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The normal electrocardiogram.
Acute inferior myocardial infarction
Acute anterior myocardial infarction
Acute posterior myocardial infarction
Old inferior myocardial infarction
Acute myocardial infarction in the presence of LBBB
Left ventricular and left atrial hypertrophy - aortic stenosis
Mitral Stenosis
Right atrial hypertrophy
Left ventricular hypertrophy in the presence of left anterior hemiblock
First degree AV block
2 to 1 Atrioventricular block
Complete Heart Block
Complete heart block and atrial fibrillation
Right Bundle Branch Block
Left anterior hemiblock
Left bundle branch block
'Trifascicular' block
Sinus bradycardia
Sinus tachycardia
Atrial Bigeminy
Atrial Premature Beat
Atrial fibrillation with rapid ventricular response
Atrial fibrillation with pre-existing LBBB
Atrial Flutter
Atrial flutter with 2:1 AV conduction
Wolff-Parkinson-White syndrome with atrial fibrillation (20k)
Ventricular premature beats
Ventricular bigeminy
Idioventricular escape rhythm in Complete Heart Block
Ventricular tachycardia with clear AV dissociation
Ventricular tachycardia with subtle AV dissociation (20k)
Torsade de pointes ventricular tachycardia
Polymorphic Ventricular Tachycardia with an ICD
Ventricular Fibrillation
Ventricular pacemaker
Dual Chamber Pacemaker with an ICD
WPW syndrome - left lateral pathway
WPW syndrome - anteroseptal pathway
Wolff-Parkinson-White syndrome with atrial fibrillation (20k)
Wolff-Parkinson-White syndrome with atrial fibrillation (another example)
Implantable Cardioverter Defibrillator
Electrical Alternans - pericardial effusion
Long QT interval Romano-Ward Syndrome
Lown-Ganong-Levine Syndrome
Acute pulmonary embolus
Hyperkalaemia
Hypokalaemia
Piggy-back heart transplant
Digitalis effect
 

ischaemic heart disease

hypertrophy patterns

atrioventricular (AV) block

bundle branch block

supraventricular rhythms

ventricular rhythms

pacemakers

Wolff Parkinson White syndrome

miscellaneous

other

The electrical axis at a glance.
A brief history of electrocardiography
A page of comments and corrections for our book 'ECGs by Example'.
 

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Using leads I and aVF the axis can be calculated to within one of the four quadrants at a glance.

If the axis is in the "left" quadrant take your second glance at lead II.

• both I and aVF +ve = normal axis
• both I and aVF -ve = axis in the Northwest Territory
• lead I -ve and aVF +ve = right axis deviation
• lead I +ve and aVF -ve
  • lead II +ve = normal axis
  • lead II -ve = left axis deviation

causes of a Northwest axis (no man's land)

• emphysema
• hyperkalaemia
• lead transposition
• artificial cardiac pacing
• ventricular tachycardia

causes of right axis deviation

• normal finding in children and tall thin adults
• right ventricular hypertrophy
• chronic lung disease even without pulmonary hypertension
• anterolateral myocardial infarction
• left posterior hemiblock
• pulmonary embolus
• Wolff-Parkinson-White syndrome - left sided accessory pathway
• atrial septal defect
• ventricular septal defect

causes of left axis deviation

• left anterior hemiblock
• Q waves of inferior myocardial infarction
• artificial cardiac pacing
• emphysema
• hyperkalaemia
• Wolff-Parkinson-White syndrome - right sided accessory pathway
• tricuspid atresia
• ostium primum ASD
• injection of contrast into left coronary artery

note: left ventricular hypertrophy is not a cause left axis deviation

The normal electrocardiogram.

ischaemic heart disease

hypertrophy patterns

atrioventricular (AV) block

bundle branch block

supraventricular rhythms

ventricular rhythms

pacemakers

Wolff Parkinson White syndrome

miscellaneous

other

The electrical axis at a glance.
A brief history of electrocardiography
A page of comments and corrections for our book 'ECGs by Example'.