SIEMENS
BURDICK
For
Interpretive
BURDICK E 500
Electrocardiographs
Physician's
Interpretation
Guide
Criteria
To
BURDICK E 550
BURDICK E 600
BURDICK
ELITE
Miscellaneous
Arm
lead
св
Dextrocardia
Ventricular
1.
Type
2,
Type
3.
Atypical
Atrial
1.
Right
2.
Left
Axis
1.
Left
2.
Right
3.
Indeterminate
Low
QRS
1.
Low
2.
Low
3.
Si-S2-S3
4,
Pulmonary
Copyright
reversal
pre-excitation
A
B
enlargement
deviations
voltage
limb
chest
Mortara
All
and
lead
lead
pattern
disease
rights
CONTENTS
related
voltage
voltage
Instrument,
reserved
(WPW)
phenomena
Inc.
II.
III.
Conduction
a.
Right
1.
2.
3.
4,
b.
Left
1.
2.
3.
c.
Nonspecific
1.
2.
Hypertrophy
a.
Right
1。
2.
Abnormalities
bundle
RSR'
Incomplete
Right
RBBB
(OR)
bundle
+
RVH
pattern
right
bundle
Left
bundle
Left
anterior
Left
posterior
abnormality
Intraventricular
Intraventricular
ventricle
RVH
ВУН
+
repolarization
bundle
branch
branch
fascicular
fascicular
delay
block
branch
block
block
block
block
abnormality
block
Product
Number
086002
b.
Left
1.
2.
3.
ventricle
LVH
(voltage
LVH
LVH
+
only)
repolarization
abnormality
—)
=3
二
IV.
VI.
Myocardial
Anterior
Septal
ge
Lateral
Inferior
Inferior
nn
Infarct
ST
elevation
Nonspecific
Early
Pericarditis
Loc»
Subepicardial
1.
2.
3,
4
ST
depression
a.
Junctional
b.
ST
c.
Subendocardial
Infarction
+
suppressions
repolarization
Septal
Anterior
Lateral
Inferior
segment
posterior
ST
elevation
injury
injury
LT
1
7
71
2)
—J
J
VII.
T
a.
cano
wave
abnormalities
Ischemia
l.
Anterior
2.
Lateral
3.
Inferior
Abnormal
Nonspecific
Tall
T
wave
QT
interval
QRS-T
T
angle
wave
abnormality
ー
1
TJ
I
22
—
1
Ad
PROLOGUE
The
strument
conventions
pleteness.
At
fined
the
ments
are
Statement
following
electrocardiographs
are
These
the
beginning
for
beginning
are
implicitly
sections
used
each
for
include:
interpretation.
of
explicitly
defined
is
issued.
document
to
reasons
of
the
the
interpretation
defined
(as
the
interpret
of
brevity,
interpretation
All
for
later
true)
when
criteria
acquired
and
process
such
elements
process.
use,
the
used
1l2-lead
at
the
a
in
same
test
are
Occasionally
but
most
corresponding
Mortara
ECGs.
time,
element
set
false
these
frequently
interpretive
In-
Several
com-
is
de-
at
ele-
they
Following
The
first
Statement.
made
previous
a
are:
to a prior
condition
NML
ATY
BO
ABN
NFI
X
each
acronym,
These
statement
associated
interpretive
*ABC"
are
used
statement,
is
required.
with
Normal
Atypical
Borderline
Abnormal
No
No
ECG
Further
Condition
statement
is
an
subsequently
as
for
the
ECG
-
meaning
been
specific
ECG
-
specificity
or
met.
Interpretation
tecting
tion,
tion
Associated
fixes
two
abbreviation
example
The
second
statement.
an
observed,
significance.
used
where
where
the
no
of
the
-
and
acronyms
or
when
when
part,
The
unusual
criteria
or
only
-
used
phenomenon
further
record
used
suffixes
will
acronym
a
reference
suppression
"XYZ"
possible
pattern
but
which
prognostic
minimal
where,
useful
is
possible.
with
statement
be
found.
for
must
represents
variations
has
has
have
limited
significance
criteria
upon
in
ques-
interpreta-
the
of
no
de-
pre-
be
a
are
Interpretive
terpretive
immediately
a
short
synopsis
specified
statements
all
ECGs
Interpretation
via a setup
listing.
within
weaker
ments
statement
within
dent
a
given
forms)
from
a
subsections
statements
text,
and
follows
of
conclusion.
where
of
users
the
Ordinarily
section
in
previous
is
used,
section,
in
the
the
a
have
(2)
the
each
principle
The
find
function
ECG
the
last
supplants
same
sections
Whenever
*
two
optional
statement
intention
them
on
proceeds
valid
section.
is
multiple
”will
components:
"reason"
below,
criteria
is
to
helpful.
the
electrocardiograph.
in
the
statement
all
prior
Whenever
required,
statements
separate
(1)
statement,
and
used
to
provide
They
sequence
or
conclusion
statements
suppression
an
explicit
the
logically
the
which
reach
these
can
of
are
actual
which
provides
the
reason
be
omitted
the
criteria
reached
(usually
of
“suppress”
possible
indepen-
in-
on
state-
73
ARM
LEAD
Criteria:
IF:
Rationale:
Simultaneously
likely
Qr
(or
arm
leads
typical
wise,
dextrocardia
REVERSAL
and
and
and
say
"Arm
“Inverted
otherwise
in a properly
rSr')
upright
configuration,
are
reversed
configuration,
or
then
is
&
DEXTRACARDIA
QRS
axis
P
axis
PR
durations
if:
leads
say
reveresed”
P & QRS
"Dextrocardia"
"Inverted
negative
recorded
the
or
destrocardia
the
remaining
>
Q(I)
0(1)
>
90
P
ECG.
arm
90
>
>
= 0 and
R(V6)
or
R(V6)
or
P(V6)
or
P'(V6)
in
and
most
lead
110
ms
0
>=
>
S(V6)
>=
>=
lead
P & QRS
QRS
contours
If,
in
probable
is
reversal
plausible
RI)
500
LV
20
mV
-20
mV
I"
in
addition,
explanation
present.
explanation.
<
lead
is
150
ARM.
V6"DEX.
in
lead I are
the
If
lead
more
QRS
is
that
V6
likely:
has
has
ATYP
ATYP
un-
a
the
other-
a
I
—
29
-
}
CJ
こす
9)
A
]
Although
cardia
mentions
of a Or
ample,
but
the
can
QRS
diseases.
infarction,
unexpected,
the
reason
(rSr')
readily
only
morphology
the
cause
configuration
A
Qr
configuration
but a simultaneously
statement
inverted
is
important.
right
is
rS
may
P & QRS
axis
in
this
occur
inverted
for
both
deviation
and
in
lead
in
lead
Pulmonary
of
other
rare
P
in
such
reversal
I,
the
disease,
both
the
typical
instances
events
and
dextro-
requirement
for
ex-
P
and
QRS,
right
from
heart
lateral
would
be
.
i
-
CII
I
WPW
Skip
Criteria:
IF:
IF:
IF:
test
if:
or
or
or
or
or
and
and
and
and
Coupled
PR
duration
QRS
duration
Heart
QRS
duration
PR
duration
PR
duration
Delta
say
“Atypical
Delta
R
amp
say
“Type
Delta
S
amp
PR
duration
P
wave
rate
wave
wave
wave
>
> S amp
A
>=
R
to
QRS
is
>
170
ms
<
100
ms
120
BPM
>
200
ms
>
100
ms
and
<
140
is
present
Wolff-Parkinson-White
is
present
in
Wolff-Parkinson-White
is
present
amp
in
<
140
in 2 leads
in 2 leads
VI
in 2 leads
Vl
ms
not
QRS
present
duration
WPWZ.
Pattern"
WPWA,
>
Pattern"
160
ms
ABN
ABN
or
and
QRS
R
say
dur
area
>
"Type
ratio > 0.4
30
in
VZ
B
Wolff-Parkinson-White
in 1 of
I/V5/V6
WPWB.
