Page 1
63
150 Practice ECGs
Part I I
As you read the practice ECGs, write the ECG report including rate, rhythm, intervals, axis, and interpretation. If you do not commit yourself on paper, it does not count! Read five to ten ECGs in a row before checking answers. There is a rhythm to this exercise that you should not interrupt. After you have read 150 ECGs, you will be reading them with confidence.
Page 2
64 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
1
A57
-yea
r-old
man
,pre
oper
ative
ECG
.
Page 3
Part ii:150PracticeECGs 65
Prac
tice
ECG
2
A78
-yea
r-old
man
,no
hist
ory
prov
ided
.
Page 4
66 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
3
A54
-yea
r-old
wom
an,a
dmitt
edw
ithc
hole
cyst
itis.
Page 5
Part ii:150PracticeECGs 67
Prac
tice
ECG
4
A49
-yea
r-old
man
,no
hist
ory
give
n.H
ash
eha
dan
MI?
Whe
n?
Page 6
68 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
5
A78
-yea
r-old
wom
anw
itha
hist
ory
ofM
Iis
now
inth
eem
erge
ncy
room
with
che
stp
ain.
The
reis
ap
riorE
CGfo
rcom
paris
on.C
any
ou
bes
ure
that
her
pai
nis
due
toM
I?
Page 7
Part ii:150PracticeECGs 69
Prac
tice
ECG
6
A36
-yea
r-old
man
;life
insu
ranc
eex
amin
atio
n,n
ohi
stor
yof
hea
rtd
iseas
e.
Page 8
70 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
7
A79
-yea
r-old
man
bro
ught
from
the
nurs
ing
hom
ewi
tha
rapi
dpu
lse.
Page 9
Part ii:150PracticeECGs 71
Prac
tice
ECG
8
A72
-yea
r-old
wom
anw
ithh
eart
failu
re.W
hati
sth
eca
use?
Page 10
72 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
9
Ana
ctive
82-
year
-old
wom
anw
ithh
yper
tens
ion.
Sho
uld
wew
orry
abo
utp
ossib
les
ynco
pe?
Page 11
Part ii:150PracticeECGs 73
Prac
tice
ECG
10
A94
-yea
r-old
wom
anw
ithfa
iling
mem
ory.
Page 12
74 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
11
A72
-yea
r-old
man
with
alo
ngh
istor
yof
hea
rtd
iseas
e,o
ndi
goxin
.
Page 13
Part ii:150PracticeECGs 75
Prac
tice
ECG
12
A73
-yea
r-old
wom
anw
ithh
yper
tens
ion,
on
mul
tiple
med
icine
s.Ca
nyo
uid
entif
yon
eof
them
?
Page 14
76 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
13
A48
-yea
r-old
wom
an;r
outin
eex
am.
Page 15
Part ii:150PracticeECGs 77
Prac
tice
ECG
14
A67
-yea
r-old
man
;no
hist
ory
prov
ided
.
Page 16
78 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
15
A43
-yea
r-old
wom
anw
ithh
istor
yof
MIi
sin
the
emer
genc
yro
omw
ithlo
werc
hest
,epi
gast
ricd
iscom
fort
not
qui
teli
keth
ehe
arta
ttack
pa
in.W
ould
you
con
sider
thro
mbo
lytic
ther
apy?
Page 17
Part ii:150PracticeECGs 79
Prac
tice
ECG
16
A73
-yea
r-old
wom
anw
ithb
lood
pre
ssur
e15
0/75
and
no
hist
ory
ofh
eart
dise
ase.
Sho
uld
she
betr
eate
dfo
riso
lated
sys
tolic
hy
perte
nsio
n?
Page 18
80 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
17
A46
-yea
r-old
man
;rou
tine
exam
.Nor
mal
ora
bnor
mal
?
Page 19
Part ii:150PracticeECGs 81
Prac
tice
ECG
18
An8
9-ye
ar-o
ldw
oman
with
dizz
ines
swh
ens
hes
tand
s.
Page 20
82 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
19
A74
-yea
r-old
man
;no
clini
cald
ata
prov
ided
.
