NEET-PG
NEET-PG Cardiology: The 10 ECG Patterns You Cannot Afford to Miss
ECG questions account for 10-12% of NEET-PG. We reviewed NEET-PG past-paper patterns to identify the 10 ECG patterns that appear most consistently - and how to interpret each one in under 60 seconds.
MedNext Editorial Team | Feb 20, 2026 | 8 min read
NEET-PG Cardiology: The 10 ECG Patterns You Cannot Afford to Miss
ECG questions account for 10-12% of NEET-PG. We reviewed NEET-PG past-paper patterns to identify the 10 ECG patterns that appear most consistently - and how to interpret each one in under 60 seconds.
ECG interpretation is one of the most heavily-tested areas of NEET-PG. Yet many candidates lose marks not because they can't read ECGs, but because they haven't practised systematically.
The 10 Patterns
1. STEMI - Recognising the Territory Anterior STEMI: ST elevation in V1-V4. LAD territory. Look for reciprocal changes in II, III, aVF. Inferior STEMI: ST elevation in II, III, aVF. RCA or LCx. Always check V3R/V4R for right ventricular involvement.
2. LBBB - The Masquerader Left Bundle Branch Block (QRS >120ms, broad monophasic R in V5-V6, QS in V1) can mask an acute MI. In the context of chest pain, treat new LBBB as STEMI equivalent.
3. Hyperkalaemia - A Silent Killer Peaked T waves are the earliest sign. As K rises: widening QRS sine wave pattern VF. In a renal patient with a broad QRS, always check K.
4. Atrial Fibrillation - Irregularly Irregular No P waves. Irregularly irregular rhythm. Rate can be fast (>100 bpm) or controlled. The NEET-PG question usually asks about rate control vs rhythm control, or when to anticoagulate (CHADS-VASc).
5. Complete Heart Block - Third Degree AV Block P waves and QRS complexes bear no relationship to each other. Atrial rate > ventricular rate. The escape rhythm is wide (idioventricular) or narrow (junctional). Clinical: hypotension, syncope, Stokes-Adams attacks.
6. WPW - Pre-Excitation Short PR interval (<0.12s), delta wave (slurred upstroke of QRS), broad QRS. The danger: AF in WPW can conduct rapidly via the accessory pathway VF. Do NOT give AV nodal blockers (digoxin, verapamil, adenosine).
7. Long QT QTc >440ms (males), >460ms (females). Causes: drugs (amiodarone, haloperidol, erythromycin), hypokalaemia, hypomagnesaemia, hypothyroidism, congenital. Risk: Torsades de Pointes.
8. Pulmonary Embolism Classic (but rare): S1Q3T3 - S wave in lead I, Q wave and T-wave inversion in lead III. More common: sinus tachycardia right heart strain (T-wave inversion V1-V4, RBBB).
9. Ventricular Tachycardia Regular, broad QRS tachycardia (QRS >120ms). Rate 140-220 bpm. If in doubt: assume VT over SVT with aberrancy. Capture beats and fusion beats confirm VT.
10. Pericarditis Saddle-shaped ST elevation in multiple leads (not territory-specific). PR depression is the most specific sign. No reciprocal changes (unlike STEMI).
The 60-Second Approach Rate Rhythm Axis P wave PR interval QRS width ST segment T waves QT interval. Every time. Without fail.
*MedNext runs NEET-PG Cardiology Masterclasses every month on MedNext Live. Join free with your MedNext account.*
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