R-wave progression probably secondary to LVH with a sudden...Figure 31.18 Normal and abnormal RA and LA deflections. Atrial depolarizatio...Figure 31.19 Right atrial enlargement and left atrial enlargement. Reproduce...Figure 31.20 LVH with secondary ST–T depression in the left lateral leads, d...Figure 31.21 QRS is (–) in lead I and (+) in lead aVF, implying a right-axis...Figure 31.22 In RBBB, the vector of depolarization spreads from the left sep...Figure 31.23 RBBB. rSR’ is seen in V1, notched R wave is seen in V2, and rsR...Figure 31.24 Sinus tachycardia with RBBB (rSR’ in V1–V2, wide and slurred S ...Figure 31.25 LBBB. In the lateral leads, there may be an “M-shaped” R wave (...Figure 31.26 LBBB (slurred R wave in the left leads: V5–V6 and I–aVL) (arrow...Figure 31.27 WPW with short PR segment and slurred R wave. The upslope of R ...Figure 31.28 In LAFB, the vector of depolarization spreads from the posterio...Figure 31.29 LAFB + RBBB. QRS is wide > 120 ms with rSR’ in V1 and a wide...Figure 31.30 RBBB + LPFB. Since QRS is wide > 120 ms, look in V1 and in V6 t...Figure 31.31 (a) Electrical alternans. Note the alternation between two main...Figure 31.32 Wide Q wave (QS or QR) may be normally seen in lead III of a ho...Figure 31.33 Examples of an abnormal Q wave. (a) ECG shows minimal ST elevat...Figure 31.34 Inferior Q waves and anterolateral QS waves (QS waves are wide ...Figure 31.35 QS pattern is seen in leads V1–V2, small R wave is seen in lead...Figure 31.36 In expiration, Q wave is wide and deep in leads III and aVF (ar...Figure 31.37 ST-segment and T-wave morphologies in cases of (a) secondary ab...Figure 31.38 Example of left ventricular hypertrophy with typical secondary ...Figure 31.39 Electrocardiogram of a patient with angina at rest and elevated...Figure 31.40 Examples of Wellens-type T-wave abnormalities. (a) Wellens-type...Figure 31.41 Non-Wellens biphasic T waves. (a) Biphasic T wave in leads V2–VFigure 31.42 Examples of posterior infarction. (a) ST-segment depression in ...Figure 31.43 Example of subtle ST-segment elevation in two contiguous leads ...Figure 31.44 Hypokalemia and electrocardiographic abnormalities. (a) Note th...Figure 31.45 Global T-wave inversion with marked QT prolongation in a 77-yea...Figure 31.46 Examples of normal variants of repolarization. (a) Persistent j...Figure 31.47 (a) Upsloping ST-segment depression in sinus tachycardia. Durin...Figure 31.48 Various patterns of ST-segment elevation. Reproduced with permi...Figure 31.49 Diffuse ST elevation in ~ all leads and ST depression in lead a...Figure 31.50 ECG of a patient who has lung cancer. Sinus tachycardia with di...Figure 31.51 Early repolarization with ST-segment elevation in the inferior ...Figure 31.52 Early repolarization with a normal variant T-wave inversion in ...Figure 31.53 Diffuse ST elevation in most leads, with ST depression in lead ...Figure 31.54 SVT with a typical LBBB in leads I and aVL. Concordant ST eleva...Figure 31.55 LBBB with discordant ST-segment changes. However, the T wave is...Figure 31.56 LBBB with abnormal T waves. (a, b) Discordant ST elevation in VFigure 31.57 At first glance, it seems there is ST elevation in the inferior...Figure 31.58 (a) There are ST elevations in leads V1–V4, ST depressions in t...Figure 31.59 Atrial flutter that simulates ST-segment elevation. “F” indicat...Figure 31.60 Atrial flutter that simulates ST-segment depression. The undula...Figure 31.61 Type 1 Brugada pattern in V1 and V2, with a downsloping ST elev...Figure 31.62 STEMI ECG variants. Right image- DeWinter complex in V1-V6.Mi...Figure 31.63 QT is not measured using the end of the T wave. Instead, a line...Figure 31.64 Typical ST–T morphologies in hypokalemia, hypocalcemia, congeni...Figure 31.65 On the left, markedly prolonged QT with a notched T wave is see...Figure 31.66 Hypokalemia and a pattern that should not be confused with hypo...Figure 31.67 Two ECG examples of hypokalemia. (a) Prolonged QT (QT ~600 ms, ...Figure 31.68 Stages of hyperkalemia.Figure 31.69 (a) Hyperkalemia of 6.1 mEq/l. Note that T waves are not tall, ...Figure 31.70 Hypocalcemia and hypercalcemia.Figure 31.71 Digitalis effect in a patient with AF. Note the prominent U wav...Figure 31.72 Hypothermia. QRS is prolonged > 120 ms. It is not a typical LBB...Figure 31.73 Change of vector of depolarization