Page 21
Part ii:150PracticeECGs 83
Prac
tice
ECG
20
A76
-yea
r-old
man
with
hist
ory
ofM
Iand
mild
hea
rtfa
ilure
.Doe
sth
isEC
Gte
llyo
uan
ythi
nga
bout
the
patie
nt’s
coro
nary
ana
tom
y?
Page 22
84 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
21
A59
-yea
r-old
wom
anw
ithp
erip
hera
lede
ma,
jugu
larv
enou
sdi
sten
sion,
and
alo
uds
ysto
licm
urm
urth
atin
tens
ifies
with
insp
iratio
n.
Page 23
Part ii:150PracticeECGs 85
Prac
tice
ECG
22
A56
-yea
r-old
wom
ana
dmitt
edth
roug
hth
eem
erge
ncy
room
.Any
gue
ssa
bout
the
natu
reo
fher
acu
teil
lnes
s?
Page 24
86 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
23
A70
-yea
r-old
man
with
are
mot
ehi
stor
yof
fain
ting
spel
ls.N
owin
the
emer
genc
yro
omw
ithd
yspn
eaa
ndfe
ver.
Page 25
Part ii:150PracticeECGs 87
Prac
tice
ECG
24
A75
-yea
r-old
man
with
as
ysto
licm
urm
ura
ndh
eart
failu
re.W
hati
sth
edo
min
antv
alvu
larl
esio
n?
Page 26
88 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
25
An8
0-ye
ar-o
ldm
antr
eate
dwi
thd
iure
tics
and
digo
xin.W
hatl
abw
ork
isne
eded
?
Page 27
Part ii:150PracticeECGs 89
Prac
tice
ECG
26
A52
-yea
r-old
man
who
had
a2
0-ho
urs
iege
ofi
ndig
estio
na
mon
the
arlie
r.H
eha
sse
vere
fatig
ue.T
hec
ardi
olog
isth
aso
rder
eda
nec
hoca
rdio
gram
.Why
?
Page 28
90 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
27
A71
-yea
r-old
wom
anin
the
emer
genc
yro
om.A
long
epi
sode
ofc
hest
pai
nwa
sre
lieve
dbe
fore
her
arri
valb
yni
trogl
ycer
ine.
Is
angi
ogra
phy
indi
cate
d?W
hatw
ould
its
how?
Page 29
Part ii:150PracticeECGs 91
Prac
tice
ECG
28
A79
-yea
r-old
wom
anw
ithm
ildh
yper
tens
ion.
Page 30
92 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
29
A74
-yea
r-old
wom
anw
itha
hist
ory
ofa
tria
lfib
rillat
ion,
dia
bete
s,hy
perte
nsio
n,o
besit
y,an
dM
I.N
owin
the
emer
genc
yro
omw
ith
pulm
onar
yed
ema.
Page 31
Part ii:150PracticeECGs 93
Prac
tice
ECG
30
An8
5-ye
ar-o
ldm
anw
ithc
hest
pai
n.T
here
isa
hist
ory
ofM
I.W
hati
shi
spr
ogno
sis?
Page 32
94 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
31
A61
-yea
r-old
wom
anw
ithp
oorly
con
trolle
dhy
perte
nsio
n.
Page 33
Part ii:150PracticeECGs 95
Prac
tice
ECG
32
A42
-yea
r-old
man
with
inte
rmitt
entp
alpi
tatio
nss
ince
chi
ldho
od.H
isdo
ctor
isc
once
rned
abo
uth
isco
nduc
tion
abno
rmal
itya
nda
sil
enth
eart
atta
ck.
Page 34
96 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
33
A38
-yea
r-old
wom
anw
ithp
alpi
tatio
nsa
ndd
izzin
ess.
Page 35
Part ii:150PracticeECGs 97
Prac
tice
ECG
34
An8
1-ye
ar-o
ldw
oman
inth
eem
erge
ncy
room
with
che
stp
ain.
Wha
tare
the
treat
ing
phys
ician
’sne
xts
teps
?W
ould
you
con
sider
th
rom
boly
ticth
erap
y?
Page 36
98 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
35
A73
-yea
r-old
man
;no
hist
ory
prov
ided
.