Pattern"
ABN
]
ATRIAL
Criteria:
IF:
IF:
IF:
ENLARGEMENT
and
and
and
Heart
amp
P
say
"Possible
"0.25
Heart
amp
P
say
"Right
“0,3
P'
amp
negative
say
"Possible
"0.1
P'
amp
negative
lead
say
“Left
"-0.15
rate
>
rate
>
<
¢
<
250
mV
<
300
atrial
mV
-100
P'
wave
mV
-150
p'
wave
atrial
mV
120
in
uV
right
P
wave"
120
in
uV
enlargement"
P
wave"
pV
area
left
atrial
P
wave
pV
area
enlargement"
P
wave
any
atrial
any
in
Vl
in
in
V1
leads
of
enlargement"
leads
of
or
V2
>=
4000
enlargement"
lead
>=
in
or
6000
lead
V1/V2"
V2
II/III/aVF/V1/V2
RAE,
II/III/aVF/V1/V2
RAE.
uV/ms
uV/ms
]
Vl/Ve"
in
LAE.
in
LAE.
same
the
BO
=
ABN
A
lead
DJ
BO
1
same
I
ABN
Rationale:
The
only
information.
or
tude
minimal
above,
at
criteria
for
elevated
are the
criteria,
Right
the
atrial
reason
rates
customary
the
qualifier
enlargement
that
is
properly
it
ones,
"possible"
is
unclear
attributed
is
not
For
is
"read"
whether
to
enlargement.
those
used
records
to
convey
for
rates
increased
meeting
this
of
120
P
ampli-
=
A
o
1
—
a
J
一
二
1)
LUI
AXIS
Criteria:
DEVIATION
IP:
IF:
IF:
IF;
IF:
and
QRS
axis
say
"Moderate
"QRS
QRS
axis
say
“Abnormal
“QRS
ORS
axis
say
“Moderate
"QRS
QRS
axis
age > 15
say
"Abnormal
"QRS
The
total
is < 33%
and
III
«
axis
«
axis
>
axis
>
axis
net
of
-20
-30
90
100
the
Left
<
Left
<
Right
>
Right
>
QRS
total
axis
-20"
axis
-30"
axis
90"
axis
100"
amplitude
QRS
deviation"
deviation"
deviaiton"
deviation"
in
deflection
leads
LAD.
LAD.
RAD.
I,
in
RAD.
II
leads
and
ABN
ABN
I,
BO
BO
III
II
Rationale:
The
characterized
statements
may
be
regarded
Whenever
deflection
ing.
The
criteria
by
are
omitted
the
in
each
term
“indeterminate
are
the
as
lead,
say
use
the
net
"Indeterminate
more
when
or
of
the
subsequently
probably
amplitude
the
measurement
less
terms
cause
is a small
axis"
axis"
conventional.
"moderate",
identified
of
the
fraction
of
axis
is
used
to
axis
is
convey
DAX.
Borderline
(Axis
diagnostic
deviation
deviation.)
of
the
lacking
this
ATY
cases
total
in
information.
are
categories
QRS
mean-
LOW
VOLTAGE
AND
S1-S2-S3
PATTERN
(1
21
Skip
Criteria:
IF:
IF:
IF:
IF:
test
if:
QRS
(a)
(b)
(c)
or
and
and
and
duration
Total
say
Total
say
If
((a)
say
R
amp
and
and
no
R'
S
amp
age
ORS
“Low
"QRS
QRS
"Low
"ORS
"Low
"QRS
>
is
>
15
>=
120
deflection
QRS
deflection
deflection
QRS
deflection
and
(b)
QRS
deflection
< S amp
S
amp
S
amp
S
amp
present
200
uV
ms
voltage
<
voltage
<
are
voltage"
<
in
leads
>
300
>
400
>
700
in
in
leads
<
500
in
0,5
<
1000
in
1.0
both
0.5/1.0
pV
pV
pV
any
pV
limb
mV
uV
chest
mV
true
I,
Il, & III
in
I
in
II
in
III
of
these
I,
Ii, & III
in
all
leads"
in
limb
in
all V leads
leads"
in
chest
mV
in
leads
limb
limb/chest
leads
leads"
LVL,
leads"
LVV.
LV.
ATYP
ATYP
ATYP
leads”
ZI
4
τι
TI
LA
一
TI
二
一
1
一
say
"S1~-S2-S3
disease,
pattern,
RVH,
consistent
or
normal
with
variant"
pulmonary
SSS.
BO
Y
3)
一
PULMONARY
DISEASE
Skip
Criteria:
The
typical
Three
test
test
points
IF:
Rationale:
if:
QRS
for
pulmonary
characteristics
(1)
(2)
(3)
{4}
(4)
(5)
(6)
QRS
(and
Right
QRS
QRS
QRS
51-52-53
Low voltage
Low
are
awarded
net
R')
cumulative
say
duration
disease
are
atrial
axis
axis
axis
<
>
is
pattern
voltage
amplitude
amplitude
"Consistent
>=
120
is
present.
enlargement
-30
90
indeterminate
in
limb
in
chest
if:
is
negative
in
points
based
V6
with
ms
One
leads
leads
<«
>
3
on
counting
point
in
lead
500
pV.
pulmonary
is
awarded
V5
disease"
how
and
many
for
the
PUL,
R
of
each
its
of:
ABN
There
diagnose
distinct)
comment
is
room
pulmonary
features
“consistent
to
disease.
common
with"
doubt
to
whether
pulmonary
seems
However,
prudent.
sufficient
if
at
disease
ECG
criteria
exist
least 4 (from a list
are
present,
then
of
the
to
8
TI
RIGHT
Criteria:
IF:
or
IF:
and
and
IF:
or
BUNDLE
CONDUCTION
(a)
(b)
R
present
R'
not
say
ventricular
QRS
S
either
say
QRS
and
and
and
and
QRS
and
and
and
and
amp
>
in
amp
>
present
"RSR
duration
dur
>=
(a)
"Incomplete
"90+
V2,
duration
S
dur
R
dur
QRS
Vl
does
duration
S
dur
R
dur
R
or
QRS
100
Vl
100
(OR)
conduction
40
or
MS
40+
>=
¢
area
>=
«
R'
area
pV
and
or
V2
pV
and
in
Vl
or
in
lead
>
90
ms
in
(b)
is
right
QRS
duration,
MS S in
>=
120
40
ms
100
ms
> 0 in
not
terminate
>
105
60
ms
100
ms
dur
>
> 0 in
ms
any
ms
60
R
dur
R'
V2
V1/V2
delay"
2
true
bundle
lead
ms
in
any
in
VI
in
any
in
ms
VI
>
20
dur
>
consisitent
of
leads
branch
terminal
I/AVL/V5/V6"
2
of
any
4
of
in S or
3
of
any
4
of
in
VI
ms
and
20
ms
and
I/aVL/V4/V5/V6
block"
R
in
IRBBB.
leads
leads
S'
leads
leads
S
is
not
S'
is
with
RSR.
I/aVL/V4/V5/V6
I/AVL/V4/V5/V6
I/aVL/V4/V5/V6
I/AVL/V4/V5/V6
lead
right
V1/
I
一
一 1
—
BO
1)
BO
and
IF:
and
and
Rationale:
Right
rightward
ticeably
bundle branch
directed
prolonged.
say
"Right
"120+
in
suppress
Right
R
or
QRS
axis
say
"Right
"RBBB,
terminal
Thus,
lead
bundle
R'
amp
conduction
bundle
MS
QRS
I/AVL/V5/V6"
Right
branch
>
>
110
bundle
1.5
forces.
in
addition
-
brance
duration,
Axis
1500
branch
mV
R
abnormalities
The
10
-
block"
Deviation,
block
pV
in
to
is
in
V1
block,
Vl,
rightward
QRS
upright
Borderline
present
plus
RAD"
exhibit
force
conduction
RBBB.
Vl,
possible
RBRVH.
40+
anterior
should
time
ABN
MS
S
RVH"
ABN
be
criteria,
and
no-
一
-
=
I
TI
LI
tests
minal
2
of
are
included
positive
the
lateral
for a terminal
wave
in
leads.
Vl
and
positive
widened
wave
terminal
in
S
Vl
and
waves
widened
in
at
ter-
least
to
read
wide
read
as
portion
Conventional
bundle
R
in
an
RBBB
of
the
Specific
branch
upright
by
most
complete
criteria
criteria
block.
V1,
interpreters.
RBBB
for
requires
and
test.
RBBB
However,
a
QRS
+
RVH
QRS
duration
This
are
widths
very
is
also
in
wide
>
105
the
included.
excess
lateral
basis
ms
will also
of
of
S
the
0.12
waves,
second
sec
a
be
-
11
-
一
LEFT
Criteria:
IF;
IF;
BUNDLE
and
and
and
and
and
and
and
CONDUCTION
QRS
duration
QRS
net
Q/S
duration
no
Q
is
R
duration
say
“Incomplete
"105+
"no Q and
suppress
QRS
axis
R
amp > Q
a O is
S
or
S'
say
"Left
"QRS
amplitude
present
>=
ms
Borderline
<
-44
amp
present
amp
anterior
axis
>
105
< 0 in
>=
80
in 2 of
60
ms
left
QRS
duration,
60+
ms
in
I & aVL
in
I
> R and
fascicular
<
-44,
ms
ms
in
in 2 of
bundle
R
Left
R'
QR
Vl & V2
Vl & V2
1/V5/V6
I/aVL/V5/V6
branch
80+
in
lead
Axis
amp
block"
in
I,
block"
ms
Q/S
I/AVL/V5/V6"
Deviation
in
II
RS
in
II"
ILBBB.
in
lead
LAFB.
