 Axis: I and avF

o 1 and avF + = normal axis

o RAD: 1 (-) and avF (+)
 RBBB
 RVH
o LAD: 1 (-) and avF (+/-)
 If avF (-)  check if lead 2
 If II is positive, normal axis.
 If II is negative, left axis deviation is present
 Intervals
o PR Intervals: 120-200 (< 1 big box)
 PR prolongation (>200ms):
 Fixed PR >200: 1st degree AV block
 Progressively prolonged PR: 2nd degree Mobitz Type 1
 Progressively prolonged PR until QRS is dropped = 2nd degree Mobitz Type 2
o Every 3rd or 4th P wave = 3:1 or 4:1
 Shorter PR: re-entry tract (<120ms)
 Atrial impulse gets to ventricle faster via accessory pathway
 Delta waves = Wolf Parkinson White
o Slurred QRS upstroke
o QRS Interval: < 120 ms (< 3 small boxes)
 Narrow
 Wide: > 120ms = Bundle Branch Block
 PVC, Ventricular rhythm, ventricular ectopy, vtach and pacemaker with
ventricular stimulation:
o Spontaneous action potentials discharged within the ventricles may
depolarize the ventricles. The cell/structure which discharges the action
potential is referred to as an ectopic focus. Such a focus may fire single or
multiple impulses (either consecutively or intermittently). A single
impulse gives rise to a premature ventricular beat, whereas multiple
impulses may establish a ventricular rhythm, or even ventricular
tachycardia.
 External (artificial) pacemakers: inserted in the R ventricular apex
o Wide QRS + vertical tics near QRS