Page 37
Part ii:150PracticeECGs 99
Prac
tice
ECG
36
A65
-yea
r-old
wom
anw
itha
long
hist
ory
ofb
orde
rline
hyp
erte
nsio
n.W
hatd
oes
this
ECG
tell
you
abou
tcon
trolo
fher
blo
od
pres
sure
?
Page 38
100 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
37
An8
6-ye
ar-o
ldw
oman
,ann
ualE
CG.
Page 39
Part ii:150PracticeECGs 101
Prac
tice
ECG
38
An8
2-ye
ar-o
ldm
anw
ithfa
tigue
and
ank
lee
dem
afo
r2w
eeks
.
Page 40
102 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
39
A62
-yea
r-old
man
inth
eem
erge
ncy
room
ofa
com
mun
ityh
ospi
tal.
Befo
rea
rriva
l,he
had
che
stp
ain
for2
hou
rs,t
hen
relie
f.Pa
inh
as
now
recu
rred.
Isit
too
late
forr
eper
fusio
nth
erap
y?
Page 41
Part ii:150PracticeECGs 103
Prac
tice
ECG
40
Sam
epa
tient
(N
o.3
9),2
hou
rsa
ftert
reat
men
twith
tiss
uep
lasm
inog
ena
ctiva
tor.
Page 42
104 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
41
A26
-yea
r-old
with
no
sym
ptom
s.W
hich
dia
gnos
ticte
stis
nee
ded?
Page 43
Part ii:150PracticeECGs 105
Prac
tice
ECG
42
A32
-yea
r-old
man
with
fixe
dsp
littin
gof
the
seco
ndh
eart
sou
nda
nda
loud
mur
mur
.Wha
tis
the
illnes
s?
Page 44
106 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
43
A40
-yea
r-old
man
inth
eem
erge
ncy
room
follo
wing
an
episo
deo
fsyn
cope
.He
has
been
trea
ted
with
ery
thro
myc
ina
nda
ntih
istam
ines
fo
rare
spira
tory
illn
ess.
Page 45
Part ii:150PracticeECGs 107
Prac
tice
ECG
44
Tele
met
ryre
cord
ing
the
sam
epa
tient
(N
o.4
3)4
hou
rsla
ter.
Dur
ing
the
arrh
ythm
ia,h
elo
stc
onsc
ious
ness
.
Page 46
108 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
45
Rhyt
hms
trip
sfro
ma
52-
year
-old
wom
anw
ithc
ardi
omyo
path
yan
dep
isodi
cdi
zzin
ess.
Dur
ing
the
third
trac
ing,
she
lost
con
scio
usne
ss.
Page 47
Part ii:150PracticeECGs 109
Prac
tice
ECG
46
An8
7-ye
ar-o
ldw
oman
with
ah
istor
yof
dizz
ysp
ells.
Page 48
110 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
47
A45
-yea
r-old
man
afte
ra4
5-m
inut
eep
isode
ofc
hest
pai
n.
Page 49
Part ii:150PracticeECGs 111
Prac
tice
ECG
48
A68
-yea
r-old
wom
ana
fteri
ndig
estio
nof
9h
ours
dur
atio
n.W
hatt
reat
men
tis
indi
cate
d?
Page 50
112 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
49
A76
-yea
r-old
wom
anw
ithd
iabe
tes;
year
lye
xam
inat
ion.
Page 51
Part ii:150PracticeECGs 113
Prac
tice
ECG
50
A75
-yea
r-old
man
who
take
she
artp
ills.
Page 52
114 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
51
An8
2-ye
ar-o
ldw
oman
with
mild
hea
rtfa
ilure
.
Page 53
Part ii:150PracticeECGs 115
Prac
tice
ECG
52
A40
-yea
r-old
man
with
syn
cope
.
Page 54
116 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
53
A69
-yea
r-old
man
with
ah
istor
yof
hea
rtfa
ilure
.
Page 55
Part ii:150PracticeECGs 117
Prac
tice
ECG
54
A70
-yea
r-old
wom
anw
itha
rem
ote
hist
ory
ofM
Iand
ah
istor
yof
atr
ialf
ibril
latio
n.