LI
4
4
1
ABN
V1/V2"
TIV
LI
ABN
=
IF;
IF:
and
and
and
and
and
and
and
and
and
suppress
S1-S2-S3
Consistent
QRS
axis
R
amp
> Q amp
a Q is
say
present
"Left
"QRS
suppress
Incomplete
QRS
area
R + R'
QRS
duration
or
QRS
and
or
QRS
and
and
Borderline
is
not
with
>=
110
posterior
axis
Borderline
Left
ratio
duration
>=
duration
the
duration
the
QRS
present
Pulmonary
in
in
>
109,
Bundle
>
>=
160
average
average
area
and
Abnormal
III & aVF
III & aVF
fascicular
inferior
and
Abnormal
Branch
0.25
100
in I or
ms
ms
>=
140
R + R'
>=
120
R + R'
ratio
>
Disease
block"
Q"
Block
in 1 of
ms
duration
ms
duration
0.4
Left
has
Right
is
V6
I/aVL/V6
in 2 of
Axis
been
LPFB.
Axis
present
>
83
>
83
I/aVL/V6
Deviation
ruled
out.
Deviation
ms
in
ms
in
ABN
I/aVL/V6
I/aVL/V6
__J
I
—t
J
a
3
TI
-
MA
-
71
Ta
say
"Left
"120+
85+
bundle branch
ms
QRS
duration,
ms
R
in
lead
block"
804+
I/AVL/V5/V6"
ms
Q/S
in
LBBB.
lead
ABN
V1/V2,
Rationale:
The
known.
defined,
block
is
The
ratio",
area
and
of a rectangle
tive
amplitude.
has a wide
above
LBBB
to
QRS
patterns.
better
with
creased
Strict
noted
by
meaining
For
and
available,
test
which
LBBB
discriminate
nonspecific
QRS
readers
suppress
this
reason
whenever
for
is
defined
The
or
tests
are
The
duration.
criteria
who
Borderline
of
ILBBB
a
the
term
LBBB
defined
area
notched
empirically
area
between
terminal
for
use
beyond
the
criteria
specific
ILBBB
introduces
as
the
by
QRS
ratio
R
wave
ratio
true
slurring
fascicular
simple
Left
Axis
describing
for
label
is
a
measurement
ratio
of
onset
is
large
peak.
determined
is
used
LBBB
blocks
axis
Deviation
this
statement
such
as
suppressed.
the
QRS
and
offset
whenever
The
to
in
lieu
and
a
of
the R wave
are
used.
deviation
an
ECG
pattern
are
left
anterior
called
area
the
the
(algebraic)
and
the
QRS
thresholds
correlate
with
of R duration
monophasic
leading
This
tests.
narrowly
fascicular
“QRS
peak
is
upright
used
typical
in
(upright)
to
should
is
in
order
in-
un-
area
to
the
posi-
the
be
-
118
-
NONSPECIFIC
CONDUCTION
ABNORMALITY
Criteria:
IF:
IF:
and
and
and
and
Right
Incomplete
Left
Incomplete
Left
Left
RSR
QRS
say
Right
Left
QRS
say
suppress
terior
consistent
lay.
Bundle
Bundle
anterior
posterior
Pattern,
duration
“Nonspecific
"110+
Bundle
Bundle Branch
duration
"Nonspecific
*130+
fascicular
Right
Left
ms
ms
Left
with
Branch
Bundle
Branch
Bundle
fasicular
fasicular
>
110
intraventricular
QRS
duration"
Branch
>
130
intraventricular
QRS
duration"
anterior
block
right
Block
Branch
Block,
Branch
block,
block,
ms
are
Block
Block
ms
is
fascicular
and
ventricular
not
is
not
RSR
Block,
Block,
present.
conduction
not
present
present
conduction
block,
in
conduction
IVCDF.
AVCB.
lead
left
VI/V2
delay"
block"
ABN
pos-
de-
BO
一
TY
TI
』
ー
dd
|
0
Rationale:
Intraventricular
which
as
to
be
does
considered
not
fit
conduction
any
block.
previously
delay
-
defined
12
-
is
used
to
pattern,
connote
and
is
QRS
not
widening
so
great
=1
__J
JP
—
—]
』
ーー
DJ
RIGHT
VENTRICULAR
HYPERTROPHY
(RVH)
Skip
Criteria:
The
many
One
test
test
of
point
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
if:
for
(or
is
R/R'
net
net
net
QRS
QRS
QRS
Possible
Sl, S2,
age
if
given
right
in
Right
or
or
or
or
or
or
Left
age
All
S
QRS
QRS
0
or
what
awarded
QRS
QRS
QRS
axis
axis
axis
Q
ventricular
degree)
amp
>
amp
amp
amplitude
>=
>=
>=
right
S3
>
30
Indeterminate
for
QRS
Bundle
<
of O amp,
amp
axis
duration
in
Vl
amp
for
each
500
> 0 in
>
500
90
100
110
atrial
is
present
axis)
Bundle
16
>
1000
«
> S amp
hypertrophy
its
of:
pV
in
wV
uV
« 0 and
enlargement
Axis
Branch
Branch
S
pV
60
>
common
Vl
in
in
is
true,
Block
Block
amp,
140
and
in
V1
ms
R
or
and
exists
is
characteristics
VI
VI
S
amp
has
(in
is
S'
based
>
500
which
is
present
present
amp
net
in
been
<
QRS
I
on
pV
in
called.
case
250
amplitude
counting
are
present.
V5
no
points
uV
or
in
how
V6
I
<
are
IF:
IF;
IF:
and
and
cumulative
say
“Possible
"Some/all
ition
suppress
cumulative
say
"Right
*Some/all
ition,
"Possible
STJ>
STM>STE
pV
in
V1,
QRS
duration
points
right
of:
RAD,
RAD.BO,
RSR.BO,
IVCD.BO
points
ventricular
of:
RAD,
right
or
V2,
and
«
-
13
>
3
ventricular
prominent
RAE,
S1-S2-S3"
RAD.ABN,
LVL.ATYP,
» 5
prominent
RAE,
ventricular
one
120
S1-S2-S3"
of
V3
ms
-
R
LPFB.ABN,
LVV,ATYP,
hypertrophy"
R
hypertrophy"
(STM,
STE,
hypertophy"
RVH.
in
V1,
late
SSS.BO,
RVH.
in
Vl,
late
AND
T)
ABN
trans-
LV,ATYP,
ABN
trans-
is
called,
<
-100
say
“Right
ization
ventricular
abnormality"
hypertrophy
with
RVHR.
00
repolar-
ABN
Rationale:
STJ,
amplitudes
peak
STM,
of
the
STE,
at
T,
and
T,
QRS
offset,
respectively.
"Some/all
ition,
ST
as
used
the
of:
RAD,
depression"
above
midpoint
prominent
RAE,
refer
of
S1-S2-S3,
to
ST,
the
ST
R
in
right
segment
end
of
Vl,
precordial
and
ST,
late
and
trans-
T
wave
the
-
14
-
LEFT
Criteria:
VENTRICULAR
HYPERTROPHY
(LVH)
Tests
ization
lated
standard
threshold.
as
Skip
Thresholds
A
Voltage
for
factor).
the
test
Age/Measure
threshold
(1)
(2)
(3)
(4)
LVH
include
abnormalities
To
criteria
These
lead
or
if:
or
<
20 ーー ーー
20-29
30-39
40
+
of
criteria
R/R'{aVL)
S/S'(V1)
are
combination
"Left
ORS
1.1
are
R/R'(V5)
R/R'(V5/V6)+S/S'(V1)
various
(strain),
arrive
thresholds
Bundle Branch
duration
」
mV
scored
>»
>
at
scored
S(V1)
3.0
2.4
2.4
for
>
1.1
threshold
threshold
voltage
and
composite
by
depend
of
leads.
>
140
mV
mV
mV
R(aVL)
as
follows:
mV
degree
>
criteria,
left
voltage
of
on
Block"
ms
and
R(V5)
3.0
2.6
2,6
is
used
threshold
atrial
excess
the
is
net
mV
mV
mV
independent
QRS
enlargement
criteria,
over
age
of
present
QRS
R(Max
2
points
2
points
2
points
2
points
duration,
the
the
the
patient,
amplitude
of
ーー
4.5
mV
4.0
mV
3.5
mV
of
+ 1 point/0,1
+ 1 point/0.2
+ 1 point/0.2
+ 1 point/0.3
repolar-
(as a corre-
common
appropriate
as
ς 0 in
V5
or
V6)
age
or
sex.
well
Vl,
mV
mV
mV
mV
=
S(V1)
excess
excess
excess
excess
The
measure
onset
to
Ordinarily,
IF:
IF:
IF:
IF:
IF:
the
of
peak
the
QRS
latter
and
or
conduction
negative
point
cumulative
then
cumulative
then
cumulative
then
peak
then
Atrial
(STE
mV)
T(V1)
then
time
second
corresponds
LVH
is
moderate
voltage
2nd
derivative
the
conduction
Fibrillation
«
STJ)
in
at
least
>
T(V6)
LVH
exists
derivative
points
possible
points
voltage
points
criteria
and
+
in
one
with
the
to
>
0:
>
2:
>
4:
for
-
time
is
not
(STE
of
200
LV
repolarization
context
after
of
the
the S nadir:
TEST
TEST
criteria
TEST
LVH
QRS
threshold
«
-50
I,
1
2
for
3
are
onset
present:
pv)
aVL,
V4,
LVH
is
R
peak
LVH
exists
present
>
68
ms
is
met
TEST
and
(R
V5
abnormalities
and
from
in
in
5
amp
V6
QRS
V5.
