Give me 40 ECG cases practice (ICU level and OPD) ECG all details according to disease ECG kaise dekhe with photos case and uses treatment

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ECG interpretation 12 lead electrocardiogram cases

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STEMI myocardial infarction ECG ST elevation VF ventricular fibrillation cardiac arrest

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complete heart block third degree AV block atrial flutter ECG pacemaker

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hyperkalemia hypokalemia ECG changes peaked T waves WPW syndrome Wolff-Parkinson-White delta wave

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pulmonary embolism ECG S1Q3T3 right heart strain ventricular tachycardia torsades de pointes

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🫀 40 ECG Cases — ICU + OPD Practice Guide

ECG Kaise Dekhe: Systematic Approach + Disease Patterns + Photos + Treatment

📋 ECG DEKHNE KA SYSTEMATIC APPROACH (7-Step Method)

Har ECG ko is order mein dekho:

Rate — 300 ÷ R-R squares (normal: 60–100 bpm)
Rhythm — Regular ya irregular? P waves hain?
P waves — Shape, axis, har QRS ke aage?
PR interval — Normal: 120–200 ms (3–5 small squares)
QRS — Normal: <120 ms (<3 small squares)
ST segment — Elevation ya depression?
T waves — Upright, inverted, peaked?

🔴 ICU EMERGENCIES (Cases 1–20)

CASE 1 — Anterior STEMI (LAD Occlusion)

Clinical scenario: 55M, sudden chest pain, diaphoresis, BP 90/60

ECG:

ECG Feature	Finding
ST elevation	V1–V6, I, aVL (tombstone pattern)
Reciprocal changes	ST depression in aVR, III, aVF
QRS morphology	Lambda waves / QS pattern V1–V3
Artery involved	LAD proximal occlusion

Kaise pehchano: V1–V4 mein ST elevation = anterior STEMI. "Tombstone" = QRS aur T wave ek saath upar → very large MI.

Treatment:

🚨 Activate cath lab immediately — door-to-balloon <90 min
Aspirin 325 mg + Clopidogrel/Ticagrelor loading
Heparin UFH 60 IU/kg bolus
Primary PCI (preferred) or thrombolysis (Streptokinase/Alteplase) if PCI unavailable
Morphine, O₂, Nitrates (no nitrates if RV infarct)
ICCU monitoring, echo

CASE 2 — Inferior STEMI (RCA Occlusion)

Clinical scenario: 60M, chest pain radiating to jaw, bradycardia HR 45

ECG:

ECG Feature	Finding
ST elevation	II, III, aVF
Reciprocal depression	I, aVL
V1/aVR elevation	Suggests proximal RCA or RV involvement
Key clue	III > II elevation → RCA territory

RV infarction pehchanein: Right-sided leads lagao (V4R mein ST elevation ≥1 mm = RV infarct)

Treatment:

Primary PCI for RCA
⚠️ NO nitrates if RV infarct (preload-dependent!)
IV fluid challenge (NS 250–500 mL) for hypotension
Atropine for bradycardia
Temporary pacemaker if needed

CASE 3 — Inferior STEMI + Atrial Fibrillation

Clinical scenario: 65F, palpitations + chest pain, irregular pulse

ECG:

Feature	Finding
Rhythm	Irregularly irregular, no P waves
ST changes	Tombstone elevation in II, III, aVF
Reciprocal	Depression in aVL

Kaise pehchano: Irregular rhythm + inferior ST elevation = AF + acute MI. Emergency!

Treatment:

Primary PCI immediately
Rate control with caution (avoid AV nodal blockers if hypotensive)
Anticoagulation — unfractionated heparin
DC cardioversion if hemodynamically unstable

CASE 4 — NSTEMI / Lateral Ischemia

Clinical scenario: 58M, exertional chest pain, troponin mildly elevated

ECG:

ECG Feature	Finding
T wave inversions	V5, V6 (lateral wall)
ST depression	V5–V6 subendocardial ischemia
No ST elevation	→ NSTEMI, not STEMI

Kaise pehchano: No elevation + troponin rise = NSTEMI. T inversion in V5/V6 = lateral wall ischemia (LCx territory).

