ECG Interpreting

1. Rate
300/# of large boxes
If rate abnormally first rule out tachyarrhythmias
Are P waves present?
Are P waves followed by QRS complexes?
Are Q waves narrow or widened?
2. Rhythm
Look for sinus rhythm (P wave precedes each QRS complex)
Look for regularity by assessing R-R interval
3. Interval
PR (normal 0.12 0.2)
QT (QT interval < half of R-R interval or QT/squared root of
R-R interval
4. Axis
Assess axis and approximate its angle in degrees
5. Hypertrophy
Assess for right and left atrial enlargement/hypertrophy using lead 2
and V1
Assess for right and left ventricle enlargement using recommended
criteria
6. Ischemia/Infarction
Assess inferior lead (2, 3, aVF) for changes in the T wave, ST segment,
and Q wave
Assess left lateral leads (1, aVL, V5, V6) for changes in the T wave, ST
segment, and Q wave
Assess right heart leads (V1, aVR)
Assess anterior leads (V1, V2, V3, V4, V5, V6) the T wave, ST segment,
and Q wave N.B all precordial leads are assessed so as to
also observe R wave progression
Reciprocal changes in anterior leads will be suggestive of posterior
ischemia or infarcts

N.B If Notched waves or M waves are observed while interpreting the ECG, the
bundle branch blocks can be checked for.