Table of normal values 144 Amplitude of waves P waves Table of normal values 145 Q waves Table of normal values 147 Q/R ratios Table of normal values 152 Rwaves Table of normal values 148 Rattos of waves Table of normal values 152 R/S ratios Table of normal values 152 R/T ratios Table of normal values 152 Swaves Table of normal values 149 T waves Table of normal values 150 Almal premature contraction 51 60 80 With aberration of QRS 38 Nodal rhythm with retrograde conduction 94 Normal sinus rhythm 2 18 19 21 22 26 32 44 52 55 59 67 79 91 Sinus 34 70 Sinus arrest, 48 96 Sinus bradycardia 8 28 35 60 66 72 99 110 Sinus tachycardia 7 31 33 41 75 118 Superventricular tachycardia 78 Ventricular ectopic beat 17 82 93 100 107 Multifocal 97 Ventricular escape beat 96 Ventricular premature contraction 30 115 With retrograde conduction 30 Ventricular tachycardia 46 Artifacts Interferring alternating current 92 Loose electric connection 23 Loose lamp connection 29 Low standardization 97 107 Mismounting of leads I and III 25 Movement of clectrode on skin 34 Muscle tremor 12 13 29 45 Precordial leads recorded on lead a VF 37 Switching of lead I wires 114 Switching of lead It wires 57 Switching of lead Ill wires 36 Atrial Enlargement see atrial hypertrophy P waves in see P Waves Right 74 75 103 106 Fibrillation 45 50 73 97 113 Hyperthyroidism and 45 Premature contractions 29 51 60 80 or nodal with aberration of QRS 38 Flutter 61 With variable AV Block 61 81 V block Atrial flutter and 81 Complete with idioventricular thythm 119 First degrec 65 88 115 Incomplete 49 68 Partial 115 Second degree 68 64 Third degree 119 Two to one 64 WE beats 88 115 Aneurysm Ventricular 65 Anomalous atrioventricular conduction 54 83 Antenor infarct see myocard al infarcl Anterior and posterior myocardial infarct see myocardial infarct Anterior myocardial ischemta see myocardsal ischemia Anterolateral ischemia see myocardial ischemia Anterolateral myocardial infarct see myocard al infarct Anterolateral subepicardial ischemia see myocard al Ischema Anteroseptal myocardial infarct see myocardial infa cf Arrest sinus 96 114 Arrhythmias Atrial fibrillation 49 50 73 97 Atrial flutter 61 81 Atrial or nodal premature contract on 29 161 ·Barett formula 157 Block AV sec Ay block see conduction detects Bundic branch sec bundle branch block Intraventricular ste Intrerentricular block Pers infarction see perx infarction black Bradycardia see arrhyiymiai sinus bradycardia Bundle branch block Right Complete 35 41 66 89 88 103 with antstior infarct 41 Incomplete 40 71 77 107 109 Disease stalcs sce congenital heart disease Cor pulmonale chronic 42 Hyperthyroidism 45 Mistral stenosis 80 unsufficiency and 113 Pericarditis acute 90 chronic 47 Pneumothorax 95 Dnigs see specific drug Digitales 23 43 48 49 50 64 69 71 151 incomplert left bundle branch block and S-T segments and 97 112 Quinidine 29 46 52 interval and 29 32 Ventricular tachycardia and 46 Reserpine 28 Duration se specific use Pwarcs Table of normal values 146 QRS compieres Table of normal values 331 Complete 69 91 Incomplete 91 115 with digitalis 91 E Ectopic beat sec arrhythmia Ernihovens law 25 Electric axis P waves Table of normal values 158 QRS Left 62 Normal 27 Right 53 77 80 81 Table of normal values 158 TWBYES Clockwise rotation Strong 42 Complete night bundic branch block see bundle branch block right Complexes sec QRS complex Conduction defects Anomalous Atroventricular conduction 34 83 AV block complete with dioventricular shythm 119 First degree 65 88 