Assoc Prof Harry Mond
February 23, 2026
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This ECG was presented during coronary care unit rounds and came from a patient in cardiogenic shock and right ventricular failure.
What do you think?
The rhythm is sinus tachycardia (red arrows), rate 130 bpm and atrial ectopics (blue arrow).
There is evidence of an acute inferiorSTEMI (ST elevation myocardial infarction) with ST elevation and developing Q waves in leads II, III and aVF (red highlight). Note that the most prominent ST segment elevation is in lead III.
There are also reciprocal changes in the antero-lateral leads I, aVL, V2 to V6 (yellow highlight).
Although the signs are subtle, there is a right bundle branch block (120 ms) with an rsR in V1 and a broad Swave in V6.
There is another feature that makes this ECG unusual.
ST elevation in V1 and markedST depression in V2, V3.
This combination with an evolving acute inferior myocardial infarction is diagnostic of right ventricular infarction.
Aright ventricular infarct is rarely recognised on the ECG as the features are subtle and hence not recognised.
These include:
Harry Mond
October 28, 2026
As its name implies, AVNRT is a reentrant junctional or supraventricular tachyarrhythmia which involves the fast and slow pathways within the AV node creating a self-perpetuating circus movement. It can be divided into typical (slow-fast) or atypical (fast-slow) as well as several rarer forms related to more than one slow or fast pathway with similar electrophysiological properties. On the ECG, they can be identified and differentiated by the positioning of the P wave in relation to the QRS complex, which in turn is related to the direction of the re-entrant AV nodal circuit. However, in about 60% of cases, the P wave is buried in the QRS/T and cannot be identified on the surface ECG.
October 16, 2026
Retrograde conduction is defined as conduction from an ectopic site to the atrium via the AV node or accessory pathway and referred to as VA conduction. II results in a P wave configuration which differs from an anterograde P wave, and in most ECG leads is inverted. The site from where the impulse originates can be the AV node, Bundle of His, distal conducting system or the body of the ventricles including ventricular pacing. On the ECG, the QRS complex usually precedes the inverted retrograde P wave but on occasion may follow it.
October 1, 2026
In 1970, I commenced work as a “novice” cardiologist at The Royal Melbourne Hospital. Training at that time was learning how to recognise the diastolic murmur of mitral stenosis and making sure the ECG and chest x-rays were the correct way up. As this was prior to coronary artery surgery, stenting and echocardiography, the ECG was a highly respected tool for the diagnosis of many conditions. I was fortunate to befriend a number of the gurus of ECG interpretation who taught me to look into the soul of an ECG. Today, even though the ECG is the first investigation performed by a cardiologist, the art of ECG interpretation has been lost because we depend on the new tools for cardiac diagnosis.
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