This is a lecture by Dr. Patrick Carter from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.

1. Project: Ghana Emergency Medicine Collaborative
Document Title: Cardiology – EKG Interpretation
Author(s): Patrick Carter (University of Michigan), MD 2012
License: Unless otherwise noted, this material is made available under the
terms of the Creative Commons Attribution Share Alike-3.0 License:
http://creativecommons.org/licenses/by-sa/3.0/
We have reviewed this material in accordance with U.S. Copyright Law and have tried to maximize your
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speak to your physician if you have questions about your medical condition.
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2. Attribution Key
for more information see: http://open.umich.edu/wiki/AttributionPolicy
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3. $%&'()*'+"
• ,'*-'."/0"1234-2("56'(73/89:+-/6/;:"
• 51<"=2*'+"2>4"?>7'3*26+"
• 5@<"A'24+B"A-C%D"E>7'3-/3"2>4"EF;C'>7'4"
A'24+"
• G9'"H2+-(+"/0"5@<"?>7'383'72)/>"
• 5I2C86'"12+'+"
J"

4. 1234-2("56'(73/89:+-/6/;:"
Madhero88, Wikimedia Commons
K"

5. 5@<"=2*'+"2>4"?>7'3*26+"
Skvalen, Wikimedia Commons
L"

6. 5@<"=2*'+"2>4"?>7'3*26+"
• P wave: the sequential activation
(depolarization) of the right and left atria
• QRS complex: right and left ventricular
depolarization (normally the ventricles are
activated simultaneously)
• ST-T wave: ventricular repolarization
M"

7. 5@<"=2*'+"2>4"?>7'3*26+"
• U wave: origin for this wave is not clear - but
probably represents "after depolarizations" in the
ventricles
• PR interval: time interval from onset of atrial
depolarization (P wave) to onset of ventricular
depolarization (QRS complex)
• QRS duration: duration of ventricular muscle
depolarization
N"

8. 5@<"=2*'+"2>4"?>7'3*26+"
• QT interval: duration of ventricular depolarization
and repolarization
• RR interval: duration of ventricular cardiac cycle
(an indicator of ventricular rate)
• PP interval: duration of atrial cycle (an indicator
or atrial rate)
O"

9. P/3C26"?>7'3*26+"
• Q,"
– RS#R"+'("T6'++"792>"/>'"
623;'"%/IU"
• V,W"
– RSRO"X"RS!R"+'("T!Y#"+C266"
%/I'+U"
• VG"
– KLR"C+"->"C'>D"KMR"C+"->"
./C'>"
– H2+'4"/>"+'I"Z"9'237"327'"
– [260"79'",Y,"->7'3*26".-79"
>/3C26"[,"
"
Agateller, Wikimedia Commons

10. W72>4234"A-C%"A'24+"
Kychot, Wikimedia Commons
!R"

11. E>7'3-/3"A-C%"A'24+"
• ]!B"3-;97"K79"->7'3(/+726"+82('"
• "]#B"6'^"K79"->7'3(/+726"+82('"
• "]JB"9260.2:"%'7.''>"]#"2>4"
]K"
• "]KB"6'^"L79"->7'3(/+726"+82('D"
C-4Y(62*-(F623"6->'"
• "]LB"9/3-_/>726"7/"]KD"2>7'3-/3"
2I-6623:"6->'"
• "]MB"9/3-_/>726"7/"]LD"C-4Y
2I-6623:"6->'"
Mikael Häggström, Wikimedia Commons
!!"

12. H-8/623"2>4"EF;C'>7'4"A'24+"
Adnav, Wikimedia Commons
!#"

13. G9'"H2+-(+"/0"5@<"?>7'383'72)/>"
• ,27'"
• ,9:79C"
• EI-+"
• E]"H6/(`+"2>4"?>7'3*26+"
• HF>46'"H32>(9"H6/(`+"
• [:8'373/89:"
• ?>023()/>Z?+(9'C-2"
!J"

14. ,27'"
• W->F+",9:79C"a"WE"P/4'"b-+(923;'"
– MRY!RRZC->"
– $*'343-*'"WF883'++'+"EF7/C2)(-7:"c/(-"
• [,"d"!RR"a"G2(9:(234-2"
• [,"e"MR"a"H324:(234-2"
• EF7/C2)(-7:"c/(-"
– E73-2"MRYORZC->"
– E]"fF>()/>"KRYORZC->"
– ]'>73-(6'+"#RYKRZC->"
!K"

