# ECG interpretation

ECG interpretation Overview Rate Rhythm

Intervals QRS ST-T wave

ECG P- QRS- T waves Overview Rate Rhythm

Intervals QRS ST-T wave

Rate Normal heart rate 60-100 beats per minute Tachycardia is > 100 beats per minute

Bradycardia is < 60 beats per minute What is the heart rate? Rate Method 1: Count squares 300 / # of big squares between QRS

complexes Rate Method 2: Count seconds 60 Seconds between QRS complexes

60 0.92 seconds = 65 beats per minute Overview Rate Rhythm

Intervals QRS ST-T wave Rhythm

Sinus Rhythm P wave in every lead (upright in I, II, III) Every P wave is followed by a QRS complex

1 p wave for every 1 QRS Are the complexes regular or irregular? Regularly irregular vs irregularly irregular Rhythm Rhythm

Rhythm Overview Rate Rhythm

Intervals QRS ST-T wave

Intervals Intervals: PR PR interval Normal is 0.12-0.20 seconds

1st degree AV block: PR interval > 0.20 seconds 2nd degree AV block has 2 types Type 1: PR interval gets longer under QRS drops

Type 2: PR interval doesnt change. QRS drops suddenly 3rd degree AV block: No association between p and QRS 1 degree AV block st 2

nd degree AV block 3 degree AV block rd Intervals Intervals: QRS

QRS complex Normal: less than 0.10 seconds Left bundle branch block QRS > 0.12 seconds

No q wave in V5 and V6 Broad notched R wave in V5 and V6 Intervals: QRS

Right bundle branch block QRS > 0.12 seconds Deep slurred s in leads I and V6 Rabbit ears (rsR) in V1 or V2

LBBB or RBBB? LBBB or RBBB? Intervals: QT QT should be less than half of R-R interval Overview

Rate Rhythm Intervals

QRS ST-T wave QRS Is there a pathologic Q wave? (sign of previous MI)

More than 1 box wide and More than 1/3 of the height of the R wave QRS Are the QRS complexes normal, too small,

or too tall? Too small (low voltages) <5mm in leads I, II, III and <10mm in leads V1-V6 QRS

Too tall: (left ventricular hypertrophy) Most common criteria: S in V1 + R in V5 or V6 35mm Overview Rate

Rhythm Intervals QRS

ST-T wave ST segment-T wave Is there ST depression or elevation ? >1mm in 2 contiguous leads (2 leads that

are in the same area of the heart) Is there T wave inversion? What parts of the heart (leads) are involved? What part of the heart is

affected? ST elevation ST depression T waves Are they inverted? (Can suggest ischemia)

Are they peaked (Such as in hyperkalemia)? Peaked T waves Hyperkalemia Peaked T waves occurs early in hyperkalemia

As hyperkalemia gets more severe PR widens QRS widens P wave

disappears This is called a sine wave Summary Rate

Rhythm Sinus rhythm or not? Intervals PR <0.20 seconds?

QRS <0.12 seconds? QT less than of RR interval? Summary QRS

Is there a pathologic (big) Q wave? Are the QRS intervals too big/tall? Are the QRS intervals too small?

R in V1/2 + S in V5/6 >35mm? <5mm in limb leads and <10mm in V1-V6 ST- T wave Is there ST elevation or depression? What part

of the heart? Are the T waves inverted or peaked? Quiz: Interpret ECG-1 Quiz: Interpret ECG-1

Rate: 150 bpm Rhythm: Sinus tachycardia Intervals: PR, QRS, QT intervals all normal

QT interval looks long, but this is because HR is fast. When we calculate QT corrected for HR, it is normal. QRS: No pathologic Q waves, Normal size QRS ST-T: No ST depression/elevation, No T

wave changes Quiz: Interpret ECG-2 Quiz: Interpret ECG-2 Rate: 52 bpm

Rhythm: Sinus bradycardia Intervals: PR long: 1st degree AV block

QRS normal QT long QRS: No pathologic Q wave, Normal size QRS

ST-T: No ST depression/elevation. No T wave changes Quiz: Interpret ECG-3 Quiz: Interpret ECG-3 Rate: 70 bpm

Rhythm: Sinus rhythm Intervals: PR, QRS, QT all normal QRS: No pathologic Q waves. Normal size QRS

ST-T: No ST depression or elevation T waves are peaked

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