Page 56
118 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
55
A60
-yea
r-old
man
;no
clini
cald
ata
prov
ided
.
Page 57
Part ii:150PracticeECGs 119
Prac
tice
ECG
56
An8
1-ye
ar-o
ldw
oman
ine
xcel
lent
hea
lth.
Page 58
120 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
57
A72
-yea
r-old
man
with
ah
istor
yof
arrh
ythm
ias.
Page 59
Part ii:150PracticeECGs 121
Prac
tice
ECG
58
A31
-yea
r-old
wom
ans
entt
oa
clini
cbe
caus
ehe
rECG
sho
wed
ahe
arta
ttack
.She
had
no
hist
ory
ofM
I.O
nex
amth
ere
was
ahe
art
mur
mur
.
Page 60
122 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
59
A64
-yea
r-old
wom
anw
ithe
mph
ysem
aan
dan
klee
dem
a.
Page 61
Part ii:150PracticeECGs 123
Prac
tice
ECG
60
A69
-yea
r-old
man
with
eas
yfa
tigue
and
exe
rtio
nald
yspn
ea.
Page 62
124 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
61
A75
-yea
r-old
man
with
pul
mon
ary
edem
a.
Page 63
Part ii:150PracticeECGs 125
Prac
tice
ECG
62
An8
3-ye
ar-o
ldm
anw
itha
long
hist
ory
ofir
regu
larp
ulse
.He
ison
dig
oxin
.Doe
she
nee
dad
ditio
nald
rug
ther
apy?
Page 64
126 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
63
A59
-yea
r-old
man
inth
eem
erge
ncy
room
.
Page 65
Part ii:150PracticeECGs 127
Prac
tice
ECG
64
An8
2-ye
ar-o
ldm
ano
ndi
goxin
sen
tfro
mth
enu
rsin
gho
me
with
con
fusio
nan
dbl
urre
dvis
ion.
Page 66
128 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
65
A66
-yea
r-old
man
with
ah
istor
yof
vag
ue,n
onsp
ecifi
cch
estp
ain
and
apo
sitive
stre
sste
st.
Page 67
Part ii:150PracticeECGs 129
Prac
tice
ECG
66
A26
-yea
r-old
wom
anw
ithp
alpi
tatio
ns.H
erE
CGw
asn
orm
alth
eda
yaf
tert
his
tracin
gwa
sob
tain
ed.
Page 68
130 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
67
An8
6-ye
ar-o
ldm
anw
ithd
izzy
spel
lsfo
r1w
eek,
onn
om
edici
ne.W
hats
houl
dhi
sdo
ctor
do?
Page 69
Part ii:150PracticeECGs 131
Prac
tice
ECG
68
An8
5-ye
ar-o
ldw
oman
with
mild
hea
rtfa
ilure
,on
digo
xin.
Page 70
132 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
69
A70
-yea
r-old
wom
anw
itha
nkle
ede
ma
ontw
odi
uret
icsa
ndp
otas
sium
sup
plem
ents
.
Page 71
Part ii:150PracticeECGs 133
Prac
tice
ECG
70
A77
-yea
r-old
man
inth
eem
erge
ncy
room
with
pou
ndin
gin
his
ches
t.
Page 72
134 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
71
An8
1-ye
ar-o
ldw
oman
with
che
stp
ain.
Page 73
Part ii:150PracticeECGs 135
Prac
tice
ECG
72
A78
-yea
r-old
wom
an,p
osto
pera
tive
ECG
.The
pre
oper
ative
trac
ing
show
edm
ildin
trave
ntric
ular
con
duct
ion
defe
ct.
Page 74
136 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
73
A54
-yea
r-old
wom
anw
itha
hist
ory
ofp
arox
ysm
ala
tria
lfib
rillat
ion.
Page 75
Part ii:150PracticeECGs 137
Prac
tice
ECG
74
A72
-yea
r-old
wom
anw
ithc
hest
pai
nof
2h
ours
dur
atio
n.W
hati
sth
eco
rrect
trea
tmen
t?
