Textbook

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
• 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)
• Lateral MI (acute or recent)

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