Treatment:

Dual antiplatelet: Aspirin + Ticagrelor
Anticoagulation: LMWH (Enoxaparin) or UFH
High-intensity statin (Atorvastatin 80 mg)
Beta-blocker, ACE inhibitor
Coronary angiography within 24–72 hrs (GRACE score guided)

CASE 5 — Complete Heart Block (3rd Degree AV Block)

Clinical scenario: 70M, syncope, HR 35, post-inferior MI

ECG:

ECG Feature	Finding
Atrial rate	~70–80 bpm (P waves march through independently)
Ventricular rate	~35–50 bpm (escape rhythm)
PR interval	No fixed relationship (AV dissociation)
QRS width	Wide if infranodal; Narrow if junctional

Kaise pehchano: P waves aur QRS completely independent → complete AV dissociation = 3rd degree block.

Treatment:

Atropine 0.5–1 mg IV (junctional block mein kaam karta hai)
Transcutaneous pacing (temporary emergency)
Dopamine/Epinephrine infusion if unstable
Permanent pacemaker implantation — definitive treatment
Identify cause: inferior MI (RCA), Lyme disease, medications

CASE 6 — Complete Heart Block (Narrow Escape)

Clinical scenario: 65F, dizzy spells, HR 36 bpm

ECG:

Feature	Finding
Escape rate	~36 bpm (junctional)
QRS	Narrow — supraHisian escape
P waves	Present, march independently

Kaise pehchano: Narrow QRS escape = junctional (better prognosis than ventricular escape). Still needs pacemaker!

Treatment: Same as Case 5. Narrow QRS = may respond to Atropine briefly.

CASE 7 — 3rd Degree Block (Ventricular Escape, Wide QRS)

ECG:

Complete heart block wide QRS ventricular escape

Feature	Finding
QRS morphology	Widened, notched (ventricular escape)
Rate	Very slow
Risk	High — Stokes-Adams attacks, sudden death

Treatment: Emergency temporary pacing → permanent pacemaker.

CASE 8 — Atrial Fibrillation (Rapid Ventricular Response)

Clinical scenario: 55F, palpitations, HR 140 irregular

ECG:

Atrial Fibrillation rapid ventricular response

Feature	Finding
P waves	Absent — fibrillatory baseline
Rhythm	Irregularly irregular
Ventricular rate	Rapid (>100 bpm = rapid ventricular response)

Kaise pehchano: No P waves + totally irregular RR intervals = AF. Fibrillatory waves at 350–600/min.

Treatment (ICU/Emergency):

If hemodynamically unstable → DC cardioversion (synchronized, 200J biphasic)
If stable → Rate control: Metoprolol IV or Diltiazem IV or Digoxin
Anticoagulation: Heparin → NOAC (Rivaroxaban/Apixaban) or Warfarin
Treat precipitating cause: sepsis, thyrotoxicosis, PE, post-surgery

CASE 9 — Acute Pulmonary Embolism (S1Q3T3)

Clinical scenario: 40F, sudden dyspnea, pleuritic chest pain, post-surgery (DVT risk)

ECG:

Feature	Finding
Lead I	Deep S wave (S1)
Lead III	Q wave + T wave inversion (Q3T3)
V1–V4	T wave inversions (RV strain)
Rate	Sinus tachycardia
QRS	Incomplete RBBB pattern

Kaise pehchano: S1Q3T3 = classic PE sign. Sinus tachycardia is the most common ECG finding in PE.

Treatment:

Massive PE: Alteplase (systemic thrombolysis) 100 mg IV over 2h + UFH
Submassive PE: UFH anticoagulation ± catheter-directed thrombolysis
Anticoagulation: LMWH or NOAC for stable PE
O₂, hemodynamic support, ICU monitoring

CASE 10 — PE with RBBB Pattern

ECG:

Feature	Finding
S1Q3T3	Present
RBBB	rSR' in V1–V2 (right bundle branch block)
T inversions	V1–V4
Axis	Right axis deviation

Treatment: Same as Case 9 — severity determines treatment intensity.

CASE 11 — PE (Sinus Tachycardia + S1Q3T3)

ECG:

Remember: ECG alone cannot rule out PE. Always combine with D-Dimer, CTPA, Wells score.