115 with dropped bcats 88 Incomplete 49 68 88 115 Partial 135 Second degree 68 Third degree 119 Two to one 64 Pers infarctson Block 98 Intraventricular block 300 116 Congenital heart disease Atsal septal defect 109 Coarction of aort 209 complete AY block 119 Epstein $ syndrome 103 Eisenmenges complex 102 107 Pulmonary valvutar stenosis 106 Tetralogy of Fallot 53 Ventricular sepai defect 117 Coronary type T waves see I waves Cor pulgtonale chronic 47 68 74 Coved S T segments see ST segments Coved T Waves see T waves Table of normal values 158 Tables for calculating 159 160 Efectrxal connection loose see artifact Electrocardiogram normal see mormal clectrocardiogr Electrocardrographic position of heart see position of her Electrolyte desturbance Hyperkalemta 116 118 Hypokatemia 87 Escape beat Ventricular 96 F Fibrillation see arrhytheria Atrsal 45 50 73 97 113 Fluiser see arrychmia Atrial 61 with varsa b c AV block 61 81 H Digitals 43 48 49 50 64 69 71 75 112 113 Incomplete left bundle branch block and 91 QT intervals and 23 45 50 64 71 73 112 Sagging of ST segments 45 97 Saucer shaped ST segments 332 Diphasic ST segments see ST segments Discordant 3 posna see point 11 24 78 Ciscordant S-T segments see $ T segmenis 11 24 78 Discordant T waves see Txoves 13 24 78 Heart position see powtion of Heart Heart rate QT interval corrected for 157 Table for determining 144 High R waves sre specific nane High voltage see specific wave 11 ·Horizontal electrocardiographic position see position of heart 1 66 99 111 Hyperkalemia 116 118 Hypertrophy see airal or ventricular 11 17 Atrial see atrial enlargements 74 75 106 Right 103 Left 80 Left ventricular 22 23 24 49 51 64 73 75 78 84 97 107 108 113 117 Right ventricular 53 70 74 76 84 86 107 106 107 113 Right and left ventricular 84 102 Hypokalemia 87 Incomplete AV block see Al block Incomplete bundle branch block see bundle branch block Infarction of myocardium see myocardial infarct Injury see myocardial injury Intermediate position of heart see position of heart Intervals see specific interval QRS QT or PR Intraventricular block see conduction defects Intrinsicoid deflection Delayed in lead V, 32 35 40 41 71 76 80 86 102 109 Delayed in lead V, 31 59 69 82 85 91 Normal in lead V. 14 Table of normal values 153 Inverted T waves see T waves Ischemia of myocardium see myocardial ischendia Jsoelectric segments of waves see specific segment or wave notched 47 peaked 42 tall 68 talt and peaked 74 75 wide and notched 47 PR interval 83 Q waves in 31 33 large 98 QR$ complexes wide 85 98 QS waves 65 R waves tall 108 S-T segment shifts 90 Twaves flat 13 inverted 15 47 63 98 99 due to pericarditis 47 low 5 79 Lead III Pwaves peaked 42 tall 68 tall and peaked 74 75 wide and notched 47 Q waves 31 33 large 98 QS waves 65 ST segment shifts positive 88 Switching of wires 36 T waves inverted 15 63 98 99 Lead a Va Wide R waves 40 Lead a VL Q waves 82 Q/R ratio abnormal 82 Rwaves tall 17 R/T ratio abnormal 17 Swaves wide 100 ST segment shifts positive 90 Twaves negative 58 92 105 Lead av P waves Inverted 94 peaked 42 tall and peaked 75 Q waves 10 49 55 63 100 abnormal 31 33 41 59 Q/R ratio abnormal 33 49 $9 63 100 QS waves 65 Rwaves wide 100 S-T segments elevated 49 Twaves inverted 13 47 56 99 low 79 pericarditis and 47 Lead V Intrinsicoid deflection delayed 32 35 40 41 71 76 80 85 86 102 109 P waves large 103 tall 106 Q waves 32 QR waves 113 QS waves 64 110 QRS complexes potched 40 tall 40 point Discordant 11 24 78 Normal 21 L Law Einthovens 25 Leads