Page 76
138 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
75
An8
0-ye
ar-o
ldw
oman
with
pre
vious
MI.
Wha
tis
the
orig
ino
fthe
ect
opic
beat
s?
Page 77
Part ii:150PracticeECGs 139
Prac
tice
ECG
76
A64
-yea
r-old
wom
anw
ithc
hron
icco
ugh,
dys
pnea
,and
ank
lee
dem
a.S
hes
tills
mok
estw
opa
cks
ofc
igar
ette
sa
day.
Page 78
140 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
77
A67
-yea
r-old
wom
antr
ansf
erre
dbe
caus
eof
a1
-hou
repi
sode
ofc
hest
pai
non
the
prev
ious
day
.
Page 79
Part ii:150PracticeECGs 141
Prac
tice
ECG
78
A39
-yea
r-old
farm
erw
hose
wife
dro
veh
imto
the
loca
lem
erge
ncy
room
with
che
stp
ain
that
beg
an3
0m
inut
ese
arlie
r.H
eis
70m
iles
from
the
regi
onal
car
diac
cen
ter.
Wha
tis
the
appr
opria
tetr
eatm
ent?
Page 80
142 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
79
Sam
epa
tient
(N
o.7
8),a
bout
1h
ourl
ater
.Che
stp
ain
has
reso
lved.
Wha
tis
the
treat
men
tnow
?
Page 81
Part ii:150PracticeECGs 143
Prac
tice
ECG
80
Sam
epa
tient
(N
o.7
8),a
fter2
day
sof
hep
arin
ther
apy
atth
elo
calh
ospi
tal.
He
has
deve
lope
dm
ore
ches
tpai
n,b
utn
otq
uite
like
wha
the
had
att
heti
me
ofa
dmiss
ion.
Page 82
144 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
81
A46
-yea
r-old
man
with
che
stp
ain
of3
hou
rsd
urat
ion.
Wha
ttre
atm
entw
ould
be
appr
opria
te?
Page 83
Part ii:150PracticeECGs 145
Prac
tice
ECG
82
A60
-yea
r-old
wom
anin
goo
dhe
alth
;rou
tine
exam
.
Page 84
146 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
83
A75
-yea
r-old
wom
antr
ansf
erre
dfro
ma
nur
sing
hom
ewi
thd
yspn
eaa
ndp
leur
isy.
Page 85
Part ii:150PracticeECGs 147
Prac
tice
ECG
84
A74
-yea
r-old
man
inth
eem
erge
ncy
room
with
che
stp
ain
that
beg
an3
0m
inut
ese
arlie
r.Is
this
angi
nao
rMI?
Isth
eisc
hem
iaa
nte-
rioro
rint
erio
r?
Page 86
148 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
85
A56
-yea
r-old
man
with
no
card
iac
hist
ory;
he
want
sto
sta
rta
jogg
ing
prog
ram
.
Page 87
Part ii:150PracticeECGs 149
Prac
tice
ECG
86
A57
-yea
r-old
man
trea
ted
forh
yper
tens
ion.
Isth
ere
evid
ence
ofh
yper
tens
iveh
eart
dise
ase?
Page 88
150 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
87
An8
2-ye
ar-o
ldm
anw
ithp
alpi
tatio
nsa
ndd
izzin
ess.
Page 89
Part ii:150PracticeECGs 151
Prac
tice
ECG
88
An8
0-ye
ar-o
ldw
oman
with
ah
istor
yof
MIa
nda
pac
emak
er;r
outin
ecli
nic
visit.
Page 90
152 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
89
A59
-yea
r-old
wom
anw
ithin
term
itten
tind
iges
tion
of2
wee
ksd
urat
ion.
Page 91
Part ii:150PracticeECGs 153
Prac
tice
ECG
90
A48
-yea
r-old
man
with
ah
istor
yof
infe
riorM
I.H
ash
eha
da
seco
ndM
I?
Page 92
154 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
91
A50
-yea
r-old
with
ah
istor
yof
MI.
Hav
eth
ere
been
mul
tiple
infa
rctio
ns?