CASE 12 — Wolff-Parkinson-White (WPW) Syndrome

Clinical scenario: 25M, episodes of sudden palpitations, near-syncope

ECG:

Feature	Finding
PR interval	SHORT (<120 ms)
QRS	WIDE (>120 ms)
Delta wave	Slurred upstroke of QRS (most visible V3–V6)
ST-T changes	Secondary repolarization changes

Kaise pehchano: Short PR + Wide QRS + Delta wave = WPW triad. Bundle of Kent bypasses AV node.

Treatment:

Symptomatic/SVT → Adenosine (if orthodromic), Procainamide
⚠️ NEVER give Digoxin, Verapamil, Adenosine in AF+WPW (can cause VF!)
Radiofrequency catheter ablation — definitive cure
Risk stratify with electrophysiology study

CASE 13 — WPW (Mid-Septal Pathway)

ECG:

Pathway localization:

Negative delta in III + positive V4–V6 → mid-septal
V1 positive delta → left lateral pathway
V1 negative delta → right-sided pathway

CASE 14 — WPW + PACs (Pediatric Cardiomyopathy)

ECG:

Note: Delta waves + irregular baseline (PACs) + wide QRS. T inversions across multiple leads suggest secondary cardiomyopathy from incessant tachycardia.

CASE 15 — WPW (Right Midseptal Pathway)

ECG:

PR = 112 ms, QRS = 122 ms. Delta waves in I, II, aVL, aVF, V4–V6. R/S transition V4–V5 → right midseptal pathway.

CASE 16 — Left Anterior Fascicular Block (LAFB)

Clinical scenario: 67M, preoperative ECG, no symptoms

ECG:

Feature	Finding
Heart rate	54 bpm (sinus bradycardia)
PR interval	162 ms
QRS	106 ms
Axis	Left axis deviation −56°
Lead I/aVL	Small q, tall R (qR pattern)
Lead II/III/aVF	Small r, deep S (rS pattern)

Kaise pehchano: Left axis deviation more negative than −45° + rS in inferior leads + qR in I, aVL + no other cause = LAFB.

Treatment: LAFB alone is benign if no structural heart disease. Investigate for CAD, cardiomyopathy.

CASE 17 — Diffuse T Wave Inversions / Global Hypokinesis

ECG:

Feature	Finding
T waves	Diffuse inversions I, aVL, V1–V6
ST	Minimal deviation
Differential	Ischemia, cardiomyopathy, electrolyte imbalance

Causes: Global ischemia, Takotsubo cardiomyopathy, severe LV dysfunction, hypokalemia, head injury (neurogenic).

Treatment: Echo urgently, troponin, electrolytes. Treat underlying cause.

CASE 18 — Ventricular Tachycardia (VT)

ECG features (classic VT):

Feature	Description
Rate	100–250 bpm
QRS	Wide (>120 ms), bizarre morphology
AV dissociation	P waves march independent of QRS
Fusion beats	QRS morphology changes briefly (pathognomonic)
Capture beats	Normal narrow complex amidst VT

Kaise pehchano: Wide complex tachycardia + AV dissociation = VT until proven otherwise (use Brugada criteria).

Treatment:

Unstable → Synchronized DC cardioversion 200J immediately
Stable → Amiodarone 150 mg IV bolus, then 1 mg/min infusion
Lidocaine 1–1.5 mg/kg IV (second line)
Correct K⁺, Mg²⁺ levels
ICD implantation if recurrent/structural heart disease

CASE 19 — Torsades de Pointes (Polymorphic VT)

ECG features:

Feature	Description
Rhythm	Irregular wide-complex VT
Morphology	QRS axis twists around baseline (spindle pattern)
Preceding ECG	Prolonged QTc (>500 ms)
Triggers	Bradycardia, hypokalemia, drugs

Kaise pehchano: "Twisting of points" — QRS complexes cyclically flip above/below baseline.

Causes: Hypokalemia, hypomagnesemia, QT-prolonging drugs (Amiodarone, Haloperidol, Methadone, antibiotics like Azithromycin, Moxifloxacin), congenital Long QT syndrome.