V5:
>
1.1
TEST
4
-
15
-
and
or
or
the
the
the
LVH
cumulative
conduction
criteria
with
repolarization
for
points
time
possible
are
>
threshold
LAE
abnormalities
0:
is
are
TEST
1
exceeded:
met
exists
TEST
—J
4
71
IF
IF:
and
and
and
then
in
ILBBB,
The
no
say
the
no
say
the
no
non-voltage
addition,
cumulative
non-voltage
"Minimal
mal
"Meets
R(V5),
cumulative
non-voltage
"Moderate
"Meets
R(VS/V6)+S(V1)"
cumulative
non-voltage
Abnormal
variant"
criteria
R(V5/V6)
criteria
the
points
criteria
voltage
points
criteria
voltage
points
criteria
criteria
statement
are
suppressed
are
criteria
in
one
+S(V1)*
are
criteria
in
one
are
for
IVCD,
>
exist
of:
>
exists
of:
>
exists
LVH
are
present
Borderline
0:
TEST
for
LVH
for
LVH,
R{aVL),
2:
TEST
for
for
R(aVL),S(VL),R(V5),
4:
TEST
for
1
may
LVH,
2
LVH
LVH,
LVH.
3
LVH
S(V1),
may
and
be
be
nor-
BO
normal"
BO
1
I
TI
0
10
INT
IF;
IF:
IF:
and
and
or
say
"Voltage
"Meets
R(V5),R(V5/V6)+S(V1)"
the
non-voltage
repolarization
say
"Possible
"Voltage
the
non-voltage
repolarization
say
"Left
tion
ventricular
abnormality"
"Voltage
the
cumulative
non-voltage
then a flag
tion
with
other
criteria
criteria
criteria
abnormalities
left
criteria
criteria
abnormalities
criteria
points
criteria
LVHF
criteria
for
in
one
are
ventricular
plus
are
hypertrophy
plus
are > 2:
are
present
is
set
which
LVH*
of:
LAE
ST/T
R(aVL),S(V1),
met
do
not
hypertrophy"
or
met
exists
abnormality"
TEST
is
LVHV.
exist
LVHR.
QRS
with
LVHR.
used
widening"
repolariza-
2
in
confunc-
ABN
ABN
ABN
—J
DD
I
00!
a
A
]
I
-
16
-
TI
Rationale:
ECG
criteria
various
greater
general
positives.
several
order
to
records
voltage
criteria
records
for
favorite
than
90%
population
The
voltage
minimize
minimally
meeting
LVH
are,
voltage
may
criteria
initially
would evidently
philosophy
criteria
the
in
impact
exceeding
are
identified
only
voltage
to
be
in
order
of
only
criteria
brief,
are
seem
the
an
as
no
sufficient,
generate
above
to
increase
unavoidable
one
criterion
possible
are
imperfect.
better
than
more
criteria
the
normal
identified
The
30-40%.
but
application
false
has
net
decrease
and
exhibit
variants.
as
sensitivities
Specificities
than
been
true
to
combine
sensitivity.
of
specificity,
no
In
such.
to
non-
all
of
a
In
cases,
Non-voltage
QRS
widening,
present
in
statement
of
intrinsicoid
attempt
The
avoiding
Repolarization
criteria,
teral
is
motivation
spurious
include
leads,
tests
and
combination
is
made.
deflection
made
is
changes,
or a T
for
LVH
repolarization
A
new
to
measure
to
be
increases
depressed,
amplitude
with
more
for
include
at
measure
time
and/or
the
sensitive
in
the
downsloping
in
the
changes.
least
duration
total
purpose
V1
presence
one
of
QRS
the
than
QRS
of
greater
of
Whenever
voltage
widening
total
of
QRS
leftward
intrinsicoid
duration.
identifying
ST
segments
than
left
atrial
any
criterion,
is
used
width.
forces
non-voltage
in
that
in
enlargement,
of
these
a
in
Instead,
in
timing,
any
V6.
stronger
place
lead
while
of
the
are
an
V5,
LVH
la-
MYOCARDIAL
INFARCTION
JI
]
DISCUSSION
Computer
criteria
bably
scribe
have
recent
4%
using
useful
unpublished
test
naturally
criterion,
criteria,
acute
ative T waves
wise
abnormalities
or
recent
But
QRS
verting
tude,
duration.
and
(up
than
in
QRS
infarction
but
every
in
greater
expect.
stereotypical
a
high
review
New
results,
Conventional
for
the
retain
oddly
is a test
or
recent
non-diagnostic
infarcts.
gains
duration.
for
to a maximum
very
to
1
ms
every
100
duration
12
can
"Q
Likewise,
ms.
block,
small
pV
criteria
degree
The
specificity,
of
inferior
York
"gestalt"
presence
greatly
duration
is
that
Heart
computer
criteria
this
enough
for
infarction.
are
strong
be
made
These
added
4
ms
correction
This
concomittant
or
Qs,
the
for
infarction
than most
reason
infarction.
used
of
focus.
Q
waves. Taking
increases
For
factors
to
for
of
last
whatever.
the
Q
is
that
but
a
infarct
Association
programs
by
focus
infarction,
The
seldom
repolarization
For
indicators
old
infarcts,
by
considering
are
equivalents".
the
actual
each
QRS
factor
equivalent
amplitude
120
duration
of 5 ms),
with
depart
electrocardiographers
conventionally
When
very
criteria
experienced
on
mentioned
example,
both
quantitatively
attempts
To
these
low
criteria.
must
Q
wave
and
single
abnormalities
of
into
sensitivity
the
Q
Thus
Q
duration
pV
of R amplitude,
beyond
infarction,
further
duration
is
short
from
criteria
sensitivity.
reported
incorporate
ECG
duration
the
computer
most
infarction
and
or
to
important
in
reviews
elevated
account
problem
R
for
to
100
subtracted
exploit
whether
reduce
is
of
100
standard
accepted
are
For
a
sensitivity
In
order
some
interpreters.
as
tests
additional
in
characteristic
ST
segments
in
presence
these
and
specificity
is
more
wave
added
every
ms,
reduced
amplitudes,
obtain
1
the
the
pV.
below
30
an
1
ms
for
frequent
due
impact
by
textbook
would
criteria
applied,
example,
to
achieve
of
the
below
infarction
repolarization
complex.
pV
ms
is
durations
to
1
pro-
they
of
the
same
primary
of
and
of
other-
for
and
by
con-
of Q ampli-
“equivalent”
is
subtracted,
added
increase
LVH,
of a wide,
ms
for
de-
a
only
more
neg-
new
less
peri-
TJ
|
|
„I
—
Age
factors
For
uder
for
to a maximum
Q
duration
cause
they
pretation.
fiers
These
are
males,
the
age
females,
It
should
unreasonable
can
be
With
intended
qualifiers
Cannot
Possible
(Ungualified)...
and
also
1
of
1
are
expected
some
rule
sex
affect
incorporated
ms
is
subtracted
40,
ms
is
of 10
be
noted
not
very
departures
exception,
to
reflect
are:
out...
the
up
to a maximum
subtracted
ms,
that
large,
to
affect
the
Typical
"a
priori“
by
modifying
from
for
the
above
and
from
the
certainty
infarct
certainty
” . " "
.
diagnostic
equivalent
-
probability
the
the
equivalent
correction
every
so
conventional
18
2
adjustments
they
of
the
“ 9
-
equivalent
years
should
attached
statements
particular
Q
of
infarction.
Q
for
every
of
10
ms.
under
to
not
interpretation.
duration
.
50,
the
be
to a given
are
interpretation.
30-24
35-39
40+
Q
duration.
Likewise,
again
equivalent
expected
given
ms
ms
ms
2
years
Mostly,
inter-
These
up
to
quali-
İİ
+
„I
1
dl
一
VI.
The
infarct
statement).
can
presence
cause
of
repolarization
the
qualifier
to
abnormalities
be
omitted
(i.e.,
characteristic
upgrade
to
strongest
of
the
Е
ET
-
19
-
ANTERIOR
MYOCARDIAL
INFARCTION
(AMI)
Define:
Skip
Criteria:
IF:
IF:
IF:
test
Alternate
(1)
(2)
if:
or
"Left
QRS
and
and
and
and
and
T
amp
=:
if
T'
is
not
if
T'
is
present,
or
Tend
bundle branch
duration
STM
and STE
Alternate
T
is
not
then
STM
Alternate
then
the
STM
Alternate
then
the
and
the
criteria
amp
the
present,
>
140
T
amp
upward
conditions
STE
T
amp
conditions
for a new
<
30
T
amp
conditions
lesser
block"
ms
amp
>= 0 in
amp
« 0 in
uV
>= 0 in
T - larger
of T &
is
and
net
>
200
inflected
for a new
>
50
uV
V3
for a recent
or
in
V3
for
an
present
QRS
pV
in
V3
and
in
in
or
recent
and
Vá
V3
and
old
of
STE
of
T' - larger
amplitude
V3
and
V4
V4
V3
and
V4
AMI
are
V3
or
V4
V4
AMI
are
AMI
are
V4
AMI
are
Tend
of
STE
< 0 in
present.
present,
not
present.