standard see QRS compleres Loose electric connection see artifacts Loose lamp connection see artifacts Low T waves see T Hases Left complete bundle branch block see bundle branch block Left ventricutar hypertrophy see hypertrophy ventricular Low standardization see sranda di alion w voltage see specific na es rad 1 High R Waves in see Ruotes 11 17 23 92 Inverted T waves 23 Negative S-T segment shifts 88 Notched P waves 80 Positive S-T segment shifts 90 O waves 82 R/T ratios abnormal in 17 Sagging S-T segments 58 Slurring of R waves 83 ST segments negative 3 Tall R waves 11 17 39 108 Wide QRS complexes 93 Lead 11 P waves in Jarge 103 106 Rwaves tall 39 53 70 74 76 80 84 10 R prime tall 107 RR prime 40 77 107 109 R/S ratio abnormal 39 33 86 99 Swarcs decp 64 78 109 S-T segments d scordant 106 163 ·fat 22 negative 23 30 94 sagging 43 58 87 due (o hypokalcmia 87 saucer shaped 49 T waves cored 1 101 inverted $5 23 31 63 92 Bow 62 79 84 notched 62 Lead ST segments elevated 41 Twaves discordant 106 inverted 41 Lead V, P waves 20 Q waves 15 32 QS waves 64 65 130 113 wave 445 R wave notched 21 slutniag 83 tall 84 102 S wave deep 17 64 73 78 92 FOI 108 S-T segment elevated 41 65 T waves inverted 15 32 41 47 65 notched S2 Transitional zone 26 Lead V, P waves 20 Q waves 31 41 59 QS waves 44 60 65 101 104 11 t waves 110 Rwaves low 64 87 slurring 83 S waves decp 24 ST segment elevated 31 41 64 r waves caved 44 inverted 15 31 32 41 44 58 65 natched 16 92 U waves large 32 Intrs scoid deflection delayed 31 59 69 82 91 normal 1 Pwrres 20 Qwqxes S3 $9 decp 84 farge 78 QRS completes hurgh voltages 78 84 Isoclectric portion 16 low voltage 95 R Waves law 63 96 99 shurting 83 tatt 17 23 64 75 R/Trstic abnormal 17 $ Swave deep 74 wide 40 41 66 88 ST segments flat 22 segafise 23 94 positive 90 sagring 43 58 87 due to hypokalema 87 saucer shared 49 Twaves cored 101 snvested 5 23 47 63 92 96 99 due to pericarditis 47 low 79 84 M I waves Lead V P Waves 20 waves 31 59 QRS complexes high voltage 78 M shaped 93 OS waves 60 111 rwaves 104 110 Rwaves tail 22 72 78 slutning 83 S wave wide 66 ST segments flat 22 svegative 30 88 positive 31 41 90 sagging 14 43 87 due to hypokalemia 87 coved 44 101 low 79 notched 16 tall 72 inverted 15 31 32 45 44 58 U waves tall 72 73 87 Lead V, Pwaves 20 Q waves 31 53 59 111 deep 84 large 78 Q/R raiso abnormal 121 QRS complexes high voltage 78 84 low voltage 13 99 R waves sluiting 83 tal! 23 47 49 64 Swaves wide 66 ST segments elevated 31 90 Mean electric axis see electric ant Mismounted lends I and III see arufact M shaped QRS complexes see QRS complexes Myocardial infarct 89 Anterior 17 with right bundle branch block 41 Anterior and posterior 39 Anterolateral 110 farge 111 subacure or chronic 104 110 Anteroseptal 15 32 301 Posteriar 31 55 89 100 old 33 33 63 96 98 acute 49 Posterior infarct old with per infarction block 98 Posterolateral 39 99 Subacute extensive 31 Myocardial injury 3 3 58 Subepicardial acute 90 Subendocardia) 3 13 14 115 Posterior $ 88 Myocardial ischemia 3 24 58 92 Antertos 58 Anterolaterat 18 Posterior S 36 99 Posterolateral 63 101 164 ·Subendocardial 14 Subepicardial 13 18 Subcpicardial and anterolateral 18 With inverted T waves 32 uscle tremor see artifact N Posterior and anterior myocardial infarct see myocardial infarct Posterior myocardial infarct see myocardial infarci Posterior myocardial injury see myocardial injury Posferios myocardial ischemia see myocardial ischemia Posterolateral myocardial infarct see myocardial infarct Posterolateral