Basic ECG Analysis and Interpretation Skills

What is an ECG?
An ECG (electrocardiogram) is a tracing of the
electrical impulses as they travel through the
heart.
Why Do We Perform ECG’s?
 Documenting type of arrhythmia a patient may have
 Baseline for evaluating cardiac size and rhythm
characteristics
 Anesthetic monitoring
 Pre and Post surgical monitoring
 Monitoring a patient’s response to antiarrhythmic
therapy
Questions to Ask Yourself When Evaluating an ECG

• Is the heart rate and rhythm normal

• Are all the complexes similar in
appearance
• Is there a P wave present for each QRS
complex
• Is there a QRS for each P wave
• Is the ECG tracing free from artifacts
and have a clean baseline
Conduction System
Lead Placement
Lead I RA and LA

Lead II RA and LL

Lead III LA and LL

Movement Artifact
Poor Contact
 Heart Rate Calculation

Paper speed set at 50mm/sec Paper speed set at 25mm/sec

• Count number of complexes in a • Count number of complexes in a

3 second time frame and
multiply by 20
• Count number of small boxes
from one R wave to the next
consecutive R wave and divide
into 3000
6 second time frame and
multiply by 10
• Count number of small boxes
from one R wave to the next
consecutive R wave and divide
into 1500
 Ventricular Premature Beats
• Premature beats that arise • Usually have a wide bizarre
within the ventricle pattern to the QRS complex
• Can be caused from cardiac or • P waves may or may not be
systemic disease, splenic tumors, visible
post surgical procedures such • Can have a negative or positive
GDV and splenectomy deflection
• Stress and excitement may • May occur as single beat,
cause increase in frequency couplet, triplet, or sustained run
 Couplet vs. Triplet
Couplet Triplet
Ventricular Tachycardia

 Ventricular arrhythmia that

has more than 3 VPC’s in a
row
 Medical intervention is
appropriate for rates
>160beats/min
 Lidocaine is drug of choice to
terminate rhythm
 Patients with runs of V-Tach
may experience episodes of
syncope or sudden death
Ventricular Escape Rhythm
 Atrial Premature Beats
• Premature beats that arise
above the ventricle with in the
atria
• Can be caused from
progression of cardiac disease
with increased atrial size,
inflammatory and systemic
disease, tumors and cancer that
involve atrial tissue
• Stress and excitement may
cause increase in frequency
• Usually they have a similar
appearance to other QRS
complexes, just happen at an
earlier interval
• P waves may or may not be
visible
• P waves can have a negative or
positive deflection
• May occur as single beat,
couplet, triplet, or sustained run
 Supraventricular Tachycardia

 Runs of atrial tachycardia

either intermittent or
sustained
 Usually sustained SVT occurs
at high heart rates and should
be encouraged to break with
IV drugs
 Sustained SVT can cause the
heart muscle to become weak
and mimic DCM but effects
can be reversed with
arrhythmia control
Supraventricular Tachycardia
 SVT vs. Sinus Tachycardia

SVT (supraventricular tachycardia) Sinus Tachycardia

 Atrial Fibrillation
 Classified as an irregularly
irregular rhythm
 High ventricular rate of
supraventricular origin
 No P waves present
 Lone primary atrial fibrillation or
can be secondary to structural
heart disease
 Goal is to get patients heart rate
<160 beats/min
 Heart Block
Heart Block can be referred to
a conduction disturbance that
occurs between the Sinoatrial
node and the Atrioventricular
node.
1st Degree
2nd Degree
3rd Degree
• 1st Degree heart block is a prolonged P-R
interval
• 2nd Degree Mobitz type I is a gradual
prolongation of P-R interval leading to a
dropped beat ( P wave with no QRS complex)
• 2nd Degree Mobitz type II has a normal and
constant P-R interval with intermittent
blocked QRS complexes
• 3rd Degree (complete) heart block there is no
electrical conduction through the AV node. P
waves are present at a constant rate with
ventricular escape rhythm
2nd Degree AV Block Mobitz Type I
2nd degree AV Block Mobitz Type II
3rd Degree Heart Block
1st Degree Heart Block, Wandering Pacemaker,
with Sinus Arrhythmia
Electrical Alternans
Examples for Group Review

* Note if normal Sinus Rhythm

* Identify Arrhythmia if present
* Calculate Heart Rate