Textbook

Thist list includes all items published in the clinical competence statement on electrocardiology of the American College of Cardiology and American Heart Association.ACCECG. Also read the recent guidelines for standardized ECG interpretation.ACCtech1ACCtech2

Normal tracing

• Normal ECG

Technical Problems

• Leads misplaced
• Artifacts

Sinus node rhythms and arrhythmias

• Sinus rhythm
• Sinus tachycardia (>100 beats per minute)
• Sinus bradycardia (<50 beats per minute)
• Sinus arrest or pause
• Sino-atrial exit block

Other Supraventricular Rhythms

• Atrial Premature Complexes
• Atrial premature complexes, nonconducted
• Ectopic Atrial Rhythm
• Atrial Fibrillation
• Atrial Flutter
• Atrial Tachycardia
• Junctional Premature Complexes
• Supraventricular Tachycardia, paroxysmal

Ventricular Arrhythmias

• Ventricular premature complexes
• Ventricular escape complexes or rhythm
• Accelerated idioventricular rhythm
• Ventricular tachycardia
• Ventricular tachycardia, polymorphous (including torsade de pointes)
• Ventricular fibrillation

Genetic Arrhythmias

• Long QT syndrome*
• Brugada syndrome*
• Arrythmogenic Right Ventricular Cardiomyopathy*
• Catecholamin Induced Ventricular Tachycardia*

Atrial Ventricular Conduction

• First-degree AV block
• Mobitz Type 1 second-degree AV block (Wenckebach)
• Mobitz Type 2 second-degree AV block
• AV block or conduction ratio, 2:1
• AV block, varying conduction ratio
• AV block, advanced (high-grade)
• AV block, complete (third-degree)
• AV dissociation

Intraventricular Conduction

• Left bundle branch block (fixed or intermittent)
• Right bundle branch block (fixed or intermittent, complete or incomplete)
• Intraventricular conduction delay, nonspecific
• Aberrant conduction of supraventricular beats
• Left anterior fascicular block
• Left posterior fascicular block
• Ventricular pre-excitation (Wolff-Parkinson-White pattern)

QRS axis and voltage

• Right axis deviation (+90 to +180 degrees)
• Left axis deviation (-30 to -90 degrees)
• Indeterminate axis
• Electrical alternans
• Low voltage (less than 0.5 mV total QRS amplitude in each extremity lead and less than 1.0 mV in each Precordial lead)

Chamber Hypertrophy and Enlargment

• Left atrial enlargement, abnormality, or conduction defect
• Right atrial abnormality
• Left ventricular hypertrophy (QRS abnormality only)
• Left ventricular hypertrophy with secondary ST-T abnormality
• Right ventricular hypertrophy with or without secondary ST-T abnormality

Repolarization (ST-T,U) Abnormalities

• Early repolarization (normal variant)
• Juvenile T waves (normal variant)
• Nonspecific abnormality, ST segment and/or T wave
• ST and/or T wave suggests ischemia
• ST suggests injury
• ST suggests ventricular aneurysm
• Q-T interval prolonged
• Prominent U waves
• Cardiac Memory*

Myocardial Infarction

• Inferior MI (acute or recent)
• Inferior MI (old or age indeterminate)
• Posterior MI (acute or recent)
• Posterior MI (old or age indeterminate)
• Septal MI (acute or recent)
• Anterior MI (acute or recent)
• Anterior MI (old or age indeterminate)
• Lateral MI (acute or recent)
• Lateral MI (old or age indeterminate)
• Right ventricular infarction (acute)

Clinical Disorders

• Chronic pulmonary disease pattern
• Acute pericarditis
• Suggests hypokalemia
• Suggests hyperkalemia
• Suggests hypocalcemia
• Suggests hypercalcemia
• Suggests CNS disease

Pacemaker

• Atrial-paced rhythm
• Ventricular-paced rhythm
• Atrial-sensed ventricular-paced rhythm
• AV dual-paced rhythm
• Failure of appropriate capture, atrial
• Failure of appropriate capture, ventricular
• Failure of appropriate inhibition, atrial
• Failure of appropriate inhibition, ventricular
• Failure of appropriate pacemaker firing
• Retrograde atrial activation
• Pacemaker mediated tachycardia

Marked items (*) are not part of the ACC list

References

<biblio> ACCtech1 pmid=17322457 ACCtech2 pmid=17322456 ACCECG pmid=11748119 </biblio>