myocardial ischema see myocardial ischemia Precordial leads see also specific leads Javerted T waves 18 18 60 Recorded on lead aVF 37 Predominance of right ventricle 34 Premature contractions see arrhythmia Primary T waves see I kaver Prolonged QT intervals see Q 1 intr vals Pulmonary valvular stenosis See congenital heart disease legative segments see specific segment odal rhythm see arrhythmia ormal electrocardiogram 1 2 4 9 10 19 21 26 27 34 37 67 105 formal sinus rhythm see arrhythmias 2 19 21 22 26 32 44 57 5S 67 79 91 formal values tables of 144 160 Tormal waves see specific noves tched waves see specific notes P waves Amplitude Table of normal values 145 Duration Table of normal values 146 Flat topped 43 Electric axis Table of normal values 158 Inverted in lead a VF 94 Large in lead 11 107 in lead V, 103 Normal 20 Worcted 4 in lead I 80 Peaked 7 in lead 42 in lead III 42 in Icad a Ve 42 Prolonged 43 Retrograde following QRS complexes 30 tn lead II 68 in lead M7 68 12 lead 106 Tall and peaked in lead Il 74 75 in lead III 74 75 in lead a VF 75 Wide and notched in lead IT 47 in lead It 47 Partial AV Block see AV block Q waves Deep In lead Vs 84 in lead v 84 in lead j 82 in lead II 31 33 in lead III 31 33 in lead a V., 87 in lead aVe 12 31 33 49 $5 63 in lead V 23 in lead V 15 23 in lead V, 31 41 59 in lead V 31 59 in lead V, 31 53 59 111 in lead V 53 59 In precordial leads 6 Large in lead II 98 in lead jul 98 in lead a VF 41 100 in lead V 78 in lead V. 78 Normal 10 Table of normal values 147 Wide in lead a Vy 59 98 QRS complexes Table of normal values 158 Electric axis Table of normal values 138 High vallage in lead v, 40 in lead V 78 in lead V 78 84 in lead V, 78 84 I eft axis deviation 62 Low voltage 16 in lead V 95 in lead V 95 standard leads 96 97 M shaped 66 93 Normal width 16 Notched in lead y 40 Right axis deviation 53 77 80 81 Transitional zone 26 QiR ratios Abnormal in lead a VL 82 in lead aVe 33 49 59 63 100 in lead Vs 111 Table of normal values 152 QR waves in lead V, 113 PR intervals Prolonged 65 88 Short 54 83 94 Table of normal values 154 Peaked P waves see P Waves Pericarditis see disease sales Pen intaction block see condiction defects Pretrothorax 95 Position of heart Horizontal 1 66 99 111 Intermediate 6 Vertical & SO 105 Semihorizontal 9 37 Semiverti al 18 29 35 36 50 56 64 67 79 5 ·R/T ratia in lead I 17 in lead a VL 17 in lead V. 17 31 Table of normal values 152 OS waves see specstc leads in lead V, 64 100 in lead V, 64 65 110 111 QT interval Long 15 29 46 52 101 Quinidine and 29 32 Short 43 48 50 due to digitalis 23 45 50 64 71 75 112 Cable of normal values Lepeschkin and Ashman 156 Bazett 157 Quinidine 29 46 50 S R Swaves Deep in lead y, 64 78 108 in lead V, 17 64 73 78 92 102 108 in lead V, 24 in lead V. 74 in precordial leads 42 Notched in lead V, 7 Table of normal values (amplitude) 149 Wide in lead a VL 100 in lead V. 66 in lead V, 66 in lead V, 40 41 66 88 Rwaves Low in lead V, 64 82 in lead V. 63 96 99 Notched in lead V, 21 Slurred in lead I 83 in lead V, 83 in lead V, 83 in lead V 83 in lead V, 83 in lead V, 83 Small 15 42 44 104 110 Table of normal values (amplitude) 148 Tan in lead I 11 17 23 92 108 in lead II 108 in lead aVL 17 in lead V 39 53 70 74 76 80 84 102 106 in lead V, 84 102 in lead V. 22 72 in lead V, 23 47 49 64 in lead V 17 23 64 75 Wide in lead aVR 40 in lead aVe 100 R prime wave in lead v 40 77 109 Tall in lead V 40 107 S-T segments Coved 15 31 101 Diphasic 49 Discordant 11 24 78 in lead V, 106 Flat in lead V. 