Treatment:

⚠️ IV Magnesium sulphate 2g over 5 min — FIRST LINE
Temporary pacing (overdrive pacing at 90–100 bpm)
Isoproterenol infusion (pause-dependent TdP)
STOP QT-prolonging drugs
Correct K⁺ (target >4.5 mEq/L)
Defibrillation if degenerated to VF

CASE 20 — Ventricular Fibrillation (VF)

ECG features:

Feature	Description
Rhythm	Chaotic, irregular
QRS/T	Not identifiable — only fibrillatory waves
Rate	150–500/min (baseline undulation)
Clinical	Pulseless arrest

Treatment:

🚨 CPR immediately
Defibrillation: 200J biphasic (unsynchronized) — shock first
Adrenaline 1 mg IV every 3–5 min
Amiodarone 300 mg IV after 3rd shock
Identify reversible causes: 4H + 4T (Hypoxia, Hypovolemia, Hypothermia, H⁺/acidosis; Tension pneumo, Tamponade, Toxins, Thrombosis)

🟡 OPD CASES (Cases 21–40)

CASE 21 — Normal Sinus Rhythm

ECG:

Feature	Normal Values
Rate	60–100 bpm
P waves	Upright in II, inverted in aVR; before every QRS
PR interval	120–200 ms
QRS	<120 ms, narrow
R-wave progression	Increases V1→V6
T waves	Upright in I, II, V3–V6

Remember: aVR mein sab kuch ulta hoga (P, QRS, T — all negative normally).

CASE 22 — Sinus Bradycardia

ECG features:

Feature	Finding
Rate	<60 bpm
P wave	Normal morphology, precedes QRS
Rhythm	Regular
PR interval	Normal

Causes (OPD): Athletes (physiological), hypothyroidism, vasovagal, beta-blockers, digoxin toxicity, inferior MI.

Treatment:

Asymptomatic → No treatment, monitor
Symptomatic → Atropine 0.5–1 mg IV
Beta-blocker/digoxin dose reduction
Pacemaker if irreversible + symptomatic

CASE 23 — Sinus Tachycardia

ECG features:

Feature	Finding
Rate	>100 bpm
P waves	Present before each QRS
Onset	Gradual (unlike paroxysmal SVT)

Causes (OPD): Fever, anemia, anxiety, hyperthyroidism, dehydration, pain, PE, heart failure, pregnancy.

Treatment: Treat the CAUSE — not the tachycardia itself!

CASE 24 — First Degree AV Block

ECG features:

Feature	Finding
PR interval	>200 ms (>5 small squares)
Conduction	All P waves conduct (every P → QRS)
QRS	Normal

Causes: Vagal tone, inferior MI, rheumatic fever, digoxin, beta-blockers, hypothyroidism, Lyme disease.

Treatment: Usually benign, no treatment. Stop offending drugs if symptomatic. Monitor for progression.

CASE 25 — Second Degree AV Block Type I (Wenckebach / Mobitz I)

ECG features:

Feature	Finding
PR interval	Progressively lengthens
QRS drop	Occurs after longest PR
Grouped beating	RR intervals get shorter before drop

Kaise pehchano: "Longer, longer, longer, DROP — then you have a Wenckebach block!"

Causes: Inferior MI, increased vagal tone, digoxin, athletes.

Treatment: Usually benign, often reversible. Monitor, treat cause.

CASE 26 — Second Degree AV Block Type II (Mobitz II)

ECG features:

Feature	Finding
PR interval	FIXED (no lengthening)
QRS drop	Sudden, unexpected
QRS	Often wide (infranodal disease)

Kaise pehchano: PR fixed → sudden non-conducted P wave = Mobitz II. More dangerous than Mobitz I!

Treatment: Pacemaker often required — risk of progressing to complete block. Avoid AV nodal blocking drugs.

CASE 27 — Right Bundle Branch Block (RBBB)

ECG features:

Feature	Finding
QRS duration	≥120 ms
V1	RSR' ("rabbit ears" / M-shaped)
V6, I	Wide S wave
T waves	Inverted V1–V3 (secondary changes)

Kaise pehchano: "RsR' in V1 with wide S in V5/V6" = RBBB. Right bunny ears!

Causes: PE, ASD, RV strain, ischemia, age-related, post-cardiac surgery.

Treatment: Isolated RBBB — no treatment. Investigate cause. New RBBB in setting of chest pain = ischemia.

CASE 28 — Left Bundle Branch Block (LBBB)

ECG features:

Feature	Finding
QRS	≥120 ms
V5/V6, I, aVL	Broad notched R wave (M-shaped)
V1	Deep QS or rS pattern
Concordance	ST/T always opposite QRS direction

Kaise pehchano: "WiLLiaM" — W in V1, M in V5 = LBBB. Sgarbossa criteria for STEMI in LBBB.

