3rd degree heart block - no correlation between p-waves and QRS complexes

May be caused by Lyme Disease

Needs pacemaker!

This is obvious atrial fibrillation but there is also several PVC's (PreVentricular contractions)

Commonly sustained arrythmia

Shock patient if also has HTN (patient is unstable)

Ventricular Escape

Note the regular rhythm until BAM that crazy widened QRS complexes (without a preceding P-wave) shows up out of no where with its inverted T-wave. Also note the PVC (premature ventricular contraction) that is often associated w/ Ventricular Escape

Torsades de pointes

Associated with Magnesium deficiency

Junctional escape rhythm

Normally this should lack a P-wave but in this tracing there is an inversion of the P-wave, nonetheless HR is approx 40bpm and no other evident pathology

This is a 2:1 AV block probably Mobitz I. 

2:1 AV block because there are 2 p-waves for every QRS complex and Mobitz I because PR interval is greater than 0.2secs

Classic second degree heart block Mobitz II.

Note lack of prolongation at PR interval. Also, note 2 dropped QRS complexes.

Requires Pacemaker!

2nd Degree Heart Block - Type II Mobitz

Note dropped QRS complex and no PR prolongation

Requires Pacemaker!

Ventricular Fibrillation

Note incomplete QRS complexes that don't get drawn all the way down. Compared to Vtach this is irregularly irregular meaning it makes no damn sense at all PLUS its also obviously tachycardic. 

incompatible w/ life = shock or die

Second degree heart block: Mobitz Type I: Wenckebach

(I know right, lotssa names)

Note prolonged PR intervals as well as dropped QRS complex - Pacemaker not required

Ventricular Tachycardia

Note wide and complete QRS complexes (as opposed to Vfib)  

Left Bundle Branch Block

Note broad, notched R waves in leads I, V5 and V6 (can also be seen in leads II and aVL)

Also note very steep R waves in anteroseptal precordial leads (V1-V4) so much so they almost overlap!

If accompanied by chest pain = cath lab immediately

Brugada Syndrome

Learn it, know it, love it.

Give away = big ST elevation in V1 + V2

history will include young patient w/ multiple syncopal episodes

Right Bundle Branch Block

V1-V2 --> secondary R wave (R')

V5-V6 --> slurred T wave (droopy/inverted)

as opposed to LBBB, does not interfere w/ MI diagnosis

P mitrale aka Left Atrial enlargement (get it? mitral valve...left atrium...yeah)

Note Tall or notched P-wave(s) usually found in V1 

Good tracings of this are scarce so sorry :/

P Pulmonale aka Right Atrial enlargement 

Look for: large P-waves in leads II, III and aVF

Wolff–Parkinson–White syndrome (example of Atrioventricular Reciprocating Tachycardia)

Note the very very small delta wave which is the slurred upstroke of the QRS complex on lead I (mostly)