22 in lead V, 22 in lead V, 22 Isoelectric 44 60 Negative in lead I 73 88 in lead V, 88 in lead V. 30 88 in lead V, 23 30 94 in lead V 323 Positive 7 in lead I 90 in lead II 90 in lead III 88 in lead a VF 49 in lead a VL 90 in lead V, 41 in lead V, 41 65 in lead V, 31 41 65 in lead V 31 41 in lead V, 31 90 in lead V 90 Sagging due to digitalis 45 97 in lead I 58 in lead aVF S in lead V 14 43 87 in lead V, 14 43 87 in lead V. 14 43 87 Saucer shaped 48 50 in lead V, 49 in lead V 49 Table of normal values (elevation or depression) 155 Table of normal values (in vertical electrocardio graphic position) 155 Sagging of ST segments see ST segments Saucer shaped see ST segments Short QT intervals see QT intervals Secondary T waves see T waves Second degree AV block see At block incomplete Semshorizontal position of heart see position of heart Semuvertical position of heart see position of heart Ratos of waves see specific ratio Table of normal values (amphtude) 152 Reserpine Electrocardiogram in 28 Retrograde conduction see arrhythmia Nodal rhythm 94 Ventricular premature contraction 30 Right atrial enlargement see atrial enlargement Right axis deviation see electric ans Right bundle branch block see bundle brunch block right Right ventricular hypertrophy see hypertrophy right ventricular Right ventricular predominence see ventricular right predominence Rotation of heart see clockwise Counter clockwise see questions in volume !! R/S ratio Abnormal in lead V 39 53 86 99 Table of normal values 152 166 ·tal defect ventricular sec congenital heart disease us arrest 48 96 114 us arrhythmia 34 70 u bradycardia 8 28 35 60 66 77 99 110 us rhythm see normal sinus rhythm 18 19 21 2? 26 144 52 SS 59 67 79 91 15 tachycardia see arrhythmia 7 31 33 41 75 118 in lead V, 16 32 in lead V, 16 in lead V, 62 Primary 79 Secondary 79 93 Tall in lead V. 72 precordiat leads 118 Table of normal values (amplitude) 150 Tachycardia see arrhythmia also Sinus see sin its tachycardia 7 31 33 41 75 118 Supraventricular 78 Ventricular 46 ndardization low 91 107 Transitional zone of QRS complexes see QR$ compleres Tremor see arnfact cute myocardial infarct see myocardial infarci endocardial injury see myocardial injury Endocardial ischemia sce myocardial ischemia picardial injury see myocardial injury picardial ischemia see myocardial ischemia aventricular tachycardia 78 ching of wires see arnfacts U U waves Large 20 297 73 87 112 T V Ventricular aneurysm 65 Ventricular ectopic beat 17 87 93 100 107 Multifocal 97 aves see also specific leads Coronary type 101 Coved in lead V, 44 101 in lead y +$ 101 in lead V, 101 in lead V 101 Discordant 11 24 78 106 Flat 13 Inverted in lead I 23 in lead 11 98 99 in lead I 98 99 in lead aVL 58 92 105 in lead aVF 13 47 56 99 in lead V 41 in lead V 15 41 47 65 in lead V, 15 31 32 41 44 58 65 in lead V 315 31 32 41 44 58 63 in lead V, 15 3 31 63 92 In lead V. 15 73 47 63 97 96 99 in precordial leads 18 60 Low in lead II S 79 in lead III 3 in lead a VF 79 in lead V 79 in lead V, 62 79 84 in lead V 79 84 Notched 29 in lead V, 52 Ventricular escape beat 96 Ventricular hypertrophy 11 Left 17 22 23 24 49 51 64 73 75 78 92 108 113 117 Right 53 70 74 76 86 106 107 113 Right and left 84 10. Ventricular premature contractions 30 115 Ventricular predominence see predominence of ventricle Ventricular septal defect 117 Ventricular tachycardia 46 Vertical position of heas see position of hears Voltages see QRS waves 1 w Waves see specific waves Wolff Parkinson White see conduction defects