Clinical Pharmacy department MIU

Practical Notes of ECG

Diagram 1:

Normal ECG module

Represents all components of ECG waves and intervals.
 Presence of P wave represents = sinus activity
 Uniform R-R and P-P intervals spaces represent = Normal rhythm
 Rule of 300 is used due to normal rhythm & sinus activity revealing normal
rate of Approx (300/4) = 75 beats/min

Diagram 2:

Atrial fibrillation module:

Represents absence of P wave therefore this patient is Not sinus. In addition there
are different R-R and P-P width areas representing irregular rhythm.

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 Clinical Pharmacy department MIU

Diagram 3:

Module: Sinus Bradycardia

Sinus rhythm: due to the presence of P wave the rhythm intervals are normal and
we can apply rule of 300 to calculate heart rate. While Bradycardia is due to
decreased heart rate per minute (less than 60 beats per minute)

300/ 8 boxes = 37.5 approx 38 beats per minute

Diagram 4:

Module: Sinus Tachycardia

Sinus rhythm: due to the presence of P wave the rhythm intervals are normal and
we can apply rule of 300 to calculate heart rate. Tachycardia is due to increased
heart rate per minute (more than 100 beats per minute)

300/ approx 2 boxes = 150 beats per minute or

300/ approx 2.5 boxes = 120 beats per minute

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Diagram 5:

Module represents Narrow ORS complex

Diagram 6:

Module represents Wide ORS complex

Diagram 7:

Module: Prolonged QT interval

Time from the beginning of the Q to the end of the T wave is calculated
via the ECG machine and should fall within a normal range according to
age and gender (QT interval represents total ventricular function).
Prolonged QT interval presents one of 3 possibilities that must be identififed
1. Drugs causing prolonged QT ( patient is asked about Med including old)
2. Bradycardia or tachycardia that may affect length of QT ( calculate QTc)
3. Congenital or recent problem in the heart's electricity (Heart disease)

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Diagram 8:

Module: Ventricular fibrillation / ((PVT))polymorphic ventricular tachycardia

Rate and Rhythm are irregular and hard to be determined. Absence

of PR interval representing delay of impulse from atrium to ventricle.

Polymorphic ventricular tachycardia (PVT) is a form of ventricular

tachycardia in which there are multiple ventricular foci with the resultant
QRS complexes varying in amplitude, axis and duration. The commonest
cause of PVT is myocardial ischemia

Diagram 9:

Module of Torsades de pointes (TdP)

Torsades de pointes (TdP) is a specific for of polymorphic ventricular tachycardia occurring in
the context of QT prolongation.

Polymorphic ventricular tachcardia + QT prolongation = Torsades de pointes

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Drugs that can cause Torsades de pointe
Student Notes:

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