1. FLUTTER =
II P – V1 P RHYTHM REGULAR SAW TOOTHED – BLOCK 2:1 3:1 4:1 etc –
RA HTfy : P DURATION = NORMAL – P MAYBE RIGHT AXIS – ATRIAL BPM 250 – 350 – VENTICULAR BPM ½ 1/3 ¼ etc – CAROTID MASSAGE INCREASES
BLOCK
P 1ST POSRTION INCREASE AMPLITUDE
LA HTfy : P DURATION = INCREASED – P 2ND PORTION INCREASED –
P NO AXIS
RV HTfy : RIGHT AXIS – V1 R – V6 S FIBRILATION :
LV HTfy IREGULAR – ATRIAL BPM 350 – 500 –
PRECORDIAL CRITERIA
VENTRICULAR BPM VARIABLE –
V5 OR V6 R + V1 OR V2 S > 35mm CAROTID MASSAGE MAY SLOW VENTRICULAR RATE
V5 R > 26 mm – V6 R > 18 mm – V6 R > V5 R
LIMB CRITERIA
VL R > 13mm – VF R > 21 mm – I R > 14 mm –
I R + III S > 25 mm
MAT = MULTIFOCAL ATRIAL TACHYCARDIA
REPOLARIZATION ABNORMALITIES
IREGULAR – P 3 – MORE DIFFERENT MORPHOLOGIES –
ST ASYMMETRIC DIPRESSION – T INVERSION : IN LEADS WITH TALL T = SIGNIFICANT HYPERTROPHY, VENTRICULAR DILATON, FAILURE
BPM 100 – 200 OR LESS – CAROTIDMASSAGE NO EFFECT
PAT = PAROXYSMAL ATRIAL TACHYCARDIA
PSVT = PAROXISMIC SUPRAVENTRICULAR TACHYCARDIA
REGULAR – BPM 100 – 200 – C
RHYTHM REGULAR – P IF VISIBLE, RETROGRADE – BPM 150 – 200 – CAROTID MASSAGE
SLOWS OR TERMINATES AROTID MASAGE NO EFFECT OR ONLY MILD SLOWING

2. LEFT ANTERIOR HEMIBLOCK = LA HEMI-
QRS NORMAL DURATION – ST,T NO CHANGES – LEFT AXIS –
NO OTHER CAUSES OF LEFT AXIS
LEFT POSTERIOR HEMIBLOCK = LP HEMI-
QRS NORMAL DURATION – ST, T NO CHANGES – RIGHT AXIS –
NO OTHER CAUSES OF RIGHT AXIS
BIFASCICULAR BLOCK
RBBB + LA HEMI- = QRS >0.12 – V1,V2 RSR’ – LEFT AXIS
RBBB + LP HEMI- = QRS >0.12 – V1,V2 RSR’ – RIGHT AXIS
AV BLOCKS
ST PREEXCITATION
1 DEGREE = PR > 0.2 SEC – P:QRS
ND
WPW = PR < 0.12 SEC – QRS > 0.12=WIDE – DELTA WAVES
2 DEGREE = PR > 0.2 SEC – NOT ALWAYS P:QRS
LGL = PR < 0.12 – QRS NORMAL – NO DELTA WAVES
MOBITZ I =WENCKENBACH = PR PROGRESSIVE PROLONGATION UNTIL QRS IS DROPPED
COMMON ACOMPANING ARRYTHMIAS =
MOBITZ II = PR NO PROLONGATION - QRS ARE DROPPED
RD PSVT WITH NARROW QRS – AtFibril  VentFibril
3 DEGREE = COMPLETE BLOCK = AV DISSOCIATION = INDEPENDED Pacemakers
MI = EXAM – ENZYMES – ECG
T PEAK  T INVERSION -- ST ELEVATION -- Q WAVES
Q WAVE CRITERIA
>0.04 SEC – Q DEPTH => 1/3 R IN THE SAME COMPLEX
MI NONQ CRITERIA =
RIGHT BUNDLE BRANCH BLOCK = RBBB T INVERSION – ST DEPRESSION > 48 HOURS
QRS > 0.12 – V1,V2 RSR’ = RABIT EAR – ST DEPRESSION – INFERIOR MI =
T INVERSION – V5,V6,I,VL RECIPROCAL CHANGES II,III,VF – RIGHT CORONARY OR DESCENDING BRANCH –
LBBB ANTERIOR, LEFT LATERAL LEADS RECIPROCALS
QRS > 0.12 SEC – V5,V6,I,VL R BROAD OR NOTCHED – LATERAL MI =
V5,V6,I,VL – OFTEN = LEFT CIRCUMFLEX OCLUSSION –
ST DEPRESSION – T INVERSION – V1,V2 RECIPROCALS –
INFERIOR RECIPROCALS
LEFT AXIS MAYBE
ANTERIOR MI = V1,…,V6 – OFTEN = LEFT ANTERIOR DESCENDING – INFERIOR RECIPROCALS

3. POSTERIOR MI = V1 RECIPROCALS = ST DEPRESSION T TALL = OFTEN = RIGHT CORONARY ATHLETE HEART
OCCLUSION
SINUS BRADYCARDIA – ST,T NONSPESIFIC CHANGES –
ST ELEVATION = MI – PRINZMETAL ANGINA
LV HTfy -- RV HTfy – RBBB INCOMPLETE –
ST DEPRESSION = NONQ MI – TYPICAL EXERTIONAL ANGINA – POSSITIVE
AV BLOCK 1ST DEGREE – OR WENCKENBACH AV BLOCK – SUPRAVENTRICULAR
STRESS TEST
TACHYCARDIA OCCASIONAL
HYPERKALEMIA
T PEAK, PR PROLONGATION, P FLAT,
QRS WIDE  QRS + T MERGE TO SINE WAVE,  Vent Fibril
HYPOKALEMIA =
ST DEPRESSION, T FLAT, U WAVES
HYPOCALCEMIA = QT PROLONGATION
HYPERCALCEMIA = QT SHORT
HYPOTHERMIA = OSBORNE WAVE
DIGITALIS
THERAPEUTIC LEVELS = ST,T CHANGES IN LEADS WITH TALL R
TOXI LEVELS = TACHYARRYTHMIAS, CONDUCTION BLOCKS, PAT + BLOCK = MOST
COMMON
SOTALOL, QUINIDINE, PROCAINAMIDE, AMIODARONE, TRICYCLICS,
QUINOLONES, PHENOTHIAZINES, ERYTHROMYCIN, SOME ANTISTAMINES,
ANTIFUNGALS = QT PROLONGATION – U WAVE
PERICARDITIS =
ST,T DIFFUSE CHANGES – LOW VOLTAGE IF LARGE EFFUSION
HOCM = LEFT AXIS – Q SEPTAL LEADS
MYOCADITIS = CONDUCTION BLOCKS
COPD =
LOW VOLTAGE – RIGHT AXIS – R POOR PROGRESSION –
RV HTfY , P PULMONALE – REPOLIRIZATION ABNORMALITIES
ACUTE PULMONARY EMBOLISM =
RBBB – I S – III Q – RV HTfy –
ARRYTMIA = COMMON = SINUS TAVHYCARDIA OR ATRIAL FIBRILATION
CNS DISEASE =
T DIFFUSE INVERSION = WIDE AND DEEP -- U WAVES