ACC/AHA Clinical Competence in ECG Diagnoses

The following list of ECG diagnoses was derived from a recently published statement of the American College of Cardiology/American Heart Association (ACC/AHA) Committee to Develop a Clinical Competence Statement on Electrocardiography and Ambulatory Electrocardiography (J Am Coll Cardiol 2001;38:2091-2100). These diagnoses are considered to be the minimum knowledge necessary for competence in interpreting 12-lead ECGs. Items in the list are linked to topics in the ECG Outline of the Alan E. Lindsay ECG Learning Center or to ECG examples in the Image Index.

Normal Tracing

• Normal ECG

Technical Problems

• Lead Misplaced
• Artifact
  • Normal Variants or Artifacts
  • Muscle Tremor Artifact

Sinus Rhythms/Arrythmias

• Sinus rhythm (50-90 bpm)
• Sinus tachycardia (>90 bpm)
• Sinus bradycardia (<50 bpm)
• Sinus Arrhythmia
• Sinus arrest or pause
• Sino-atrial exit block

Other SV Arrythmias

• PAC's (nonconducted)
• PAC's (conducted normally)
• PAC's (conducted with aberration)
• Ectopic atrial rhythm or tachycardia (unifocal)
• Multifocal atrial rhythm or tachycardia
• Atrial fibrillation
• Atrial flutter
  • Atrial Flutter With 2:1 AV Conduction
  • Atrial Flutter with 3:2 Conduction Ratio
  • Atrial Flutter With Variable AV Block And Rate-Dependent LBBB
  • LBBB and Atrial Flutter with 2:1 AV Block
  • Atrial Flutter With 2:1 and 4:1 Conduction and Rate Dependent LBBB
  • Atrial Flutter With Variable AV Block
  • Atrial Flutter With 2:1 Conduction
  • Atrial Flutter with 2:1 Block
• Junctional prematures
• Junctional escapes or rhythms
• Accelerated Junctional rhythms
• Junctional tachycardia
  • Junctional Tachycardia With Exit Block
  • Junctional Tachycardia With and Without AV Block
  • Junctional Tachycardia With and Without Exit Block
• Paroxysmal supraventricular tachycardia

Ventricular Arrythmias

• PVC's
• Ventricular escapes or rhythm
• Accelerated ventricular rhythm
• Ventricular tachycardia (uniform)
• Ventricular tachycardia (polymorphous or torsade)
• Ventricular fibrillation
• Ventricular escapes or rhythm

AV Conduction

• 1st degree AV block
  • 1st Degree AV Block
  • A Most Unusual 1st Degree AV Block
  • Left Atrial Abnormality & 1st degree AV Block
  • A Very Subtle 1st Degree AV Block
• Type I 2nd degree AV block (Wenckebach)
• Type II 2nd degree AV block (Mobitz)
• AV block, advanced (high grade)
• 3rd degree AV block (junctional escape rhythm)
• 3rd degree AV block (ventricular escape rhythm)
• AV dissociation (default)
  • Subsidiary escape pacemaker takes over by default
• AV dissociation (usurpation)
  • Incomplete AV Dissociation due to accelerated ventricular rhythm

Intraventricular Conduction

• Complete LBBB, fixed or intermittent
• Incomplete LBBB
• Left anterior fascicular block (LAFB)
• Left posterior fascicular block (LPFB)
• Nonspecific IVCD
• WPW preexcitation pattern

QRS Axis and Voltage

• Complete LBBB, fixed or intermittent
• Incomplete LBBB
• Left anterior fascicular block (LAFB)
• Left posterior fascicular block (LPFB)
• Low voltage frontal plane (QRS amplitude < 0.5 mV)
• Low voltage precordial (QRS amplitude < 1.0 mV)

Hypertrophy/Enlargements

• Left atrial enlargement
• Right atrial enlargement
• Left ventricular hypertrophy
• Right ventricular hypertrophy

ST-T, and U Abnormalities

• Left atrial enlargement
• Nonspecific ST-T abnormalities
  • ST Segment Depression
• ST elevation (transmural injury)
• ST elevation (pericarditis pattern)
• Symmetrical T wave inversion
  • Inferior MI: Fully Evolved
• Hyperacute T waves
• Prominent upright U waves
• U wave inversion
• Prolonged QT interval

MI Patterns (acute, recent, old)

• Inferior MI
• Inferoposterior MI
• Inferoposterolateral MI
• True posterior MI
• Anteroseptal MI
• Anterior MI
• Anterolateral MI
• High lateral MI
• Non Q-wave MI
• Right ventricular MI

Clinical Disorders

• Chronic pulmonary disease pattern
• Suggests hypokalemia
  • Giant TU Fusion Waves
• Suggests hyperkalemia
• Suggests hypocalcemia
• Suggests hypercalcemia
• Suggests digoxin effect