Page 93
Part ii:150PracticeECGs 155
Prac
tice
ECG
92
A56
-yea
r-old
man
;pre
oper
ative
ECG
.
Page 94
156 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
93
A65
-yea
r-old
wom
anw
iths
epsis
.
Page 95
Part ii:150PracticeECGs 157
Prac
tice
ECG
94
A52
-yea
r-old
man
sen
tto
card
iolo
gyc
linic
beca
use
ofa
nab
norm
alE
CG.H
eha
shy
perte
nsio
nbu
tno
hist
ory
ofc
hest
pai
n.
Page 96
158 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
95
A63
-yea
r-old
man
;ann
uale
xam
.
Page 97
Part ii:150PracticeECGs 159
Prac
tice
ECG
96
A71
-yea
r-old
man
with
che
stp
ain
for3
hou
rs.
Page 98
160 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
97
A58
-yea
r-old
man
;no
clini
cald
ata
prov
ided
.
Page 99
Part ii:150PracticeECGs 161
Prac
tice
ECG
98
An8
1-ye
ar-o
ldw
oman
;no
clini
cald
ata
prov
ided
.
Page 100
162 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
99
A73
-yea
r-old
man
ing
ood
heal
th.
Page 101
Part ii:150PracticeECGs 163
Prac
tice
ECG
100
A
63-y
ear-o
ldm
an;r
outin
eex
amin
atio
n.
Page 102
164 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
101
A
46-y
ear-o
ldm
an;i
nsur
ance
phy
sical
.
Page 103
Part ii:150PracticeECGs 165
Prac
tice
ECG
102
A
patie
ntw
itha
nirr
egul
arp
ulse
.
Page 104
166 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
103
A
68-y
ear-o
ldw
oman
with
acu
tein
ferio
rMI.
Doe
ssh
ene
eda
tem
pora
ryp
acem
aker
?
Page 105
Part ii:150PracticeECGs 167
Prac
tice
ECG
104
A
55-y
ear-o
ldm
anw
ithp
alpi
tatio
nsa
nda
hist
ory
ofM
I.
Page 106
168 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
105
A
75-y
ear-o
ldw
oman
with
obs
truc
tive
lung
dise
ase
and
ankle
ede
ma.
Page 107
Part ii:150PracticeECGs 169
Prac
tice
ECG
106
A
54-y
ear-o
ldm
anw
ithn
ohi
stor
yof
hea
rtd
iseas
e.H
ewe
ighs
275
pou
nds.
Page 108
170 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
107
A
53-y
ear-o
ldm
anh
adc
hest
pai
nof
90
min
utes
dur
atio
nea
rlier
inth
eda
y.Sh
ould
we
cons
ider
thro
mbo
lytic
ther
apy?
Page 109
Part ii:150PracticeECGs 171
Prac
tice
ECG
108
A
70-y
ear-o
ldw
oman
with
che
stp
ain
of5
hou
rsd
urat
ion.
Sho
uld
she
have
thro
mbo
lytic
ther
apy?
Page 110
172 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
109
An
86-
year
-old
wom
ano
ndi
goxin
.
Page 111
Part ii:150PracticeECGs 173
Prac
tice
ECG
110
A
70-y
ear-o
ldw
oman
with
che
stp
ain
of2
hou
rsd
urat
ion.
The
reis
no
old
ECG
forc
ompa
rison
.Sho
uld
she
have
thro
mbo
lytic
th
erap
y?
Page 112
174 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
111
Sa
me
patie
nt(
No.
110
),3
hour
slat
er.
Page 113
Part ii:150PracticeECGs 175
Prac
tice
ECG
112
A
46-y
ear-o
ldm
anw
ithp
oorly
con
trolle
dhy
perte
nsio
nan
dre
nalf
ailu
re.
Page 114
176 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
113
A
43-y
ear-o
ldm
anre
ferre
dfo
reva
luat
ion
ofh
eart
failu
re.
Page 115
Part ii:150PracticeECGs 177
Prac
tice
ECG
114
A
52-y
ear-o
ldw
oman
with
pal
pita
tions
.The
reis
no
othe
rhist
ory
ofh
eart
dise
ase.
