READING AN EKG
– if regular, then count the number of large squares between R waves; 1 square = 300 bpm, 2 = 150 bpm, 3 = 100 bpm, 4 = 75 bpm, 5 = 60 bpm, 6 = 50 bpm. Each small box = 0.04 s, each large box = 5 small boxes = 0.20 s.
– is it regular? (use calipers/ruler to make sure all R-R intervals are the same); are there P waves, and arethey in front of every QRS? (in sinus rhythm, P waves will be upright in lead II); are P waves all identical?3.
PR interval: normally 0.12 to 0.20 seconds (will not exceed a large box)
QRS interval: normally 0.04 to 0.10 seconds (no larger than half a large box)
QT interval: should be less than half the R-R interval (if HR < 100)4.
– net QRS deflection should be positive in both leads I and aVF
Right axis deviation: QRS negative in I, positive in aVF
Left axis deviation: QRS positive in I, negative in aVF5.
Left ventricular hypertrophy: sum of deepest S in V
and tallest R in V
> 35 mm (patients > 35 yo); R inaVL > 12 mm indicative of “strain”.
Left atrial enlargement: P waves are notched (M-shaped) in I, II, or aVL or a deep terminal negative component to P inV
Right atrial enlargement: tall, peaked P waves (> 2.5 mm) in II, III, aVF
Right ventricular hypertrophy: right atrial enlargement, right axis deviation, incomplete RBBB, low voltage tall R wavein V
, persistent precordial S waves, right ventricular strain are all suggestive.6.
: small, normal Q waves can be seen in lateral leads (I, aVL, V
), while moderate-large sized Q wavesmay be normal in leads III, aVF, aVL, and V
. To localize the infarction, look for groupings of Q waves in the followingleads…