Vl
met
IF:
IF:
IF:
IF:
IF:
and
or
and
or
and
and
the
criteria
then
Equivalent
then Test
Equivalent
then Test 2 for
Équivalent
Test 1 for
Equivalent
Test 2 for
R
then
when
Equivalent
the
LVH
the
amp
<
the
appropriate.
equivalent
is
for a new,
age
O
1
for
Q
Q
AMI
Q
AMI
200
statement
Q
not
present
description
dur
dur
dur
dur
pV
dur
is
is
Q
AMI
AMI
in
dur
>=
30
is
>=
30
is
>=
30
positive
>=
30
positive
V4
"cannot
>=
35
>
recent
is,
“age
ms
in
positive,
ms
in
positive.
ms
in
ms
in
rule
ms
in
30
ms
or
old
undetermined"
V2
or
νά
V3
or
VS
V3
V4
out
AMI"
V3
in
V2
or
AMI
V4:
are
is
not
used
(TEST
met
1)
-
20
-
or
and
Equivalent
the
equivalent
Q
dur
Q
>=
dur
35
>
ms
30
in
ms
V4
in
V3
or
V5:
(TEST
2)
IF;
and
and
and
and
or
and
or
and
then
the
Equivalent
Test
LVH
low
1
for
is
not
voltage
non-specific
not
present
Equivalent
Test 2 for
cannot
either
then
as
rule
Recent
an
AMI
unqualified
test
for
an
Q
dur
>=
AMI
is
present
in
the
intraventricular
Q
dur
>=
AMI
is
out
AMI
or
New
exists
AMI
40
ms
positive
chest
40
ms
positive
is
true
criteria
and
it
is
positive
in
leads
in
will
V3
is
not
conduction
Vá
have
be
classified
been
present
block
met
is
IF:
the
measurements
say
“Cannot
"30
positive
say
“Possible
"35
an
“unqualified"
say
“Anterior
“40+
lead
any
AMI
ing
aualifiers
if
the
append
mS
criteria
mS
ms
V3/V4"
criteria
AMI
*,
rule
Q
wave
anterior
O
wave
myocardial
O
wave
is
new
POSSIBLY
suggest
out
in
for
in
AMI
and/or
are
acute
that
anterior
lead
an
AMI
myocardial
lead
exists
infarction"
met,
an
myocardial
V3/V4
exist
V3/V4"
ST/T
append
AMI
+
CROAMI.
or
R « 0.2
infarction"
POSAMI.
AMI.
abnormality
one
may
exist
infarction"
of
the
ABN
mV
in
ABN
ABN
in
follow-
NEW
V4"
-
21
-
if
the
append
if
the
append
AMI
",
age
",
is
new
PROBABLY
of
the
AGE
undetermined"
AMI
recent"
is
undetermined
REC
AU
]
|
M
if
the
append
AMI
",
is
old
PROBABLY
old"
I
OLD
二
=
1
Y
-
22
-
SEPTAL
Skip
Criteria:
test
IF:
MYOCARDIAL
if:
or
and
or
and
and
INFARCTION
Left
Bundle Branch
if
AMI
Q
amp
= 0 in
duration
QRS
Vl
in
STM
and
Alternate
T
is
not
then
a
cannot
STE
T
upward
"new"
(SMI)
be
V1
>
amp
amp
septal
Block
ruled
ms
140
>
200
>=
0
inflected
infarct
and
in
out
pV
V2
is
net
in
in
present
QRS
Ve
V2
is
present
amplitude
<
0
IF;
IF:
IF;
IF;
IF:
and
and
and
or
and
and
STM
and
STE
Alternate
then
the
septal
STM amp
Alternate
then
the
criteria
it
is
"age
Equivalent
Right
Equivalent
T
a
“recent
infarct
<
T
the
septal
neither
undetermined"
Q
Bundle
Q
then a septal
Equivalent
LVH
is
not
Q
present
amp
>
50
amp
« 0 in
septal
is
not
50
pV
in
V2
amp
>= 0 in
infarct
for a septal
new,
recent,
will
dur
>=
30
Branch
dur
>
Block
20
infarct,
dur
>=
35
pV
V2
infarct
new
V2
is
infarct
be
ms
ms
"cannot
ms
in
Va
is
or
"old"
or
old,
used
in
is
present
in
V2
in
present
recent
have
V2
be
V2
the
ruled
been
met
qualifier
out”
and
L
IF:
IF:
and
then
positive
Equivalent
LVH
is
then
a
say
a
septal
“Cannot
"30
Q
not
septal
infarct
mS
-
criteria
dur
present
infarct
rule
Q
wave
23
>=
cannot
out
in
-
for
40
ms
is
present
be
septal
lead
a
septal
in
V2
ruled
myocardial
Vl/V2"
infarct
out
CROSMI.
exist
infarction"
ABN
了
二
IF:
IF:
IF:
positive
say
"Possible
"35
a
septal
say
“Septal
“40+
any
SMİ
ing
gualifiers.
if
the
append
if
the
append
if
the
append
criteria
ms
infarct
ms
criteria
SMI
",
SMI
",
age
of
",
septal
Q
wave
is
myocardial
O
wave
is
new"
POSSIBLY
is
"recent"
PROBABLY
the
AGE
undetermined"
for a septal
myocardial
in
lead
present
infarction"
in
lead
are
met,
acute"
recent"
SMI
append
is
undetermined
infarct
infarction"
V1/V2"
V1/V2"
exist
POSSMI.
SMI,
one
of
the
ABN
ABN
follow-
NEW
REC
AU
=)
Id
J
if
the
append
SMI
",
is
"old"
PROBABLY
old"
그
OLD
m
77
LD
-
24
-
A
ANTEROSEPTAL
MYOCARDIAL
INFARCTION
(ASI)
Skip
Criteria:
IF;
IF;
test
if:
and
and
say
“*Anteroseptal
positive
both
say
an
an
“Cannot
farction"
"30
anteroseptal
either
say
“Possible
"35
an
anteroseptal
either
exists
criteria
AMI
rule
ms
O
positive
ms
Q
an
unqualified
myocardial
for a Lateral
and
a
SMI
out
wave
infarct
AMI
or
anteroseptal
wave
infarct
cannot
anteroseptal
in
lead
cannot
SMI
in
lead
cannot
anterior
infarction"
Infarct
be
Vl-V4"
be
is
called
myocardial
V1-V4"
be
or
exists
ruled
myocardial
ASCRO.
ruled
infarction"
ASPOS.
ruled
septal
out
ASUNQ.
out
in-
ABN
ABN
infarct
ABN
IF;
IF;
IF:
IF:
and
and
"40+
ms
either
then
to
the
the
either
"possibly
the
calls
determined
then
both
then
Q
wave
a
recent
"probably
ASI
ASI
is
a
new
ASII
of
"age
SI
is
SI
old
"probably
in
lead
SI
or
recent"
call,
not
recent
SI
or AI
acute”
not
age
are
undetermined"
and
is
new
undetermined
present
AI
old"
V1-V4"
AI
has
will
exists
appended
is
old
are
is
appended
been
be
appended
then
to
the
and/or
appended
called
called
to
ASI
AI
to
the
call
age
the
ASI
un-
ASI
call
REC
NEW
call
AU
OLD
-
25
-
DO
LATERAL
Criteria:
IF:
IF:
IF:
IF:
MYOCARDIAL
and
and
and
and
and
and
and
INFARCTION
STM
and
STM
and
Alternate
T
is
not
then
STM
Alternate
then
the
STM
a
and
a
criteria
<
Alternate
then
a
then
Equivalent
a
new,
LMI
an
an
cannot
STE
STE
T
amp
upward
new
lateral
STE
T
amp
recent
for
30
pV
T
amp
old
LMI
recent
unqualified
Q
(LMI)
amp
amp
amp
lateral
new
in
or
dur
be
>
200
>
100
>= 0 in
inflected
infarct
>
50
ς 0 in
infarct
or
I,
AVL,
>= 0 in
is
present
old
LIM
LMI
>=
30
ruled
out
pV
uV
I,
in
is
wV
in
I,
AVL,
recent
V5
I,
are
is
ms
in
V5 & V6
in I &
AVL,
I,
AVL,
present
I,
AVL,
V5
is
called.