Sgarbossa Criteria for MI in LBBB:

ST elevation ≥1 mm concordant with QRS (+5 points)
ST depression ≥1 mm in V1–V3 (+3 points)
ST elevation ≥5 mm discordant (+2 points) Score ≥3 = STEMI

Treatment: New LBBB with chest pain = treat as STEMI!

CASE 29 — Left Ventricular Hypertrophy (LVH)

ECG features:

Feature	Finding
Sokolow-Lyon	S(V1) + R(V5 or V6) ≥35 mm
Cornell	R(aVL) + S(V3) ≥28mm (M) / ≥20mm (F)
Strain pattern	ST depression + T inversion in I, aVL, V5, V6

Causes: Hypertension (#1), aortic stenosis, HCM, coarctation.

Treatment: Treat hypertension (ACE inhibitor/ARB preferred — cause LVH regression). Treat valvular disease.

CASE 30 — Right Ventricular Hypertrophy (RVH)

ECG features:

Feature	Finding
Dominant R in V1	R > S in V1 (R ≥7 mm)
S in V5/V6	Persistent deep S
Axis	Right axis deviation (>+90°)
Strain	T inversion V1–V3

Causes: Pulmonary hypertension, mitral stenosis, COPD, ASD, VSD.

Treatment: Treat underlying cause (pulmonary hypertension: Sildenafil, Bosentan, prostacyclins).

CASE 31 — Atrial Flutter

ECG features:

Feature	Finding
Flutter waves	Sawtooth pattern in II, III, aVF
Atrial rate	~300 bpm
AV conduction	Usually 2:1 → ventricular rate ~150 bpm
QRS	Narrow (if no aberrant conduction)

Kaise pehchano: Regular rate of 150 bpm + sawtooth baseline = flutter until proven otherwise!

Treatment:

Rate control: Beta-blocker, Diltiazem, Digoxin
DC cardioversion: Low energy 50–100J biphasic (converts easily)
Anticoagulation same as AF
Radiofrequency ablation — curative (cavotricuspid isthmus ablation)

CASE 32 — SVT (Paroxysmal Supraventricular Tachycardia)

ECG features:

Feature	Finding
Rate	150–250 bpm
QRS	Narrow (usually)
P waves	Not visible or buried in QRS
Onset	Sudden ("paroxysmal")

Types: AVNRT (most common), AVRT (WPW), atrial tachycardia.

Treatment:

Vagal maneuvers (Valsalva, carotid sinus massage)
Adenosine 6 mg rapid IV push (second dose 12 mg)
Verapamil 5–10 mg IV (if no pre-excitation)
DC cardioversion if unstable
Long-term: Catheter ablation (curative >95%)

CASE 33 — Premature Ventricular Complexes (PVCs)

ECG features:

Feature	Finding
QRS	Wide, bizarre, early
No P wave	Before premature beat
Compensatory pause	Full compensatory pause after PVC
T wave	Opposite direction to QRS

Bigeminy = every other beat is PVC. Trigeminy = every 3rd beat.

Causes: Electrolyte imbalance, ischemia, stimulants (caffeine), anxiety, LV dysfunction.

Treatment:

Benign PVCs, no structural heart disease → reassurance
Frequent PVCs + symptoms → Beta-blocker, Flecainide
PVC-induced cardiomyopathy (burden >20%) → ablation
Correct K⁺, Mg²⁺

CASE 34 — Hyperkalemia (Peaked T waves → Sine Wave)

ECG progression with rising K⁺:

K⁺ Level	ECG Change
5.5–6.0	Peaked, narrow, symmetric T waves (tent-like)
6.0–7.0	PR prolongation, P wave flattening
7.0–8.0	P wave disappears, wide QRS
>8.0	Sine wave pattern → VF

Kaise pehchano: Narrow-based, tall, symmetric T waves (like a tent) = hyperkalemia. V4 mein sabse prominent.

