STEP BY STEP APPROACH TO READ AN ECG

STEPS: CHECK FOR STANDARDISATION 1. RATE 2. RHYTHM 3. AXIS 4. P WAVE 5. PR INTERVAL 6. QRS COMPLEX 7. T WAVE 8. QT INTERVAL 9. QTc RATE: NORMAL: 60 100 BPM Bradycardia Rate less than 60 bpm Tachycardia Rate more than 100 bpm RHYTHM: NORMAL: Regular, 10% variation in sinus arrhythmia IRREGULAR: Escape beat/rhythm- Atrial, Junctional, ventricular Premature beat/rhythm - Atrial, Junctional, ventricular Wandering pacemaker, MAT, Atrial Fibrillation AXIS: Normal LAD RAD P WAVE: Different looking P o Wandering pacemaker HR<100bpm o MAT HR>100bpm Inverted P o Wandering pacemaker o MAT o Retrograde - Junctional (P close to QRS-before, in or after)

-Ventricular (P far away from QRS) Saw tooth appearance (Both in V1 and 11) o Atrial flutter Shape and Size o P Pulmonale(Ht >2.5mm) o P Mitrale (Duration>.12sec) o Atrial flutter

PR INTERVAL: Short PR interval (<.12sec) o WPW syndrome short PR with slurred QRS o LGL syndrome short PR with QRS not slurred Long PR interval (>.20 sec) o AV Blocks o First degree PRI >.20s, constant o Second degree PRI > .21s, Progressive increase until one QRS is dropped Wenckebach PRI is lengthened but QRS is normal Mobitz - PRI is normal but QRS is widened QRS COMPLEX: Wide o Aberrant conduction RBBB, LBBB pattern o Progression not maintained VT o Capture, Fusion VT ST SEGMENT: o Elevation/depression Strain Pattern T WAVE: o Normal QRS with T changes - MI