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Once on the ward, you’ll be asked to comment on ECGs regularly, therefore 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.

Take our ECG quiz to put your knowledge to the test.

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ECG quiz

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Question 1
If ST-elevation was noted in leads II, III and aVF what would it suggest?
A
A septal myocardial infarction
B
An inferior myocardial infarction
C
An anterior myocardial infarction
D
A posterior myocardial infarction
Question 1 Explanation: 
Leads II, III and aVF all look at the heart in the inferior plane. Therefore ST-elevation in only these leads suggests an inferior myocardial infarction.
Question 2
Which artery is most likely to be affected if ST elevation in present in leads V3 and V4?
A
Left anterior descending coronary artery
B
Right coronary artery
C
All of the above
D
Left circumflex coronary artery
Question 2 Explanation: 
Leads V3 and V4 related to the anterior portion of the heart. Therefore ST elevation in these leads suggests an anterior infarct. The anterior portion of the heart is supplied mainly by the left anterior descending artery therefore this is most likely to have been affected.
Question 3
What does ST-elevation suggest?
A
Myocardial infarction
B
Heart murmur
C
Heart block - Mobitz type II
D
Bundle Branch Block
Question 4
What view of the heart do leads I, aVL, V5 and V6 represent?
A
Inferior
B
Lateral
C
Anterior
D
Septal
Question 5
If there were 3 large squares in an R-R interval what would the heart rate be?
A
100 bpm
B
90 bpm
C
70 bpm
D
80 bpm
Question 5 Explanation: 
To calculate heart rate from an ECG you count the number of large squares in an R-R interval then divide 300 by this number. Therefore 300/3 = 100 bpm.
Question 6
What is often the earliest ECG change seen during myocardial infarction?
A
ST-elevation
B
Tall peaked T-waves
C
ST-depression
D
Tall P-waves
Question 6 Explanation: 
Tall peaked T-waves can suggest a number of abnormalities. If seen in all leads then they usually suggest the individual has hyperkalaemia. However if tall T waves are seen in a particular group of leads it suggests early MI. The tall T waves are due to potassium leaking through the damaged membrane over the infarcted area.
Question 7
What view of the heart do leads V3 & V4 represent?
A
Lateral
B
Septal
C
Inferior
D
Anterior
Question 8
What would it suggest if lead I became more positive than lead II and lead III became negative?
A
Right axis deviation
B
Left axis deviation
Question 9
The duration of the PR interval is noted to be increasingly prolonged. In addition QRS complexes appear to be dropped at regular intervals. What diagnosis would this suggest.
A
Second degree - Mobitz Type 1 - Heart Block
B
First degree Heart Block
C
Hyperkalaemia
D
Second degree - Mobitz Type 2 - Heart Block
Question 9 Explanation: 
Second degree - Mobitz Type 1 - Heart Block is a disease of the AV node. It is seen as progressive prolongation of the PR-interval with associated regular dropping of the QRS complex.
Question 10
What is the most common cause of left axis deviation?
A
Atrial septal defects
B
Right ventricular hypertrophy
C
Defects of the conduction system
D
Left ventricular hypertrophy
Question 10 Explanation: 
Left axis deviation is rarely the result of left ventricular hypertrophy and more often due to defects in the conduction system of the heart.
Question 11
If a rhythm is described as sinus, what does this indicate?
A
A QRS-complex precedes each T-wave
B
A P-wave precedes each QRS-complex
C
P-waves are present
D
QRS-complexes are present
Question 11 Explanation: 
If a rhythm is described as sinus it indicates that a P-wave precedes each QRS-complex. However a rhythm can still be irregular even if it's sinus.
Question 12
A patient is noted to have an abnormally shortened PR-interval on their ECG. Which of the following is the most likely cause?
A
Left bundle branch block
B
AV nodal fibrosis
C
Wolf Parkinson White Syndrome
D
Right bundle branch block
Question 12 Explanation: 
A short PR-interval indicates abnormally short conduction time between the atria and ventricles. This is caused by the presence of an accessory pathway between the atria and ventricles. Wolf parkinson white syndrome is an example of this kind of disorder. In WPW the 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.
Question 13
What is the normal duration of a QRS complex?
A
0.12 seconds (3 small squares)
B
0.16 seconds (4 small squares)
C
0.04 seconds (1 small square)
D
0.08 seconds (2 small squares)
Question 13 Explanation: 
In most healthy individuals you would expect QRS complexes to be around 0.12 seconds or slightly less. If a QRS complex lasts longer it is described as a "wide QRS" and can be a sign of inefficient conduction of the ventricles such as bundle branch block.
Question 14
The absence of P-waves and an irregular rhythm would suggest a diagnosis of...
A
2nd degree heart block
B
1st degree heart block
C
Ventricular tachycardia
D
Atrial fibrillation
Question 14 Explanation: 
In atrial fibrillation the atria no longer conduct electricity from the SA in an orderly fashion. Therefore P-waves are lost. As a result of disordered atrial activity only occasional waves of depolarisation pass through to the AV node and cause ventricular activation. This causes the typical irregular rhythm.
Question 15
What view of the heart do leads II, III and aVF represent?
A
Lateral
B
Septal
C
Anterior
D
Inferior
Question 16
What is a common cause of right axis deviation?
A
Left ventricular hypertrophy
B
Ventricular septal defect
C
Right ventricular hypertrophy
D
Atrial septal defect
Question 16 Explanation: 
In right ventricular hypertrophy the increased muscle mass of the right ventricle causes 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.
Question 17
What view of the heart do leads V1 & V2 represent?
A
Anterior
B
Inferior
C
Septal
D
Lateral
Question 18
What is the duration of a normal PR-interval?
A
0.04 - 0.12 seconds (1-3 small squares)
B
0.12 - 0.2 seconds (3-5 small squares)
C
0.04 - 0.08 seconds (1-2 small squares)
D
0.08 -0.12 seconds (2-3 small squares)
Question 18 Explanation: 
n normal individuals the PR-interval is between 0.12-0.2 seconds. A PR interval longer than this can suggest the presence of heart block and a short PR-interval can suggest an accessory pathway between the atria & ventricles e.g. WPW syndrome
Question 19
What would it suggest if lead I became negative and lead III became more positive than lead II?
A
Left axis deviation
B
Right axis deviation
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