Treatment (ICU Emergency):

IV Calcium gluconate 10 mL 10% — membrane stabilization (immediate)
Sodium bicarbonate — shift K into cells
Insulin 10U + Dextrose 50% — shift K into cells (most reliable)
Salbutamol nebulization — K shift
Kayexalate / Patiromer — GI elimination
Dialysis — definitive if renal failure

CASE 35 — Hypokalemia

ECG features:

K⁺ Level	ECG Change
3.0–3.5	T wave flattening
<3.0	Prominent U waves (after T wave)
<2.5	ST depression, T-U fusion
Severe	Torsades de Pointes risk!

Kaise pehchano: U wave (small positive deflection after T wave, best seen in V2–V3) = hypokalemia.

Treatment:

Mild (3.0–3.5): Oral KCl 40–80 mEq/day
Severe (<3.0) or TdP risk: IV KCl (max 20 mEq/hr via central line)
Replace Mg²⁺ simultaneously (hypomagnesemia causes refractory hypokalemia)

CASE 36 — Pericarditis

ECG features:

Feature	Finding
ST elevation	Diffuse (I, II, aVL, aVF, V2–V6) — concave/saddle-shaped
PR depression	PR segment depressed (early finding)
Reciprocal changes	Absent (unlike MI)
Evolution	ST returns to normal, then T inversion

Kaise pehchano: Diffuse ST elevation (multiple territories) + concave shape + PR depression = pericarditis. Unlike STEMI which is convex (domed) and territory-specific.

Treatment:

Colchicine 0.5 mg BD (first-line, prevents recurrence)
Ibuprofen 600 mg TDS or Aspirin 750 mg TDS
Avoid steroids (increases recurrence)
Restrict exercise for 3–6 months

CASE 37 — Hypothermia (Osborn/J Waves)

ECG features:

Feature	Finding
J waves (Osborn waves)	Positive deflection at J-point, V2–V5
Bradycardia	Sinus bradycardia
Artifact	Muscle tremor artifact (shivering)
Severe	Junctional rhythm, AF, VF risk

Kaise pehchano: Patient cold (core temp <32°C) + J-waves (notch after QRS, before ST) = hypothermia.

Treatment:

Passive rewarming (mild: >32°C)
Active external warming (moderate: 28–32°C)
Active internal warming: warm IV fluids, bladder/gastric lavage (severe: <28°C)
ECMO for cardiac arrest + hypothermia

CASE 38 — Digoxin Toxicity

ECG features:

Feature	Finding
ST-T changes	Scooped/shovelled ST depression (reverse tick sign)
PR prolongation	AV block (1st, 2nd, 3rd)
Arrhythmias	PVCs (bigeminy), VT, atrial tachycardia with AV block
Rate	Bradycardia or tachycardia

Kaise pehchano: "Scooping" of ST segment (looks like the bottom of a shoe) + AV block + increased QRS + arrhythmias = digoxin effect/toxicity.

Treatment:

Stop digoxin
Digibind (Digoxin-specific antibody fragments) — definitive antidote
Correct hypokalemia, hypomagnesemia (potentiate toxicity)
Atropine for bradycardia; Lidocaine/Phenytoin for VT
Avoid cardioversion in digoxin toxicity (causes VF)

CASE 39 — Brugada Syndrome

ECG features (Type 1 — diagnostic):

Feature	Finding
ST elevation	Coved (downsloping) in V1–V2, ≥2 mm
T wave	Inverted in V1–V2
Axis	Normal or right
QRS	Slight widening

Type 2: Saddle-back pattern (less diagnostic). Unmasked by fever, sodium channel blockers, flecainide challenge.

Kaise pehchano: "Coved" ST elevation in V1–V2 in right precordial leads = Brugada pattern. Danger: SCD risk!

Treatment:

ICD (implantable cardioverter-defibrillator) — only proven treatment
Quinidine (reduces VF storms)
⚠️ Avoid: Sodium channel blockers (Flecainide, Propafenone), Tricyclic antidepressants, fever

CASE 40 — Long QT Syndrome (LQTS)

ECG features:

Feature	Finding
QTc	Prolonged: >450 ms (male), >460 ms (female)
T wave morphology	Broad, notched, biphasic
Risk	Torsades de Pointes → VF → sudden death

QTc calculation: QT ÷ √(RR interval in seconds) — Bazett formula

Causes:

Congenital: LQT1, LQT2, LQT3 (ion channel mutations)
Acquired: Hypokalemia, hypomagnesemia, drugs (Amiodarone, Haloperidol, Azithromycin, Moxifloxacin, Methadone, Chloroquine)