Thi
sis
hers
econ
dep
isode
.Wha
twor
kup
isne
eded
?
Page 116
178 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
115
A
78-y
ear-o
ldw
oman
with
che
sth
eavin
ess
of5
hou
rsd
urat
ion
and
dysp
nea.
Wou
ldth
rom
boly
ticth
erap
yin
fluen
ces
urviv
al?
Page 117
Part ii:150PracticeECGs 179
Prac
tice
ECG
116
A
41-y
ear-o
ldm
ano
nth
eps
ychi
atric
uni
t.
Page 118
180 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
117
A
19-y
ear-o
ldw
oman
with
cya
nosis
,let
harg
y,an
da
hist
ory
ofh
eart
mur
mur
.Wha
toth
erp
hysic
alfi
ndin
gsw
ould
you
exp
ect?
Page 119
Part ii:150PracticeECGs 181
Prac
tice
ECG
118
A
73-y
ear-o
ldm
anw
itha
sys
tolic
mur
mur
that
radi
ates
toh
isne
ck.
Page 120
182 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
119
A
28-y
ear-o
ldm
anw
ithlo
ngfi
nger
s,hi
gha
rche
dpa
late,
and
ad
iasto
licm
urm
ur.
Page 121
Part ii:150PracticeECGs 183
Prac
tice
ECG
120
A
51-y
ear-o
ldm
anw
itha
hist
ory
ofM
I.
Page 122
184 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
121
A
68-y
ear-o
ldm
anro
used
from
sle
epb
ych
estp
ain
6ho
urs
earli
er;a
ntac
ids
did
noth
elp.
Alth
ough
the
pain
iss
ever
e,is
itto
olat
efo
rre
perfu
sion
ther
apy?
Page 123
Part ii:150PracticeECGs 185
Prac
tice
ECG
122
A
67-y
ear-o
ldw
oman
with
ah
istor
yof
hyp
erte
nsio
n.Is
ther
ehy
perte
nsive
hea
rtd
iseas
e?
Page 124
186 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
123
A
56-y
ear-o
ldm
anre
ferre
dbe
caus
eof
sile
ntM
I.
Page 125
Part ii:150PracticeECGs 187
Prac
tice
ECG
124
An
82-
year
-old
wom
anin
goo
dhe
alth
unt
ilth
eon
seto
fche
stp
ain
2ho
urs
earli
er.S
houl
dsh
eha
veth
rom
boly
ticth
erap
y?
Page 126
188 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
125
A
51-y
ear-o
ldw
oman
with
hyp
erte
nsio
nan
dpa
roxy
smal
atr
ialf
ibril
latio
n.W
hich
med
icine
sis
she
takin
g?
Page 127
Part ii:150PracticeECGs 189
Prac
tice
ECG
126
A
76-y
ear-o
ldm
anw
hois
ap
atie
ntin
the
pulm
onar
yun
it.W
hich
med
icine
sco
uld
beu
sed
toc
ontro
lthe
hea
rtra
te?
Page 128
190 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
127
A
35-y
ear-o
ldm
ano
nth
eda
yaf
terc
oron
ary
bypa
sss
urge
ry.
Page 129
Part ii:150PracticeECGs 191
Prac
tice
ECG
128
A
72-y
ear-o
ldw
oman
with
vag
ue,n
onsp
ecifi
cch
estp
ain
unre
spon
sive
toa
ntac
ids.
Page 130
192 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
129
A
77-y
ear-o
ldm
anw
itha
hist
ory
ofM
Iand
con
gest
iveh
eart
failu
re.
Page 131
Part ii:150PracticeECGs 193
Prac
tice
ECG
130
A
23-y
ear-o
ldw
oman
with
irre
gula
rpul
se.M
ustw
ebe
con
cern
edb
yth
isar
rhyt
hmia
?
Page 132
194 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
131
A
73-y
ear-o
ldm
anw
ithc
hest
pai
n.S
houl
dhe
hav
eth
rom
boly
ticth
erap
y?W
hato
ther
test
swo
uld
you
reco
mm
end?
Page 133
Part ii:150PracticeECGs 195
Prac
tice
ECG
132
A
52-y
ear-o
ldm
anw
ithh
istor
yof
MI.