between a normal heart and p...Figure 31.74 Poor precordial R-wave progression with a very small R wave < 1...Figure 31.75 Poor precordial R-wave progression with a monophasic Q (QS) in ...Figure 31.76 Approach to narrow complex tachycardias.Figure 31.77 Narrow complex tachycardia. A deflection is seen at the end of ...Figure 31.78 Narrow complex tachycardia, irregular. Differential diagnosis:...Figure 31.79 The rhythm is irregular. Look for P waves: P waves are present,...Figure 31.80 Regular wide complex tachycardia. SVT vs.VT? Look for P wave...Figure 31.81 Run of irregular wide complex tachycardia. The irregularity doe...Figure 31.82 Location of the AV block.Figure 31.83 Repetition of groups of beats separated by a pause. Think of se...Figure 31.84 Regular, narrow complex rhythm, rate ~55 bpm. P waves are seen ...Figure 31.85 AF with a ventricular rate that is slow and mostly regular. Thi...Figure 31.86 Regular wide complex rhythm interrupted by narrower complexes t...Figure 31.87 2:1 AV block that can be easily mistaken for sinus bradycardia,...Figure 31.88 Outside the PVCs, the rhythm seems grossly regular. Analyze the...Figure 31.89 Regular narrow complex rhythm without any P wave. This is a jun...Figure 31.90 Regular narrow complex rhythm (~50 bpm). Negative P waves are s...Figure 31.91 Sinus rhythm is interrupted by a wide complex rhythm. The wide ...Figure 31.92 Right and left arm electrodes switched. The leads’ axis changes...Figure 31.93 Right arm and right leg electrodes switched. The leads’ axis ch...Figure 31.94 Right arm and right leg electrodes switched. Note how lead II i...Figure 31.95 Subendocardial ischemia (diffuse ST depression, not localized t...Figure 31.96 Phases of STEMI.Figure 31.97 The patient presents with chest discomfort that has started 4 h...Figure 31.98 In inferior MI, the LCx current of injury looks to the left and...Figure 31.99 The rhythm initially appears to be sinus bradycardia (~55 bpm)....Figure 31.100 Frontal plane of left-axis deviation. This may be secondary to...Figure 31.101 Horizontal plane of LV hypertrophy. The vector of depolarizati...Figure 31.102 (a) Frontal plane of RV hypertrophy or RV strain such as PE. T...Figure 31.103 (b) Horizontal plane of COPD. (a) Horizontal plane of RV hyper...30 Chapter 32Figure 32.1 (a) Frontal view showing how the parasternal short-axis views cut...Figure 32.2 (a) Diagram of the parasternal short-axis view and various LV se...Figure 32.3 (a) Parasternal short-axis view at the level of the mitral valve...Figure 32.4 Diagram of the parasternal short-axis view at the level of the a...Figure 32.5 Parasternal short-axis view as described in Figure 32.4. A bicus...Figure 32.6 (a) Diagram of the parasternal long-axis view. Concerning the ao...Figure 32.7 (a) Parasternal long-axis view. Measurements are obtained from t...Figure 32.8 (a) Parasternal RV inflow view, which is obtained by angling the...Figure 32.9 (a) Diagram and (b) echocardiogram of the apical four-chamber vi...Figure 32.10 (a) Diagram and (b) echocardiogram of the apical two-chamber vi...Figure 32.11 (a) Diagram and (b) example of the subcostal view.Figure 32.12 Subcostal view with a medial tilt to visualize the IVC. A large...Figure 32.13 Arterial distribution of various echo segments on the short-axi...Figure 32.14 (a) Example of RV enlargement and RV volume overload on the para...Figure 32.15 During systole, in LBBB: (1) the septum moves in towards the LV...Figure 32.16 M-mode imaging shows paradoxical septal motion of RV volume ove...Figure 32.17 Constrictive pericarditis. Two septal abnormalities and one pos...Figure 32.18 Pericardial processes are characterized by septal compression t...Figure 32.19 Posterior mitral leaflet prolapse. In systole, the leaflet prol...Figure 32.20 Rheumatic mitral valve. (a) Long-axis view in diastole. See the...Figure 32.21 Posterior mitral annular calcifications (MAC) in the long-axis ...Figure 32.22 Difference in aortic orifice shape between the tricuspid and bi...Figure 32.23 MR, four-chamber view. The blue, backward flow between the LV a...Figure 32.24 Severe MR on four-chamber TEE view. Severity criteria of MR:...Figure 32.25 MR, long-axis view. The blue flow between LV and LA is MR (arro...Figure 32.26 Systolic flow reversal of pulmonary venous flow in a patient wi...Figure 32.27 CW Doppler across the
