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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 ECGย effectively.ย If you want to learn more about ECGs, you can check out ourย ECG guides.

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

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ECG quiz

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Question 1
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 2
An ECG is performed and reveals a progressively increasing PR interval and dropping of QRS complexes at regular intervals. Which of the following is the most likely diagnosis?
A
First-degree heart block
B
Second-degree heart block (Mobitz type 2)
C
Second-degree heart block (Mobitz type 1)
D
Hyperkalaemia
Question 2 Explanation: 
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.
Question 3
What view of the heart do leads V1 and V2 represent?
A
Inferior
B
Septal
C
Anterior
D
Lateral
Question 4
Which artery is most likely to be affected in the context of ST elevation being 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 4 Explanation: 
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.
Question 5
What is the most common cause of left axis deviation?
A
Defects of the conduction system
B
Left ventricular hypertrophy
C
Right ventricular hypertrophy
D
Atrial septal defects
Question 5 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 6
Which of the following is a common cause of right axis deviation?
A
Right ventricular hypertrophy
B
Ventricular septal defect
C
Left ventricular hypertrophy
D
Atrial septal defect
Question 6 Explanation: 
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.
Question 7
What does ST-elevation suggest?
A
Myocardial infarction
B
Heart murmur
C
Heart block - Mobitz type II
D
Bundle branch block
Question 8
A patient is noted to have an abnormally shortened PR-interval on their ECG. Which of the following is the most likely cause?
A
Right bundle branch block
B
Atrioventricular nodal fibrosis
C
Wolff-Parkinson-White (WPW) syndrome
D
Left bundle branch block
Question 8 Explanation: 
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.
Question 9
If ST-elevation was noted in leads II, III and aVF, what would it suggest?
A
A posterior myocardial infarction
B
An inferior myocardial infarction
C
A septal myocardial infarction
D
An anterior myocardial infarction
Question 9 Explanation: 
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.
Question 10
What view of the heart do leads V3 and V4 represent?
A
Anterior
B
Septal
C
Inferior
D
Lateral
Question 11
What is the normal duration of a QRS complex?
A
0.04 seconds (1 small square)
B
0.08 seconds (2 small squares)
C
0.16 seconds (4 small squares)
D
0.12 seconds (3 small squares)
Question 11 Explanation: 
In most healthy individuals, you would expect QRS complexes to be around 0.12 seconds in duration. If a QRS complex lasts longer it is described as a "wide QRS" and indicates inefficient conduction ventricular conduction (e.g. bundle branch block).
Question 12
Which of the following best describes the ECG leads shown below?
A
Left axis deviation
B
Right axis deviation
Question 13
If there were 3 large squares in an R-R interval what would the heart rate be?
A
70 bpm
B
80 bpm
C
90 bpm
D
100 bpm
Question 13 Explanation: 
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.
Question 14
What view of the heart do leads I, aVL, V5 and V6 represent?
A
Inferior
B
Septal
C
Lateral
D
Anterior
Question 15
An ECG reveals an absence of P-waves and an irregular rhythm. Which of the following is the most likely diagnosis?
A
2nd-degree heart block
B
1st-degree heart block
C
Atrial fibrillation
D
Ventricular tachycardia
Question 15 Explanation: 
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.
Question 16
What is the duration of a normal PR-interval?
A
0.04 - 0.08 seconds (1-2 small squares)
B
0.08 - 0.12 seconds (2-3 small squares)
C
0.12 - 0.2 seconds (3-5 small squares)
D
0.04 - 0.12 seconds (1-3 small squares)
Question 16 Explanation: 
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).
Question 17
What view of the heart do leads II, III and aVF represent?
A
Inferior
B
Septal
C
Lateral
D
Anterior
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