15. ,27'"?>7'383'72)/>"
Source Undetermined
!L"

16. ,9:79C"
• W->F+",9:79C"
– $3-;->2)>;"03/C"WE"
>/4'"
– Q".2*'"%'0/3'"
'*'3:"V,W"
– Q".2*'"->"+2C'"
4-3'()/>"2+"V,W"
Skvalen, Wikimedia Commons
!M"

17. !"#$%&'()*+,'-./0.$'
Source Undetermined
()*+,'1#%2/3%#2)%'
Source Undetermined
()*+,'4%3./3%#2)%'
Source Undetermined
!N"

18. EI-+"?>7'383'72)/>"
! Represents the overall direction of the heart’s activity
! Axis of –30 to +90 degrees is normal
!O"

19. G9'"VF2432>7"E883/2(9"
• V,W"F8"->"?"2>4"F8"->"2]c"a"P/3C26"
!"

20. E73-/*'>73-(F623"H6/(`+"
• E]"%6/(`+"
– c-3+7"4';3''"%6/(`"""
• Q,"->7'3*26"gI'4"2>4"d"RS#"+'(""
– W'(/>4"4';3''"%6/(`D"h/%-7_"7:8'"!""T='>`'%2(9U"
• Q,";324F266:"6'>;79'>'4D"79'>"43/8"V,W""
– W'(/>4"4';3''"%6/(`D"h/%-7_"7:8'"#"""
• Q,"gI'4D"%F7"43/8"V,W"32>4/C6:"
– G:8'"J"%6/(`""
• Q,"2>4"V,W"4-++/(-27'4"
#R"

21. +7"b';3''"E]"H6/(`"
!
Source Undetermined
#!"

22. >4"b';3''"E]"H6/(`"
#
5"6)07'4/89':';<9*=96%3.>'
Source Undetermined
5"6)07'4/89'::'
Source Undetermined
##"

23. J34"b';3''"E]"H6/(`"T1/C86'7'"
['237"H6/(`U"
Source Undetermined
#J"

24. Q3/6/>;'4"VG"
• P/3C26""
– h'>"KLRC+"
– =/C'>""KMRC+"
• 1/33'(7'4"VG"TVG(U"126(F62)/>"
– VGCZiT,Y,U"
• 12F+'+"
–
–
–
–
–
–
b3F;+"TP2"(92>>'6"%6/(`'3+U"
[:8/(26('C-2D"9:8/C2;>'+'C-2D"9:8/`26'C-2"
[:8/79'3C-2""
E(F7'"h:/(234-26"?>023()/>"
1/>;'>-726"
?>(3'2+'4"?>732(32>-26"Q3'++F3'"
#K"

25. HF>46'"H32>(9"H6/(`+"
• A'^"HF>46'"H32>(9"H6/(`"
– h/>/892+-(",".2*'"->"?"2>4"]MD"V,W"d"RS!#"+'("
– A/++"/0",".2*'"->"83'(/34-26"6'24+"
– V,W"G".2*'"4-+(/342>('"?D"]!D"]M"
– 1/>+-4'3"(234-2("-+(9'C-2"-0"2">'."g>4->;"
• ,-;97"HF>46'"H32>(9"H6/(`"
– ]!B",W,"83-C'"82j'3>".-79"->*'37'4"G".2*'"
– ]MB"=-4'"4''8"+6F33'4"W".2*'""
#L"

26. Source Undetermined
Source Undetermined
#M"

27. Source Undetermined
#N"

28. Source Undetermined
Source Undetermined
#O"

29. Source Undetermined
#"

30. [:8'373/89:"
! A'^"]'>73-(F623"[:8'373/89:"13-7'3-2B""
! E44"79'"623;'3"W".2*'"/0"]!"/3"]#"->"CCD"7/"79'"623;'3",".2*'"/0"
]L"/3"]MS""
! WFC"-+"d"JLCC"a"A]["
Source Undetermined
JR"

31. ?+(9'C-2"
• k+F266:"->4-(27'4"%:"WG"(92>;'+"
– 56'*2)/>"a"E(F7'"->023()/>"
– b'83'++-/>"a"?+(9'C-2"
• 12>"C2>-0'+7"2+"G".2*'"(92>;'+"
• ,'C/7'"-+(9'C-2"+9/.>"%:"V".2*'+"
"
J!"

