1. The normal ECG

2. Normal sinus rhythm • Each p wave followed by a QRS • Normal P waves • P wave rate 60-100bpm

4. Sinus bradycardia

6. Sinus tachycardia

7. QRS axis

9. P waves • Height <2.5mm in lead II • Width < 11msec in lead II

11. Right atrial hypertrophy

12. M shaped p wave in II Prominent negative component in V1

13. Left atrial hypertrophy M shaped p wave in II Prominent negative component in V1

15. PR interval • 0.12to 0.2 sec (3-5 small squares)

20. 2nd degree AV block divided into two types by Mobitz

23. 2nd degree AV block divided into two types by Mobitz

24. 2nd degree AV block divided into two types by Mobitz Alias “Wenkebach”

26. QRS duration • <012sec • If wider then BBB • LBBB (WiLLiaM) • s wave in V1-V3 • rsr pattern in V5-V6 • RBBB (MaRRoW) • rsr in V1

30. QTc interval (normal 0.42sec) • ST segment • T wave • U wave

34. Hyperkalaemia

37. Breathlessness increasing over years ... Difficult

38. Right ventricular hypertrophy Dominant R in V1 Right axis …… = Mitral stenosis + pulmonary hypertension! + Left atrial abnormality

39. What now?

40. Atrial fibrillation with pre-excitation DC Cardioversion or iv procainamide NOT digoxin, verapamil, beta blockers, adenosine...

41. Inferior myocardial infarction & 4:3 Wenkebach block (i.e. at node)

46. Trifascicular block Lateral Q’s (A.S.H.) Voltage criteria for LVH HOCM!