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In this section you will find twenty-five, 12-lead electrocardiograms for you to interpret. The clinical history is presented above each tracing. Apply the method of interpretation you learned in Chapter 24 and the criteria found in Chapter 25. Use the concept of structured reporting to measure, identify, and then synthesize the findings into a comprehensive interpretation. Include all of the items from the list below in your report.
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ECG #1 Interpretation
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Technical quality: Satisfactory
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PR interval: 0.14 seconds
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QRS duration: 0.08 seconds
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QT interval: 0.38 seconds
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Abnormalities: Axis leftward of −30 degrees. Abnormal P terminal force, lead V1. R wave voltage in leads V1-V3 <3 mm.
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Synthesis: Sinus rhythm. Left axis deviation. Left atrial abnormality. Left anterior fascicular block. Poor R wave progression.
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Comment: Marked left axis deviation is present indicative of left anterior fascicular block. Poor R wave progression is commonly seen in left anterior fascicular block as the loss of anterior forces in the horizontal plane reduces R wave voltage in leads V1-V3. Left atrial abnormality is present with abnormal P terminal force in lead V1. The notched P waves in leads II, III, and aVF support this diagnosis.
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ECG #2 Interpretation
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Technical quality: Satisfactory
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PR interval: 0.20 seconds
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QRS duration: 0.16 seconds
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QT interval: 0.40 seconds
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Abnormalities: Prolonged QRS complex duration. Wide, notched QRS complex associated with ST segment depression and T wave inversion in leads I, aVL, V5-V6.
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Synthesis: Sinus rhythm. Left bundle branch block with secondary ST segment and T wave abnormalities.
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Comment: Left bundle branch block is frequently a marker for significant myocardial disease, left ventricular systolic dysfunction, and congestive heart failure.
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ECG #3 Interpretation
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Technical quality: Satisfactory
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