Treatment:

Remove QT-prolonging drugs
Beta-blockers (LQT1/LQT2) — Propranolol/Nadolol
ICD if symptomatic or LQTS3
Mexiletine (LQT3)
IV Magnesium if TdP develops

📊 QUICK REFERENCE TABLE — All 40 Cases

#	Condition	Key ECG Finding	Urgent Treatment
1	Anterior STEMI	ST ↑ V1–V6 tombstone	PCI/Thrombolysis
2	Inferior STEMI	ST ↑ II, III, aVF	PCI, no nitrates if RV
3	Inferior STEMI + AF	Irregular + inferior ST↑	PCI + anticoag
4	NSTEMI	T inversion V5–V6, ST↓	DAPT, angiogram
5	CHB wide QRS	AV dissociation, wide escape	Temp pacing → PPM
6	CHB narrow QRS	AV dissociation, narrow escape	Atropine → PPM
7	CHB ventricular escape	Wide notched escape	Emergency pacing
8	AF rapid response	Irregular, no P waves, fast	Cardioversion/rate control
9	PE (S1Q3T3)	S₁Q₃T₃, sinus tachy	Thrombolysis/LMWH
10	PE + RBBB	S1Q3T3 + rSR' V1	Anticoagulation
11	PE sinus tachy	Sinus tach + S1Q3T3	CTPA, anticoag
12	WPW	Short PR, delta wave	Ablation, avoid digoxin
13	WPW mid-septal	Delta wave localization	Ablation
14	WPW + PACs	Delta wave + ectopics	Ablation
15	WPW right septal	Delta V4–V6, short PR	Ablation
16	LAFB	LAD, qR in I/aVL, rS inf	Investigate CAD
17	Diffuse T inversions	T↓ across leads	Echo, troponin
18	VT	Wide QRS tachy, AV dissoc	Cardioversion/Amiodarone
19	Torsades de Pointes	Twisting QRS, long QT	IV MgSO₄, stop drugs
20	VF	Chaotic baseline	CPR + Defibrillation
21	Normal sinus	All normal	Reassure
22	Sinus bradycardia	Rate <60, normal P	Treat cause, Atropine
23	Sinus tachycardia	Rate >100, normal P	Treat cause
24	1st degree AVB	PR >200ms	Monitor
25	Mobitz I (Wenckebach)	PR lengthens then drop	Monitor, treat cause
26	Mobitz II	Fixed PR, sudden drop	Pacemaker
27	RBBB	RSR' V1, wide S V6	Investigate cause
28	LBBB	WiLLiaM pattern	New = treat as STEMI
29	LVH	Sokolow ≥35mm, strain	Treat HTN (ACEi/ARB)
30	RVH	Dominant R V1, RAD	Treat pulm HTN
31	Atrial flutter	Sawtooth 300bpm, 2:1	Cardioversion/ablation
32	SVT/AVNRT	Narrow tachy 150–250	Adenosine, ablation
33	PVCs	Wide early beats, comp pause	Beta-blocker/ablation
34	Hyperkalemia	Peaked T → sine wave	Ca²⁺, Insulin-dextrose
35	Hypokalemia	Flat T, U waves	K replacement
36	Pericarditis	Saddle ST↑ all leads, PR↓	Colchicine + NSAID
37	Hypothermia	J/Osborn waves, bradycardia	Rewarming
38	Digoxin toxicity	Scooped ST, AV block	Digibind
39	Brugada	Coved ST V1–V2	ICD, avoid Na-blockers
40	Long QT	QTc >450–460 ms	Stop drugs, BB, ICD

🔑 KEY RULES FOR ECG READING

"See Wide → Think VT first" — Wide complex tachycardia = VT until proven otherwise

"See Irregular → Think AF" — Totally irregular rhythm with no P waves = AF

"See Short PR + Wide QRS → WPW" — Don't give Digoxin or Verapamil!

"See Tombstone → Cath Lab NOW" — No time to waste in STEMI

"See S1Q3T3 + Tachycardia → Think PE" — Especially post-op or immobile patient

"See Peaked T → Check K⁺" — Hyperkalemia kills silently

"See PR Depression + Diffuse ST↑ → Pericarditis" — NOT infarction

"See J-wave + Cold Patient → Hypothermia" — Rewarm before pronouncing dead

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