Do
the
ECG
find
ings
indi
cate
pro
gnos
is?
Page 134
196 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
133
A
55-y
ear-o
ldw
oman
with
con
fusio
n,le
thar
gy,a
ndd
ifficu
ltys
peak
ing.
Page 135
Part ii:150PracticeECGs 197
Prac
tice
ECG
134
An
83-
year
-old
wom
anw
ithh
eart
failu
re.
Page 136
198 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
135
A
54-y
ear-o
ldm
anw
ith2
hou
rso
fche
stp
ain
heth
ough
twas
ple
urisy
.He
has
had
the
flu.
Page 137
Part ii:150PracticeECGs 199
Prac
tice
ECG
136
A
78-y
ear-o
ldm
anin
the
emer
genc
yro
omw
ithp
ulm
onar
yed
ema
and
ches
tpai
n(d
urin
gth
isEC
Gre
cord
ing)
.
Page 138
200 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
137
A
54-y
ear-o
ldw
oman
with
alo
ngh
istor
yof
pal
pita
tions
;yea
rlye
xam
inat
ion.
Page 139
Part ii:150PracticeECGs 201
Prac
tice
ECG
138
A
48-y
ear-o
ldm
ana
dmitt
ed2
day
sea
rlier
with
che
stp
ain
that
reso
lved
14h
ours
late
r.
Page 140
202 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
139
A
66-y
ear-o
ldm
anw
itha
hist
ory
ofp
alpi
tatio
ns.H
ewa
sad
mitt
edw
ithp
neum
onia
and
feve
r.
Page 141
Part ii:150PracticeECGs 203
Prac
tice
ECG
140
Sa
me
patie
nt(
No.
139
);th
epn
eum
onia
isb
eing
trea
ted
and
heis
afe
brile
.
Page 142
204 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
141
A
53-y
ear-o
ldw
oman
with
ah
istor
yof
hyp
erte
nsio
nan
dsm
okin
g.
Page 143
Part ii:150PracticeECGs 205
Prac
tice
ECG
142
A
72-y
ear-o
ldw
oman
with
feve
rand
exa
cerb
atio
nof
chr
onic
bron
chiti
s.
Page 144
206 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
143
A
72-y
ear-o
ldm
anw
ithc
hest
pai
nof
6h
ours
dur
atio
n.Is
ther
ean
terio
risc
hem
ia?
Page 145
Part ii:150PracticeECGs 207
Prac
tice
ECG
144
A
59-y
ear-o
ldm
anin
the
emer
genc
yro
omw
ithra
les,
ches
tpai
n,a
nda
sys
tolic
blo
odp
ress
ure
of8
0m
mH
g.W
hati
sth
eap
prop
riate
tre
atm
ent?
Page 146
208 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
145
A
59-y
ear-o
ldm
anw
hoh
adc
oron
ary
bypa
sss
urge
ry4
wee
kse
arlie
r.Fo
rthe
last
wee
khe
has
had
ple
urisy
,fev
era
ndm
yalg
ia.H
isfa
m-
ilyd
octo
rbeg
antr
eatm
entf
orp
neum
onia
,but
he
has
notr
espo
nded
toa
ntib
iotic
s.
Page 147
Part ii:150PracticeECGs 209
Prac
tice
ECG
146
A
69-y
ear-o
ldw
oman
inth
eem
erge
ncy
room
with
che
stp
ain.
Page 148
210 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
147
A
76-y
ear-o
ldw
oman
with
au
rinar
ytra
ctin
fect
ion
and
poss
ible
sep
sis.
Page 149
Part ii:150PracticeECGs 211
Prac
tice
ECG
148
A
70-y
ear-o
ldm
anw
ithc
hest
pai
n.
Page 150
212 150PracticeECGs:InterpretationandReview
Prac
tice
ECG
149
An
82-
year
-old
wom
anw
ithd
izzin
ess
and
ches
tpai
n.
Page 151
Part ii:150PracticeECGs 213
Prac
tice
ECG
150
A
24-y
ear-o
ldE
CGte
chni
cian.