32. 5*/6F)/>"/0"h:/(234-26"?+(9'C-2"
The cat, Wikimedia Commons
J#"
Displaced, Wikimedia Commons

33. 1/3/>23:"H6//4"WF886:"
Patrick J. Lynch, Wikimedia Commons
JJ"

34. 19232(7'3-+)(+"/0"2"h:/(234-26"?>023(7"
A. Anterior Infarction
A. V1,V2,V3,V4
B. Left Anterior Descending (LAD)
B. Lateral Infarction
A. I, AVL
B. Circumflex branch of Left Coronary Artery
C. Posterior Infarction
A. Depression in V1,V2,V3
B. Right Coronary
C. Provides blood supply to SA Node, AV Node, His Bundle
D. Inferior Infarction
A. II, III, AVF
B. Right or Left Coronary
A. Most Commonly Right Coronary
JK"

35. ?@A((:?'?A-B:A?'?A(C'CDA5E@C('
JL"

36. 12+'"l"!"
• #":Z/"C26'"83'+'>7+".-79"(9-'0"(/C862->7"/0"
m19'+7"82->n"
– W9238"(9'+7"82->"6/(26-_'4"7/"+F%Y+7'3>26"3';-/>"
– Q6'F3-)("Y"./3+'".Z"4''8"%3'279->;D">/"324-2)/>"
– E++/(-27'4".-79"+9/37>'++"/0"%3'279"
– P/">2F+'2"/3"4-289/3'+-+"
– ,'('>7"6/.Y;324'"0'*'3D"(9-66+"
– P/"2%4/C->26"82->D"*/C-)>;D"4-2339'2"
JM"

37. 12+'"l"!"
• Q9:+-(26"5I2C"
– G"a"JOS#D"Qa!RRD"HQ"a"!!LZNLD",,"a"!#D"W2$#"a"Oo"
– <5P5,EAB""Ep$"I"JD"PEb"
– [55PGB"P1ZEGD"Q5,,AD"5$h?D"$Q"16'23"
– P51@B"WF886'D"P/"AEb"
– [5E,GB",,,D"P/"hF3CF3+D"<266/8+"
– AkP<WB"1GE"%-627'3266:"
– EHbB"W/^D"PbD"PGD"P/"C2++'+"
– 5qGB"==QD"#p"QF6+'+"
– P5k,$B"Ep$"I"JD"P/"0/(26"P'F3/"b'g(-7+"
JN"

38. Source Undetermined
JO"

39. Source Undetermined
J"

40. Q'3-(234-)+"
• 5@<"c->4->;+"
– b-rF+'"1/>(2*'"WG"56'*2)/>"
– 1/>(/342>7"G".2*'"(92>;'+".Z"WG"
+';C'>7"
– WG"b'83'++-/>"->"2],D"]!"
– Q,"b'83'++-/>"
– P/",'(-83/(26"192>;'+"
KR"

41. 12+'"l"#"
• KM":Z/"C26'"83'+'>7+".-79"11"/0"W:>(/8'"
– Q2)'>7"3'8/37+"9'".2+"+72>4->;"27"+->`"->"`-7(9'>"2>4"0'67"
6-;979'24'4"
– Q2)'>7">/7'4"(9'+7"83'++F3'"2>4");97>'++"->"+F%Y+7'3>26"3';-/>"
– P/"324-2)/>S"P/">2F+'2"/3"4-289/3'+-+S"
– Q2)'>7"82++'4"/F7"2>4"A$1"I"#"C->S"P/"+'-_F3'"2()*-7:S"
– Q2)'>7"(/>)>F'+"7/">/7'"+9/37>'++"/0"%3'279D"6-;979'24'4>'++"2>4"
>'23"+:>(/826"+'>+2)/>"
• Q2+7"h'4-(26"[-+7/3:B"b-2%'7'+D"1/3/>23:"E37'3:"b-+'2+'D"h:/(234-26"
?>023()/>"
• h'4+B"E+8-3->D"Q62*-ID"h'7/83/6/6D"A-8-7/3"
• E66'3;-'+B"P@bE"
• W[B"p"WC/`'3D"P/"5G$[D"P/"?]bk"
K!"