LMI
and
V6
AVL,
not
present
in 2 of
AVL
V5 & V6
V5 & V6
V5
or
V6
are
not
V5
and
called
I/V5/V6
or
V6
I
V6
AA
met
-一
一 了
=)
IF:
IF:
IF:
and
or
and
then
Equivalent
a
a
either
then
a
say
a
say
a
LMI
LMI
an
LMI
"Cannot
"30
LMI
"Possible
"35
LMI
is
Q
is
present
"cannot
a
new
unqualified
cannot
rule
ms
O
is
present
ms
O
present
dur
be
or
recent
be
ruled
wave
lateral
wave
>=
ruled
out
in
in
40
ms
out"
LMI
LMI
is
out
lateral
lead
myocardial
lead
in 1 of
is
called
I/V5/V6
defined
myocardial
CROLMI.
I/AVL/V5/V6"
infarction"
POSLMI.
I/AVL/V5/V6"
infarction"
ABN
ABN
I
一
21
==)
]
)
一
IF:
the
say
LMI
is
“Lateral
"40+
ST/T
unqualified
myocardial
ms
Q
abnormality
-
26
wave
-
infarction"
in
lead
in
I/AVL/V5/V6
lead
I/AVL/V5/V6"
LMI.
CT
ABN
and/or
要
二
-I
τς
3
、
人
za
©
O
L
C.
т
|
IF:
a
LMI
exists
to
the
LMI
if a "new"
append
if a "recent"
append
if
an
append
if
the
append
if
Q(I)
euppress
",
",
"age
",
LMI
",
amp
RAD.BO,
one
of
the
statement.
LMI
is
present
possibly
LMI
probably
undetermined"
age
undetermined"
is
"old"
probably
>
S(I)
acute"
is
recent"
old"
amp
RAD.ABN
following
present
is
will
qualified
be
appended
NEW
REC
AU
OLD
OC
[O
Cc:
(©
-
27
-
7
ANTEROLATERAL
Criteria:
IF;
IF:
IF;
MYOCARDIAL
both
say
either
say
either
say
INFARCTION
an
AMI
and
"Cannot
farction"
"30
an
“Possible
"35
an
"Anterolateral
"40+
rule
ms
Q
AMI
ms
O
unqualified
ms
Q
wave
or a LMI
anterolateral
wave
a
out
myocardial
wave
(ALMI)
LMI
"cannot
anterolateral
in
lead
are
in
lead
AMI
or
in
lead
be
myocardial
ALCRO,
I/AVL/V3-V6"
called
myocardial
ALPOS.
I/AVL/V3-V6"
LMI
is
infarction"
ALUNQ.
1/AVL/V3-V6"
ruled
infarction"
present
out"
in-
ABN
ABN
ABN
т
1]
do
J
I
J
IF:
IF:
IF:
IF:
and
and
either
then
the
to
the
infarct
a
new
then
appended
is
the
infarct
age
an
mined
then
"age
both
ALMI
the
a
recent
"probably
or
is
“age
LMI
call
statement
is
not a recent
AMI
ALMI
to
is
not a new
present
undetermined"
and
will
ALMI
LMI
"new"
a
undetermined
AMI
an
undetermined"
the
LMI
recent"
is
is
statement.
the
is
AMI
be
or
AMI
is
present
present
LMI
appended
are
qualified
is
present
appended
ALMI
and
ALMI
and/or
ALMI
qualified
"probably
an
is
the
to
"probably
as
undeter-
age
present
record
“old”
as
REC
acute"
NEW
and
AU
old”
OLD
TZ
LI
-I
I
コ
ー
+
一
I
-
28
=
-
INFERIOR
Criteria:
IF:
IF:
IF:
IF:
MYOCARDIAL
and
and
and
and
and
INFARCTION
STM
and
Alternate
T
is
not
then
STM
Alternate
then
the
STM
a
and
a
IMI
amp
Alternate
then
the
then
the IMI
IMI
the
(IMI)
STE
amp
T
amp
upward
"new"
STE
amp
T
amp
"recent"
is
not
<
30
T
amp
is
is
not
qualifier
>
>= 0 in
inflected
IMI
is
< 0 in
IMI
new
uV
>= 0 in
"old"
new,
ò
or
in
"age
100
wV
IL & aVF
in
present
50
pV
II
or
is
present
recent
Il
and
Il
recent
undetermined"
in
II
II & aVF
in
II
aVF
aVF
and
or
old
and
or
aVE
aVF
aVF
will
be
used
IF:
IF:
IF:
IF:
and
or
and
and
or
Equivalent
Q(I)
Q(I)
then
amp
amp
an
Equivalent
an
IMI
then
an
an
IMI
Equivalent
the
IMI
then
an
say
the
IMI
"Cannot
Q
<
<
IMI
Q
cannot
IMI
cannot
Q
is
new
IMI
cannot
dur
Q{II)
Q(aVF)
“cannot
dur
be
is
probably
be
dur
or
is
"unqualified"
be
rule
>=
amp
amp
be
>=
ruled
ruled
>=
recent
ruled
out
30
ms
ruled
35
ms
out
present
out
40
ms
out
inferior
in
II
out"
in
Il
in
II
myocardial
or
aVF
or
aVF
or
aVF
CROIMI.
infarction"
ABN
fC.
IT
UT.
IF:
an
say
"30
IMI
is
"Possible
"35
ms
probably
ms
-
©
wave
inferior
O
wave
29
-
in
lead
present
myocardial
in
lead
II/aVF"
II/aVF"
infarction
POSIMI.
ABN
}
IF:
IF;
the
IMI
say
"Inferior
"40+
II/aVF"
if
OA
suppress
the
IMI
append
if
the
append
if
the
append
if
the
append
>
IMI
age
IMI
is
SA
is
",
*,
*,
”,
unqualified
myocardial
mS
Q
wave
in 1 of
Abnormal
"new"
possibly
is
"recent"
probably
of
the
age
undetermined"
is
"old"
probably
II/aVF
left
acute”
IMI
and/or
Axis
recent”
is
undetermined
old”
infarction"
ST/T
Deviation
IMI,
abnormality
in
ABN
lead
NEW
REC
AU
OLD
LI
1
-
一
Y
기이
А
ーー
-
-
30
ニー
-
ーー
INFERIOR
MYOCARDIAL
INFARCTION
WITH
POSTERIOR
EXTENSION
(PMI)
Skip
test
Criteria:
IF:
if:
or
and
or
or
an
IMI
Right
O
amp = 0
R
dur
R
dur
R
dur
append
ment
and
is
not
present
Bundle Branch
in
VI & Va
>=
40
ms
>=
35
ms
>=
30
ms
"with
suppress
posterior
RVH.ABN,
in
and
and
Block
Vl a VZ
QRS
net
QRS
net
extension”
RVHR.ABN,
is
present
amplitude
amplitude
> 0 in
> 0 in
to
the
PMI.
IRBBB.BO
IMI
Vl
Vl
state-
ABN
or
and
V2
V2
-
31
-
二
MYOCARDIAL
IF;
IF:
INFARCTION
SUPRESSIONS
an
IMI,
suppress
an
AMI
suppress
LMI,
or a LMI
AMI
LAD.BO,
PUL.ABN
or
SMI
ILBBB.ABN,
is
present
is
present
AVCD.BO
then
-|
二
SI
了
二
一
-|
一
+
一 -
一
27
一
—
J
—
-
32
«+
—
IT.
ST
SEGMENT
ELEVATION
„C
г.
~
ur
E
„o
Skip
Criteria:
IF:
test
if:
one
of
the
MI
or
LVHR.
STJ/STM/STE
flected
say
in 2 of
"Nonspecific
*0.05+
following
all
p=
50
1,11,111,aVF,V3-V6
ST
elevation"
mV
ST
elevation"
is
pV
present,
and
T
RBBB,
is
not
LBBB,
upward
NSTE,
ТУСВ.,
in-
BO
ČZ
„a
г
Lo,
E:
O.
+
Г
O
i
r
~
0
-
33
-
1
一
EARLY
Skip
Criteria:
IF;
IF:
IF:
test
REPOLARIZATION
if:
and
and
Corrected
any
of
MI,
LVH,
count
>
75
pV
which
sum
of
above
say
"ST
pericarditis,
"ST
ST
elevation
more
above
say
above
than
"ST
"ST
QT
interval
the
following
RBBB,
of
leads
plus
STJ & STM
STJ
test
elevation,
elevation
also
elevation,
elevation
count
count
amplitudes
is
1/2
have
> 5 and
>
are
LBBB,
V1-V6
>
or
w/o
present,
of
the
well-inflected
with
IVCB
for
of
leads
50
pV
>
consistent
early
normally
leads
probably
sum
450
ms
present:
which
1,11,111,aVL,aVF
exceeds
450
uV
with
repolarization"
per
the
passing
early
normally
>
450
or
STJ
and
2
for
leads
epicardial
STE1
inflected
above
ST
T
waves
repolarization"
inflected
STE2.
pV
STM
amp
for
passing
.
