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Automated Electrocardiographic Diagnoses

Part I. Heart Rhythm Diagnoses

Class 1. Cardiac pacemakers

  • Sinus rhythm
  • Low atrial rhythm
  • Ectopic atrial rhythm
  • Junctional rhythm
  • Supraventricular rhythm
  • Idioventricular rhythm

Class 2. Wandering pacemaker

  • Wandering atrial pacemaker
  • Consider wandering atrial pacemaker

Class 3. Heart rate

  • Severe bradycardia
  • Bradycardia (<60 bpm)
  • Normocardia (60-90 bpm)
  • Tachycardia (>90 bpm)
  • Severe tachycardia
  • Tachycardia
    • regular rhythm
    • irregular rhythm
      • HR
      • ventricular rate
      • atrial rate

Class 4. Fibrillation and flutter

  • Atrial fibrillation
  • Suggests atrial fibrillation
  • Atrial flutter
  • Atrial fibrillation with third degree AV block
  • Bradycardia
  • tachycardia

Class 5. Premature complexes

  • Atrial premature complex(es)
  • Junctional premature complex(es)
  • Supraventricular premature complex(es)
  • Left ventricular premature complex(es)
  • Right ventricular premature complex(es)
  • Ventricular premature complex(es)
  • Suggests junctional premature complex(es)
  • Suggests supraventricular premature complex(es)
  • Suggests left ventricular premature complex(es)
  • Suggests right ventricular premature complex(es)
  • Suggests ventricular premature complex(es)
  • occasional
  • frequent
  • couplets
  • quadrigeminy
  • trigeminy
  • bigeminy
  • episode of quadrigeminy
  • episode of trigeminy
  • episode of bigeminy     
  • interpolated
  • nonconducted

Class 6. Paroxysmal tachycardia

  • Severe tachycardia
  • Severe tachycardia, consider atrial flutter
  • Atrial fibrillation, consider atrial flutter
  • Intermittent

Class 7. Pre-excitation syndrome

  • WPW pattern
  • Short PR interval

Class 8. Sinoatrial block

  • Suggests sinoatrial block, type I
  • Sinoatrial block, type II
  • Sinoatrial arrest episode

Class 9. AV block

  • First-degree AV block
  • Second-degree AV block, Mobitz Type 1 (Wenckebach)
  • Second-degree AV block, Mobitz Type 2
  • AV block, advanced (high-grade)
  • Second-degree AV block
  • AV block, complete (third-degree)

Class 10. Unidentified arrhythmia

  • Unidentified arrhythmia

Class 11. Noise, drift, filter status, sport mode, signal quality, pacemaker spikes

  • Bad quality lead
  • Bad quality leads
  • Pacemaker spikes
  • High noise level in leads
  • Baseline drift in leads
  • Automatic interpretation in Sport mode
  • In-depth medical examination is recommended

PART II. QRS shape diagnoses

Class 1. General ECG conclusion

  • Normal ECG
  • Otherwise normal ECG
  • Technical error, consider dextrocardia
  • Suggests dextrocardia
  • Misplaced limb electrodes. Check electrode’s placement

Class 2. QRS axis

  • Normal axis
  • Right axis deviation
  • Indeterminate axis
  • Left axis deviation, consider left anterior fascicular block
  • Left axis deviation
  • Normal axis
  • Right axis deviation, consider right ventricular hypertrophy and left posterior fascicular block
  • Right axis deviation
  • Right axis deviation, consider right ventricular hypertrophy and left posterior fascicular block
  • Right axis deviation

Class 3. Atrial syndrome

  • Right atrial enlargement
  • Suggests right atrial enlargement
  • Left atrial enlargement
  • Suggests left atrial enlargement
  • Atrial conduction abnormality

Class 4. Intraventricular block

Right bundle branch block
  • Complete right bundle branch block
  • Incomplete right bundle branch block
  • Suggests incomplete right bundle branch block
  • rSr’ pattern in V1 or V2
Left bundle branch block
  • Complete left bundle branch block
  • Incomplete left bundle branch block
  • Suggests incomplete left bundle branch block and old anteroseptal myocardial infarction
  • Left anterior fascicular block
  • Suggests left anterior fascicular block
  • Left posterior fascicular block
  • Suggests incomplete left bundle branch block
Bifascicular and trifascicular block
  • Complete right bundle branch block and left anterior fascicular block
  • Complete right bundle branch block and left posterior fascicular block
  • Trifascicular block
  • Intraventricular block
  • Intraventricular conduction delay

Class 5. Myocardial infarction

  • Myocardial infarction
  • Suggests myocardial infarction
    • acute
    • of indeterminate age
    • old
    • anterobasal
    • anterolateral
    • inferior
    • anteroseptal
    • anteroapical
    • extensive anterior
    • anterior and inferior
    • inferolateral
    • inferoseptal
    • inferoаpical
    • extensive inferior
  • Q wave in leads
  • Consider inferobasal myocardial infarction

Class 6. Ventricular hypertrophy

Right ventricular hypertrophy
  • Right ventricular hypertrophy, consider right ventricular strain
  • Right ventricular hypertrophy
  • Right ventricular hypertrophy, consider chronic obstructive pulmonary disease
  • Suggests right ventricular hypertrophy with strain
  • Suggests right ventricular hypertrophy
  • with systolic strain
  • with diastolic strain
Left ventricular hypertrophy
  • Left ventricular hypertrophy, consider left ventricular strain
  • Left ventricular hypertrophy
  • Left ventricular hypertrophy with systolic strain
  • Left ventricular hypertrophy with diastolic strain
  • Suggests left ventricular hypertrophy
  • Prevalence of left ventricular electrical activity

Class 7. Other depolarization syndromes

  • SI SII SIII pattern, consider right ventricular hypertrophy, pulmonary disease
  • SI QIII TIII pattern, consider pulmonary embolism
  • Low voltage
  • High voltage
  • Electrical alternans

Class 8. ST and T changes

  • ST deviation
  • T-wave change
  • ST deviation and/or T-wave change
  • T-wave change
  • Nonspecific ST deviation
  • Nonspecific T-wave change
  • Nonspecific ST deviation with T-wave change
    • most evident
    • major
    • moderate
    • minor
    • possible

Class 9. Other repolarization syndromes

  • ST elevation, consider myocardial infarction, pericarditis, early repolarization
  • ST elevation, consider pericarditis, early repolarization
  • Suggests ST elevation, consider myocardial infarction, pericarditis, early repolarization
  • Suggests ST elevation, consider pericarditis, early repolarization
  • Suggests early repolarization
  • Tall T-waves in V1-V4, consider inferobasal ST-T changes, hyperkalemia
  • ST elevation in V1-V4, consider enhanced vagal tone, hyperkalemia, inferobasal ST-T changes
  • Nonspecific T-wave changes T(V1) > T(V6)
  • Consider digitalis effect
  • Juvenile T waves
  • Short QT interval
  • Prolonged QT interval
  • Suggests short QT interval
  • Suggests prolonged QT interval
  • Consider Brugada syndrome