42. 12+'"l"#"
• Q9:+-(26"5I2C"
– ]WB"GaJNSMD"Q"a"JRD"HQ"a"OLZKLD",,"a"!#D"$#"+27"a"No"
– <5PB"b3/.+:D">/"3'+8-327/3:"4-+73'++"
– [55PGB"P1ZEGD"Q5,,AD"5$h?D"$Q"16'23"
– P51@B"WF886'D"P/"AEb"
– [5E,GB"H324:(234-(D"3';F623D"P/"hF3CF3+"
– AkP<WB"1GE"%Z6S"P/"=9''_'+Z,26'+S"
– EHbB"HWpD"W/^D"PGD"PbD">/"C2++'+"
– 5qGB"G93'24:"8F6+'+D">/"(:2>/+-+S"P/"'4'C2S"
– P5k,$B"b3/.+:S"P/"0/(26"4'g(-7+S"
K#"

43. Source Undetermined
KJ"

44. Source Undetermined
KK"

45. 1/C86'7'"['237"H6/(`"
• 1/C86'7'"4-++/(-2)/>"/0"273-26"2>4"
*'>73-(F623"2()*-7:"
• ,'+F67+"03/C"(/>4F()/>"%6/(`""
– A'*'6"/0"79'"E]">/4'"
– HF>46'"/0"[-+"
– QF3`->&'"g%'3+"
• G3'27C'>7"
– E73/8->'""
• k+'"12F)/F+6:"->"82)'>7+".Z"h?"2>4".-4'"V,W"
(/C86'I'+"
– G32>+(F72>'/F+"Q2(->;"
– G32>+*'>/F+"Q2(->;"
KL"

46. CFG'E-A?4:?C'
KM"

47. b-r'3'>)26"b-2;>/+-+"/0"G2(9:(234-2"
Tachycardia
Narrow Complex
Wide Complex
Regular
ST
SVT
Atrial flutter
ST w/ aberrancy
Irregular
SVT w/ aberrancy
VT
A-fib w/ aberrancy
A-fib
A-flutter w/ variable A-fib w/ WPW
conduction
VT
MAT
KN"

48. Source Undetermined
KO"

49. E73-26"c6Fj'3"
Source Undetermined
K"

50. Source Undetermined
LR"

51. E73-26"c-%3-662)/>"
Source Undetermined
L!"

52. Source Undetermined
L#"

53. =-4'"1/C86'I"G2(9:(234-2"
• b-r'3'>)26"b-2;>/+-+"
– ]'>73-(F623"G2(9:(234-2"
– W]G".-79"E%'332>(:"
LJ"

54. Source Undetermined
LK"

55. WF832*'>73-(F623"G2(9:(234-2"
Retrograde P waves
Narrow complex, regular; retrograde P waves
Source Undetermined
LL"

56. Source Undetermined
LM"

57. A4-:A@'H@I44C-'<:4J'KA-:A1@C'
1@L?F'
LN"

58. Source Undetermined
LO"

59. A!4C-L(CE4A@'5ML?A-B:A@'
:!HA-?4:L!'
L"

60. Source Undetermined
MR"

61. :!HC-:L-'EL(4C-:L-'5ML?A-B:A@'
:!HA-?4:L!'
M!"

62. Source Undetermined
M#"

63. 5A((:KC'A5:NNNN'
MJ"

64. Source Undetermined
Source Undetermined
MK"

65. EL@M5L-EJ:?'KC!4-:?I@A-'
4A?JM?A-B:A'
4L-(ABC('BC'EL:!4C('
ML"

66. Source Undetermined
MM"

67. KC!4-:?I@A-'H:1-:@@A4:L!'
MN"

68. Source Undetermined
MO"

69. Th/+7"A-`'6:D"h/>/C/893-("]'>73-(F623"G2(9:(234-2U"
<:BC'?L5E@CD'4A?JM?A-B:A'
M"

70. Source Undetermined
NR"

71. (K4'<:4J'(:G!('LH'-A4C'
BCEC!BC!4':(?JC5:A'
N!"

72. [:8/`26'C-2"
U waves; Can also see PVCs, ST depression, small T waves
Source Undetermined
N#"

73. [:8'3`26'C-2"
Tall, narrow and symmetric T waves
Source Undetermined
NJ"

74. VF'+)/>+s"
Dkscully, Flickr
NK"