T
wave"
conditions
elevation
T
wave”
injury,
ABN
test
BO
TT
一
1
say
"Early
"ST
elevation
repolarization"
with
normally
EREP,
inflected
T
wave'
NML
ZT
LT
一
1
o
-
34
-
PERICARDITIS
Skip
test
Criteria:
IF:
if:
and
any
MI,
4
times
V4-V6
STJ
of
RBBB,
and
the
STJ
STM
following
LBBB,
amp
> T amp
amp
IVCB,
>
-100
are
present:
LVH
> 0 in
pV
in
all
at
least
leads
4
of
except
I,
II,
aVR
IF:
and
and
count
75
amp
say
of
pV
plus
>
90
"Possible
"Marked
T
wave”
Possible
count
90
amp
say
of
pV
>
"Acute
"Marked
T
plus
110
wave"
suppress
leads
pV
acute
leads
I,
II,
count
ST
is
greater
acute
elevation
of
pericarditis
I,
II,
count
pV
pericarditis®
ST
of
is
greater
elevation
aVF
with
leads
pericarditis"
V2-V6
than
without
is
aVF
with
leads
V2-V6
than
without
STJ
with
or
equal
present
STJ
with
or
equal
and
STJ
to
PCRD1
normally
and
STJ
PCRD2,
normally
STM
STM
to
and
5.
.
and
5.
NSTE.BO,STE1.ABN,STE2.BA,EREP.NML
amp
>
STM
ABN
inflected
amp
>
STM
ABN
inflected
-
35
-
ANTERIOR
Skip
Define:
Criteria:
IF:
test
AND
if:
SEPTAL
and
and
and
and
SUBEPICARDIAL
any
of
the
PCRD,
ST
(add
ς
STJ
T
LIMIT
0)
amp
is
LBBB,
100
not
Alternate
a
septal
LVH
is
not
say
"Possible
following
RBBB,
=
300
pV
for
>
ST
upward
T
amp
infarct
present
INJURY
pV
any
LIMIT/2
inflected
>= 0 in
is
septal
are
present:
IVCB
precordial
in
Vl
not
present
subepicardial
Vl
and
lead
and
V2
injury"
with
V2
SINJ.
net
QRS
-
amp
TI
ABN
IF:
IF:
IF;
and
and
and
and
and
and
and
and
and
and
and
and
"Marked
T
wave
STJ
amp
T
is
not
Alternate
a
septal
LVH
is
say
"Septal
"Marked
T
wave
STJ
amp
T
is
not
Alternate
an
anterior
LVH
is
say
"Possible
"Marked
T
wave
STJ
amp
T
is
not
Alternate
an
anterior
is
LVH
>
upward
T
infarct
not
>
upward
T
not
>
upward
T
not
ST
present'
ST
amp
present
ST
amp
present
ST
elevation
in
lead
Vl/V2"
LIMIT
inflected
amp
>=
0
is
not
subepicardial
ST
elevation
in
lead
Vl/V2"
LIMIT/2
inflected
>= 0 in
infarct
is
anterior
ST
elevation
in
lead
V2-V5"
LIMIT
inflected
>=
0
infarct
is
without
in
Vl
in
Vl
and
present
injury“
without
in 2 of
V2-V5
not
present
subepicardial
without
in 2 of
in
V2-V5
not
present
normally
and
VŽ
normally
V2-V5
injury"
normally
V2-V5
V2
SINJ
AINJ.
inflected
.
inflected
inflected
ABN
ABN
+
]
'
0
ーー』
一
say
"Anterior
"Marked
T
wave
subepicardial
ST
elevation
in
lead
-
36
-
V2-V5"
injury"
without
AINJ.
normally
ABN
inflected
一
a
I
IF:
and
there
both
cardial
say
"Possible
is a possible
possible
injury
anterior
exist
anteroseptal
anterolateral
and
possible
subepicardial
subepicardial
septal
ASINJ.
subepi-
injury"
injury
ABN
IF:
and
“Marked
T
wave
there
injury
additional
or
say
is a possibility
Septal
"Anteroseptal
"40+
in
criteria
Injury
mS
Q
ST
lead
wave
elevation
V1-V4"
substantiates
myocardial
in
without
of
anteroseptal
lead
normally
an
Anterior
infarction"
V1-V4"
inflected
subepicardial
Injury
ASINJ.
ABN
-
37
-
LATERAL
AND
INFERIOR
SUBEPICARDIAL
INJURY
Skip
Criteria;
IF:
IF;
IF:
test
if:
and
and
and
and
and
and
any
of
PCRD,
STJ
amp
T
is
not
Alternate
a
LMI
say
"Possible
"ST
in
STJ
amp
T
is
not
Alternate
a
LMI
say
"Lateral
“Marked
T
both
exist
the
the
LBBB,
>
ST
upward
T
cannot
elevation
lead
>
upward
T
cannot
wave
possibility
following
RBBB,
LIMIT/2
inflected
amp
>=
be
ruled
lateral
without
I/AVL/V5/V6”
ST
LIMIT
inflected
amp
?=
be
ruled
subepicardial
ST
elevation
in
lead
are
present:
IVCB
in 2 of
0
in
I,AVL,VS
out
subepicardial
normally
in 2 of
0
in
I,AVL,V5
out
injury”
without
I/AVL/V5/V6"
of
anterior
I,AVL,V5
and
injury"
inflected
I,AVL,V5
and
normally
and
V6
LINJ,
V6
LINJ,
lateral
and
V6
ABN
T
wave
and
V6
ABN
inflected
injury
1
一
J
1
二
3
Y
TT
IF:
ーーーーーーーーーー
and
ニ
ーー
ニーーーーーーーーーーーーーーーーーーーーーーーーーーーーーーーーー
and
and
and
say
“Possible
“Marked
T
an
anterlateral
an
anterior
say
"Anterior
"Marked
T
STJ
amp
T
is
not
Alternate
an
IMI
say
"Possible
"ST
in
wave
wave
>
upward
T
is
not
elevation
lead
anterolateral
ST
elevation
in
lead
subepicardial
and/or
subepicardial
ST
elevation
in
lead
ST
LIMIT/2
amp
>=
present
inferior
II
/aVF"
V3-V6*
lateral
V3-V6*
ニ
ーーーーーーーーーーーーーーーーーーーーーーーーー
inflected
0
in
subepicardial
without
subepicardial
without
injury
injury
injury"
without
in
II
II
and
normally
normally
exists
normally
and
AVF
inflected
injury"
ALINJ,
possibly
ALINJ.
aVF
injury"
ИМТ.
ABN
inflected
exists
inflected
ABN
ニ
ーー
ニーーー
АВМ
T
wave
OT
ZT
CI
-
38
-
CZ:
Cr
CT.
E:
E!
[o
00
0
L
~~!
人
上
IF:
and
and
and
STJ
amp
T
is
not
Alternate
an
IMI
say
“Inferior
“Marked
T
wave
>
upward
T
is
ST
LIMIT
amp
not
present
subepicardial
ST
in
lead
inflected
>= 0 in
elevation
II/aVF"
in
II
and
injury"
without
Il
and
AVF
normally
aVF
JINJ
。
inflected
ABN
'
eee
I
νι
a
Γι
E)
E
CS.
а
L
[一
„I
ET;
CT,
-
39
-
ST
DEPRESSION
Skip
tests
if:
LBBB,
IVCB,
LVHR,
or
PCRD
is
I
—
present
71
IF:
IF:
IF:
and
and
and
RVHR,
STJ
amp
(except
"Junctional
say
*0,1+
RVHR,
STJ
<
leads
say
“Abnormal
"Junctional
RVHR,
STM
or
(except
say
°ST
STEL,
«
-100
aVR
mV
STEL
-100
pV
(except
STEL,
STE
aVR
depression,
and
RBBB
uV
and
III)
ST
Junctional
and
RBBB
and
aVR
Junctional
ST
and
RBBB
«
both
and
III)
are
and
STE
depression,
ST
are
STE
< 0 and
and
III)
depression
are
STJ
and
possible
not
present
amp
probably
depression”
not
present
ST
depression"
iwth
not
present
-50
digitalis
>= 0 in 2 leads
normal”
NJDEP.
STE
>=
STJ/2
AJDEP.
weak
pV
in 2 leads
upslope"
effect"
STDIG.
in
BO
2
ABN
ABn
I
24
CA
21
21)
7
IF:
IF:
IF:
and
and
"Downsloping
RVHR,
STEL,
STJ/STM/STE
and
III)
say
"Minimal
*0.025+
RVHR,
(STM
STEL
«
-50
STM/-50
say
"Moderate
"0.05+
STJ/STM/STE
and
Ill
and
is
present)
say
"Marked
injury”
“0.1+
and
all < -25
ST
mV
and
uV
pV
in 2 leads
mV
all < -100
except
ST
mV
or
RBBB
depression"
ST
depression”
RBBB
and
ST
depression”
ST
depression"
V1/V2
depression,
ST
depression"
coved
STE
are
uV
in 2 leads
are
not
ς
0)
(except
pV
if
ST
depression"
not
present
present
or
STE
aVR
in 2 leads
RBBB
possible
is
(except
NST1
.
€
all
of
and
III)
NST2.
