ACSM-EP Electrocardiography 3

Question 1

Which ECG finding is characteristic of left bundle branch block (LBBB)?

Accepted Answer

Wide QRS (≥0.12 s) with broad monophasic R wave in V5–V6 and deep S in V1

Answer

LBBB shows a broad, notched R wave in lateral leads (I, aVL, V5–V6) and a deep QS or rS in V1, with QRS duration ≥0.12 seconds.

Question 2

A 45-year-old athlete's resting ECG shows sinus bradycardia at 48 bpm with no symptoms. What is the most appropriate action?

Accepted Answer

Consider it a normal training adaptation and document it

Answer

Sinus bradycardia in well-trained athletes is a common physiologic adaptation due to increased vagal tone and does not require intervention if asymptomatic.

Question 3

What ECG change is associated with hyperkalemia?

Accepted Answer

Peaked (tall, narrow) T waves followed by widening QRS

Answer

Hyperkalemia classically produces tall peaked T waves early, followed by PR prolongation, QRS widening, and eventually a sine-wave pattern as potassium rises.

Question 4

During an exercise test, the exercise physiologist observes three consecutive wide-complex beats at >100 bpm. This finding is best described as:

Accepted Answer

Non-sustained ventricular tachycardia

Answer

Three or more consecutive wide-complex beats at a rate >100 bpm lasting <30 seconds defines non-sustained ventricular tachycardia.

Question 5

Which ECG lead is placed at the fourth intercostal space, right sternal border?

Accepted Answer

V1

Answer

V1 is positioned at the fourth intercostal space to the right of the sternum, directly opposite V2 on the left sternal border.

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ACSM-EP Electrocardiography 3