Read ECGs Better Than a Cardiologist

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Read ECGs Better Than a Cardiologist

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All ECGs and questions were collected & created by Pendell Meyers, MD using content from his contributions to Dr. Smith’s ECG Blog.

Real ECGs, Real Scenarios

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Read ECGs Better than a Cardiologist

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Learn How To

Rapidly Interpret Real ECGs

Rapidly Interpret Real ECGs

Understand Intervals,
Morphology, and Blocks

Understand Intervals, Morphology, and Blocks

Understand R Wave Progression

Understand R Wave Progression

Easy Identification of
Bundle Branch Blocks

Easy Identification of
            Bundle Branch Blocks

Learn Lead Placement

Learn Lead Placement

Distinguish Wave Differences

Distinguish Wave Differences

From ECG to Cath Lab...

Find out if that STEMI was real

Find out if that STEMI was real

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A comprehensive guide for reading ECGs

Question

Which of the following best describes the morphology of normal sinus rhythm P waves?

A Lead I: biphasic (up-down); Lead II: upright
BLead I: upright; Lead II: biphasic (up-down)
CLead V1: biphasic (up-down); Lead II: upright
D Lead V1: upright; Lead II: biphasic (up-down)

Explanation

The P wave corresponds to atrial depolarization. The SA node is located in the right atrium near the superior vena cava, causing the direction of depolarization of normal P waves to be directed leftward and inferior, yielding upright (positive) P waves in most leads except aVR (which is oriented in the exact opposite direction). Because of the rightward placement of V1, the P wave is usually biphasic, with the initial positive deflection representing depolarization of the right atrium (toward the V1 electrode) and the subsequent negative depolarization representing the left atrium (away from the V1 electrode). Leads V1 and II are typically the best two leads for determining the P wave morphology and measurements, although this is not true in all cases.

The P wave corresponds to atrial depolarization

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