ECG Quiz

geekymedics.com/ecg-quiz

Dr Lewis Potter March 7, 2011

In clinical practice, you’ll be asked to interpret ECGs regularly. It’s really important to
understand how to read an ECG effectively. If you want to learn more about ECGs, you can
check out our ECG guides.

ECG quiz

It’s important to understand how to read an ECG effectively. If you want to learn more about
ECGs, you can check out our ECG guides.

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1 / 16

A patient is noted to have an abnormally shortened PR interval on their ECG. Which is the
most likely cause?

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A short PR-interval indicates abnormally short conduction time between the atria and
ventricles. This is typically caused by the presence of an accessory pathway between the
atria and ventricles. WPW syndrome is an example of this kind of disorder. In WPW
syndrome, an accessory pathway known as the bundle of Kent is present. Most individuals
are asymptomatic, however, there is a risk of sudden death without treatment.

A short PR-interval indicates abnormally short conduction time between the atria and
ventricles. This is typically caused by the presence of an accessory pathway between the
atria and ventricles. WPW syndrome is an example of this kind of disorder. In WPW
syndrome, an accessory pathway known as the bundle of Kent is present. Most individuals
are asymptomatic, however, there is a risk of sudden death without treatment.

2 / 16

A patient has ST-elevation in leads II, III and aVF. What is the most likely diagnosis?

Leads II, III and aVF all view the heart in the inferior plane. ST-elevation in only these leads
would be suggestive of an inferior myocardial infarction.

Leads II, III and aVF all view the heart in the inferior plane. ST-elevation in only these leads
would be suggestive of an inferior myocardial infarction.

3 / 16

Which view of the heart do leads I, aVL, V5 and V6 represent?

4 / 16

Which view of the heart do leads V3 and V4 represent?

5 / 16

What would the heart rate be if three large squares were in an R-R interval?

To calculate heart rate from an ECG you can count the number of large squares in an R-R
interval then divide 300 by this number. Therefore 300/3 = 100 bpm.

To calculate heart rate from an ECG you can count the number of large squares in an R-R
interval then divide 300 by this number. Therefore 300/3 = 100 bpm.

6 / 16

What can ST-elevation indicate?

7 / 16

2/5
What is the normal duration of a QRS complex?

In most healthy individuals, you would expect QRS complexes to be between 70 - 110
milliseconds. If a QRS complex lasts longer it is described as a "wide QRS" and indicates
inefficient conduction ventricular conduction (e.g. bundle branch block).

In most healthy individuals, you would expect QRS complexes to be between 70 - 110
milliseconds. If a QRS complex lasts longer it is described as a "wide QRS" and indicates
inefficient conduction ventricular conduction (e.g. bundle branch block).

8 / 16

Which view of the heart does lead II, III and aVF represent?

9 / 16

An ECG is performed and reveals a progressively increasing PR interval and dropping of

QRS complexes at regular intervals. Which is the most likely diagnosis?

Second-degree heart block (Mobitz type 1) is a disease of the atrioventricular node. Typical
ECG findings include progressive prolongation of the PR-interval with associated regular
dropping of QRS complexes.

Second-degree heart block (Mobitz type 1) is a disease of the atrioventricular node. Typical
ECG findings include progressive prolongation of the PR-interval with associated regular
dropping of QRS complexes.

10 / 16

An ECG shows an absence of P waves and an irregular rhythm. Which is the most likely
diagnosis?

In atrial fibrillation, the atria no longer conduct electricity from the sinoatrial node in an orderly
fashion. As a result, P-waves are lost. As a result of disordered atrial activity, only occasional
waves of depolarisation pass through to the atrioventricular node and cause ventricular
activation. This causes the typical irregular rhythm.

In atrial fibrillation, the atria no longer conduct electricity from the sinoatrial node in an orderly
fashion. As a result, P-waves are lost. As a result of disordered atrial activity, only occasional
waves of depolarisation pass through to the atrioventricular node and cause ventricular
activation. This causes the typical irregular rhythm.

11 / 16

Which of the following is a common cause of right axis deviation?

3/5
In right ventricular hypertrophy, the increased muscle mass of the right ventricle causes an
increased signal on the ECG. As a result, the axis of the heart is shifted to the right with lead
III becoming more positive and lead I and II becoming less positive.

In right ventricular hypertrophy, the increased muscle mass of the right ventricle causes an
increased signal on the ECG. As a result, the axis of the heart is shifted to the right with lead
III becoming more positive and lead I and II becoming less positive.

12 / 16

Which view of the heart do leads V1 and V2 represent?

13 / 16

Which coronary artery is most likely to be affected in the context of ST elevation in leads V3
and V4?

Leads V3 and V4 represent the anterior portion of the heart. ST elevation in these leads
would be suggestive of anterior myocardial infarction. The anterior portion of the heart is
supplied primarily by the left anterior descending artery.

Leads V3 and V4 represent the anterior portion of the heart. ST elevation in these leads
would be suggestive of anterior myocardial infarction. The anterior portion of the heart is
supplied primarily by the left anterior descending artery.

14 / 16

What is the duration of a normal PR-interval?

In healthy individuals, the PR-interval is between 0.12-0.2 seconds. A PR interval longer than
0.2 seconds suggests the presence of heart block. A short PR-interval may suggest the
presence of an accessory pathway between the atria and ventricles (e.g. WPW syndrome).

In healthy individuals, the PR-interval is between 0.12-0.2 seconds. A PR interval longer than
0.2 seconds suggests the presence of heart block. A short PR-interval may suggest the
presence of an accessory pathway between the atria and ventricles (e.g. WPW syndrome).

15 / 16

Which of the following best describes the ECG leads shown?

16 / 16

What is the most common cause of left axis deviation?

4/5
Left axis deviation is rarely the result of left ventricular hypertrophy and more often due to
defects in the conduction system of the heart.

Left axis deviation is rarely the result of left ventricular hypertrophy and more often due to
defects in the conduction system of the heart.

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