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Review ArticleContinuing Education

Electrocardiography: A Technologist’s Guide to Interpretation

Colin Tso, Geoffrey M. Currie, David Gilmore and Hosen Kiat
Journal of Nuclear Medicine Technology December 2015, 43 (4) 247-252; DOI: https://doi.org/10.2967/jnmt.115.163501
Colin Tso
1Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
2Cardiac Health Institute, Sydney, New South Wales, Australia
MBBS, PhD, FRACP, FCSANZ
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Geoffrey M. Currie
1Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
3Faculty of Science, Charles Sturt University, Wagga Wagga, New South Wales, Australia
BPharm, MMedRadSc(NucMed), MAppMngt(Hlth), MBA, PhD, CNMT
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David Gilmore
3Faculty of Science, Charles Sturt University, Wagga Wagga, New South Wales, Australia
4Faculty of Medical Imaging, Regis College, Boston, Massachusetts; and
ABD, CNMT, RT(R)(N)
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Hosen Kiat
1Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
2Cardiac Health Institute, Sydney, New South Wales, Australia
3Faculty of Science, Charles Sturt University, Wagga Wagga, New South Wales, Australia
5Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
MBBS, FRACP, FACP, FACC, FCCP, FCSANZ, FASNC, DDU
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  • FIGURE 1.
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    FIGURE 1.

    Electrocardiogram waveforms of single heart beat in sinus rhythm. Normal duration of PR interval is 120–200 ms. Width of normal QRS complex is <100 ms. Normal duration of QT interval corrected to heart rate is <440 ms. Standard electrocardiogram paper is 1-mm grid. As annotated, horizontally 1 small square is 0.04 s and 1 large square is 0.2 s; thus, 5 large boxes (25 small boxes) is 1 s. Trace moves at speed of 25 mm/s, and 10 small squares on vertical axis equates to 1 mV.

  • FIGURE 2.
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    FIGURE 2.

    (A) Normal sinus rhythm with R–R interval of approximately 1 s (60 bpm). (B) Sinus tachycardia with R–R interval of approximately 2 s (>120 bpm). Approximately 2.2 large squares indicates that heart rate is 136 bpm (300/2.2).

  • FIGURE 3.
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    FIGURE 3.

    (A) Rhythm strip demonstrating first-degree atrioventricular block with PR interval of >200 ms. (B) Rhythm strip demonstrating second-degree atrioventricular block with progressive lengthening of PR interval and 2 P waves per R–R interval (arrows). (C) Rhythm strip demonstrating third-degree atrioventricular block. Atrioventricular dissociation results in no QRS but prominent P wave. Absence of Q wave allows visualization of repolarization of atria (arrow).

  • FIGURE 4.
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    FIGURE 4.

    (A) Atrial fibrillation with rapid ventricular response. No P waves are seen, and ventricular rate is irregular and rapid. QRS complex is narrow. (B) Atrial flutter with sawtooth flutter wave (arrows). (C) VF with no organized QRS complex. (D) Ventricular ectopic beats. (E) Ventricular pacing spikes (arrow) and QRS morphology associated with left bundle branch block.

  • FIGURE 5.
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    FIGURE 5.

    (A) Electrocardiogram appearance of myocardial ischemia spectrum. Clockwise: normal (P QRS T), upsloping ST depression (>1.5 mm); horizontal ST depression (>1 mm); downsloping ST depression (>1 mm); and ST elevation. (B) Electrocardiogram appearance of myocardial infarction spectrum. Clockwise: normal, hyperacute infarction (T wave); transmural infarction (ST elevation); necrosis (ST elevation, Q waves, and T wave inversion); necrosis/fibrosis (Q waves and T wave inversion); and fibrosis (Q wave and upright T wave).

  • FIGURE 6.
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    FIGURE 6.

    (A) Electrocardiogram appearance at baseline for patient with ischemic heart disease. (B) Stress electrocardiogram demonstrating inferolateral upsloping ST depression. (C) Poststress electrocardiogram demonstrating inferolateral horizontal ST depression, which indicates myocardial ischemia.

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Journal of Nuclear Medicine Technology: 43 (4)
Journal of Nuclear Medicine Technology
Vol. 43, Issue 4
December 1, 2015
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Electrocardiography: A Technologist’s Guide to Interpretation
Colin Tso, Geoffrey M. Currie, David Gilmore, Hosen Kiat
Journal of Nuclear Medicine Technology Dec 2015, 43 (4) 247-252; DOI: 10.2967/jnmt.115.163501

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Electrocardiography: A Technologist’s Guide to Interpretation
Colin Tso, Geoffrey M. Currie, David Gilmore, Hosen Kiat
Journal of Nuclear Medicine Technology Dec 2015, 43 (4) 247-252; DOI: 10.2967/jnmt.115.163501
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Jump to section

  • Article
    • Abstract
    • THE HEART
    • THE ELECTROCARDIOGRAM
    • DYSFUNCTION OF SINOATRIAL NODE AND ATRIOVENTRICULAR CONDUCTION
    • SUPRAVENTRICULAR ARRHYTHMIA
    • VENTRICULAR ARRHYTHMIA
    • JUNCTIONAL REENTRANT TACHYCARDIA
    • BASICS OF ELECTROCARDIOGRAM INTERPRETATION
    • MYOCARDIAL ISCHEMIA
    • CASE EXAMPLE
    • CONCLUSION
    • DISCLOSURE
    • Footnotes
    • REFERENCES
  • Figures & Data
  • Info & Metrics
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Keywords

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