(except
present
subendocardial
NST3.
aVR
STJ/
aVR
or
BO
ABN
RVHR
ABN
do
TI
ーー
—
-
40
+
-—]3
IS
STJ/STM/STE
and
III
is
present
say
"Marked
cardial
"0.2+
and
all < -200
except
ST
depression,
injury"
mV
ST
UV
V1/V2
depression"
in 2 leads
if
RBBB
consistent
is
(except
present
with
NST3,
aVR
or
RVHR
subendo-
ABN
IF;
IF:
atrial
moderate
append
atrial
and
there
append
fibrillation
ST
depression
",
probably
fibrillation
is
"marked"
",
or
digitalis
is
present
digitalis
is
present
is
present
ST
depression
effect"
and
either
effect"
minimal
or
PDIG.
ODIG.
-
41
-
T
Skip
IF:
WAVE
ABNORMALITY,
test
if:
and
and
ISCHEMIA
any
of
LBBB,
an
AMI
RVHR
is
Alternate
cluding
say
"T
"-0.1+
the
IVCB,
is
not
T
V2
wave
following
LVHR,
not
present
present
amp
if
RBBB
abnormality,
mV
T
<
wave
are
RVHR,
-100
is
true:
pV
SBIN,
in 2 of
STEL,
present"
possible anterior
in
lead
V3/V4"
PCRD
V2/V3/V4
POSAI.
(ex-
ischemia"
ABN
a
I
—
22271
721
IF:
IF:
IF:
and
and
and
an
AMI
Alternate
cluding
say
"T
ischemia"
*-0.5+
a
LMI
is
Alternate
(excluding
say
"T
*-0.1+
a T wave
is
possible,
Alternate
(excluding
say
“T
ischemia"
*-0.5+
is
probably
T
amp
V2
if
wave
abnormality,
mV
not
present
T
amp
aVL
wave
abnormality,
mV
abnormality
T
amp
aVL
wave
abnormality,
mV
<
RBBB
T
wave
«
if
T
wave
<
if
T
wave
present
-500
is
present)
-100
R(aVL)
is
-500
R(aVL)
pV
consistent
in
lead
pV
<
possible
in
lead
present
pV
<
in
lead
in 1 of
V3/V4"
in 2 of
500
uV)
I/aVL/V5/V6"
and
in 1 of
500
pV)
consistent
I/aVL/V5/V6"
V2/V3/V4
with
Al,
I/aVL/V4/V5/V6
lateral
(ex-
anterior
ABN
ischemia"
POSLI. ABN
lateral
ischemia
I/aVL/V5/V6
with
LI.
lateral
ABN
—J
了
二
了
一
İl
J
DJ
IF:
IF:
and
both
say
a
anterolateral
an
say
AMI
"T
ischemia"
*-0.1+
T
wave
AMI
"T
lateral
"-0.1+
wave
and
wave
and LMI
abnormality,
mV
T
wave
abnormality
ischemia,
a
LMI
abnormality,,
ischemia"
mV
T
wave
-
42
-
are
exist
probably
possible
in
lead
is
present
consistent
in
lead
present
anterolateral
POSALI.
V3-V6"
with
V3-V6"
possible
with
ALI.
ABN
antero-
ABN
—
А
=
二
3
IF:
and
nonspecific
if
an
AMI
ST
and/or
abnormalities
a
LMI
exist
exist
IF
and
and
and
and
prefix
atrial
if
append
an
fibrillation
an
AMI
IMI
"ST
"or
is
Alternate
aVF
if
net
Alternate
say
"T
wave
"-0.1+
an
IMI
is
non-specific
prefix
"ST
& " to
and/or
digitalis
not
present
T
amp
<
QRS
amplitude
T
amp
« 0 in
abnormality,
mV
T
probably
ST
abnormalities
4 " on the
the
is
a
-100
wave
T
present
LMI
exists
effect"
wV
II
in
present
previous
wave
in
«
0)
and
possible
Il/aVF"
abnormality
II
or
aVF
AVF
inferior
POSII.
exist
statement
statement
STP,
PDGAL.
(excluding
ischemia"
ABN
STP2.
IF:
and
and
an
IMI
atrial
fibrillation
append
abnormality
an
IMI
Alternate
ing
aVF
say
"T
ischemia"
"-0.5
is
probably
"or
digitalis
statement,
is
present
T
amp
if
net
wave
mV T wave
present
is
present
effect"
<
-500
QRS
amplitude
abnormality,
in
uV
lead
to
the T wave
in
II
«
0)
consistent
II/aVF"
or
aVF
with
(exclud-
inferior
II,
PDGI.
ABN
-
43
-
T
WAVE
ABNORMALITY,
NONSPECIFIC
Skip
Define:
IF:
IF;
test
(except
and
or
and
test
Short
any
SBIN,
TMIN
QRS
T
axis
QRS
T
axis
say
count
and
say
QT)
if:
of
the
following
STEL,
="
pV
25
(1)
>
0
(2)
25
pV
axis - T
«
0
axis - T
>
90
"Abnormal
"ORS-T
of
R
amp
"Nonspecific
axis
I/II/aVL/V3-V6
>
PCRD,
+
if
axis
axis
ORS-T
500
exist:
MI,
RBBB,
QRS
net
net
amplitude
>
60
<
-60
angle"
difference
with
uV
is
T
wave
LBBB,
AMI,
amplitude/20
<
>
60"
alternate
greater
abnormality"
than
IVCB,
LMI
0
if
ORST.
T
1
NT.
LVHR,
or
net
amp
RVHR,
IMI.
amplitude
<
TMIN
ABN
BO
0
1
ー
1
IF:
IF:
IF:
IF:
and
or
and
nonspecific
abnormalities
Tall
T
waves
say
"Nonspecific
atrial
and
exist
append
T
1/11/V1-V6
T
say
QTc
Heart
say
fibriallation
either
",
amp
>
1000
amp
>
1500
"Tall T waves,
*T > both
<
360
Rate
"Short
ST
abnormalities
exist
are not
ST & T
nonspecific
probably
pV
and
pV
in 1 of
1/2 R and
ms
<
140
QT
interval"
present
is
present
T
digitalis
T
amp
possible
and
wave
wave
abnormality"
effect"
>
I/II/VL-Vó
hyperkalemia"
lmV
in 3 leads"
nonspecific
NSTT.
or
ST
abnormalities
1/2 R amp
TALLT.
SOT.
T-wave
PDIG,
in 3 of
a
1
ABN
do
LI
I
—J
ABN
ABN
IF:
OTc
say
>
450
"Long
ms
OT
-
44
interval"
-
LOT.
ABN
7
1
VIII:
nant
main
may
Rhythm
The
rhythm
rhythm
also
Statements
following
in
statement,
be
added.
the
rhythm
10
seconds
statements
a
modifier,
of
analyzed
are
listed
used
data.
after
to
the
describe
In
addition
rhythm
the
predomi-
to
the
statements,
Sinus
Sinus
Sinus
Atrial
Atrial
Atrial
Junctional
Junctional
Junctional
Supraventricular
Supraventricular
Supraventricular
Tachycardia
Rhythm
Bradycardia
Tachycardia
Rhythm
Bradycardia
Tachycardia
Rhythm
Bradycardia
Undetermined
Atrial
fibrillation
Tachycardia
Rhythm
Bradycardia
[regular]
rhythm
(abnormal
(superior
(narrow
P
P
QRS,
axis)
axis
regular
and
Short
RR,
no
PR)
P)
[
ビー
o
-
45
-
a.
rhythm
Rhythm
The
statements
Statement
following
-
Modifiers
modifiers
in
order
to
will
more
be
used
accurately
in
conjunction
describe
the
with
type
the
of
above
rhythm.
一
=
.....
.....
.....
.....
.....
.....
.....
.....
.....
.....
The
.....
with
with
with
with
with
with
with
with
in
with
SA
following
with
(marked)
1°
AV
short
2°
AV
[occasional/frequent]
[occasional/frequent]
[occasional/frequent]
[occasional/frequent]
a
pattern
marked
block,
two
statements
{rapid/slow]
block
PR
block,
AV
sinus
interval
of
bigemiry
rhythm
block,
arrhythmia
Mobitz
irregularity,
or
are
ventricular
Type
ventricular
ectopic
atrial
supraventricular
sinus
used
20/40%
(I,
premature
premature
possible
pause,
with
response
II]
atrial
RR
variation
premature
complexes
complexes
non-conducted
fibrillation
complexes
complexes
1]
с
PAC,
pa
TA
.....
The
.....
.....
vere.
.....
.....
with
following
with
cannot
electronic
contour
intermittent
AV
block
statement
aberrant
rule
(atrial/ventricular]
analysis
is
conduction
out
atrial
based
WPW
pattern
used
with
or
flutter
on
intrinsic
atrial
ventricular
flutter
(Regular
pacemaker
rhythm
premature
rate
near
complexes
150)
TJ
TA
73
1
TI
1
二
有
和
-
46
-
二
I
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