The ECG in the figure below:
is suggestive of:
Incorrect electrode placement. This patient has a sinus rhythm and right axis deviation. The vectors in leads I and aVL are incompatible with those seen in the other lateral leads, V5 and V6 . The discrepancies are explained by the inverted P waves in leads I and aVL, which suggest switched arm wires. This is a normal ECG with a technical error.
Atrial septal defect, secundum. The patient is a 6-year-old with an outflow tract murmur. Rhythm is sinus with a narrow complex. V1 shows small rSR′ with a large R ′. There is right axis deviation. This is right ventricular hypertrophy. It is a volume-overload-type pattern. Most likely an ostium secundum ASD.
Left ventricular hypertrophy by left ventricular hypertrophy by voltage and ST-T segment (secondary repolarization changes). Here there is sinus bradycardia with left ventricular hypertrophy (voltage) and secondary T-wave changes extending into the right precordium. Most likely this is a hypertrophic cardiomyopathy with apical hypertrophy. This is occasionally called Yamaguchi syndrome after the initial describer of the variant.
Nonspecific ST- and/or T-wave changes. Although leads I, aVL, and III might suggest an atrial tachycardia, other leads clearly show a sinus rhythm. This is a motion artifact due to unilateral tremor and Parkinson disease.
shows:
Atrial premature beats with aberrant intraventricular conduction. Here is a sinus rhythm with minor lateral T-wave flattening. The last beat is premature and is an aberrant PAC. Characteristics of aberrancy are preceding atrial activity (seen in the T wave) and initial narrow vector with broadening toward the end of the complex and often a right bundle branch block type of pattern.
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