Rate, regularity, and
are commonly grouped together. However, to accurately assess rhythm, it isnecessary to consider not only rate and regularity, but also the various waveforms and intervals.Determination of the ECG features requires understanding of the grid markings provided on the ECG paper(Fig. 3.1). The paper shows thin lines every 1 mm and thick lines every 5 mm. The thin lines therefore formsmall (1 mm) squares and the thick lines form large (5 mm) squares. The horizontal lines facilitatemeasurements of the various intervals and determination of heart rate. At the standard paper speed of 25mm/s, the thin lines occur at 0.04-s (40-msec) intervals and thick lines occur at 0.20-s (200-msec) intervals.The vertical lines facilitate measurements of waveform amplitudes. At the standard calibration of10mm/mV, the thin lines are at 0.1-mV increments and the thick lines are at 0.5-mV increments.Therefore, each small square is 0.04s
mV, and each large square is 0.20s
mV.Much of the information provided by the ECG is contained in the morphologies of three principalwaveforms: (i) the P wave, (ii) the QRS complex, and (iii) the T wave. It is helpful to develop a systematicapproach to the analysis of these waveforms by considering their:The guidelines for measuring and estimating these four parameters for each of the three principal ECGwaveforms are presented in this chapter. The definitions of the various waveforms and intervals werepresented in Chapter 1 in the context of describing ECG recordings of base-to-apex and left- versus right-sided cardiac activity.
RATE AND REGULARITY
5. ST-segment morphology;6. T-wave morphology;7. U-wave morphology;8. QTc interval; and9. Rhythm.P.451. General
,3. Positive and negative
in the frontal and transverse planes.P.46
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