ECG NOTES

Normal R wave
-R wave height
gradually increased
up to V4 and then
decrease.

• Left ventricular • S in V1 + R in V5 or V6 > Causes of LVH :

hypertrophy 35mm
• R in aVL >11mm LV diastolic overload
-Mitral regurgitation
-Aortic regurgitation
-L-R shunt -VSD, PDA

LV systolic overload
-Systemic hypertension
-Aortic stenosis
-Coarctation of aorta
• Right ventricular Tall R in V1/V2 Differential diagnosis of tall R in
hypertrophy V1 :
-RBBB
-Dextrocardia
Normal cardiac axis
lies between -30 to
+90

• Left axis deviation • Lead I : R>S Causes of LAD :

(-30 to-90) • Lead III : S>R -LVH
-Left anterior hemiblock
-Inferior MI
• Right axis deviation • Lead I : S>R Causes of RAD :
(+90 to +180) • Lead III : R>S -RVH
-Pulmonary embolism
-Anterolateral MI
Normal P wave
-<0.12 sec in duration
-<2.5mm in height
• P mitrale of left atrial P wave become : Causes of P mitrale :
hypertrophy -M pattern -Mitral stenosis
-Biphasis -Mitral regurgitation
-Hypertension

• P pulmonale or right Tall and peaked P waves Causes of P pulmonale :

atrial hypertrophy -Pulmonary hypertension
-Cyanotic congenital heart
disease

• Atrial fibrillation Absent of P waves

• Complete heart block Dissociation between P waves

and QRS complex
PR interval
-0.12 to 0.5 sec in
duration
• 1st degree heart A prolonged PR interval
block implies delayed AV
conduction
• Wol-Parkinson-White • A short PR interval implies
syndrome fast AV conduction down an
accessory pathway
• Widened QRS complex
• Delta wave
QRS complex
-0.06 to 0.12 sec in
duration

• Pathological Q wave Q waves prolongation 0.04 s Causes of pathological Q wave :

and depression >25% R -transmural myocardial necrosis

• Pulmonary embolism • S in lead I

• Q wave in lead III
• T inversion in lead III

• Left bundle branch • M shaped QRS in lead V5/

block V6
• Wide QRS with loss of Q
wave resembling QS pattern

• Right bundle branch • M shaped QRS in lead V1/

block V2
• Wide S in lead I
ST segment
-isoelectric

• Ischemic changes • planar elevation >1mm OR

• planar depression > 0.5 mm
Hyperkalemia • Peaked T wave
• QRS widened

Hypokalemia • Flattened T wave

• U wave

Arrhythmia

• Supraventricular • Rate : 150-250 bpm

tachycadia • Rhythm : Regular
• P wave buried in preceding
T waves
• Normal QRS complex
• Atrial fibrillation Fibrillatory waves

• Atrial flutter Sawtooth pattern

• Ventricular • Wide QRS complex
tachycardia • Absent P wave

• Ventricular • Rate : 300-600 bpm

fibrillation • Rhythm : Extremely
irregular
• Absent P wave

Heart block

• First degree heart • One P wave per QRS

block complex
• Prolonged PR interval

• Second degree heart Progressive lengthening PR

block (Mobitz type interval
1)
• Second degree heart • Constant prolonged PR
block (Mobitz type 2) interval
• One P wave is not followed
by a QRS complex

• Second degree heart Two P waves per QRS

block (2:1 type) complex

• Complete heart block • P wave rate 90/min

• QRS complex rate 36/min
• No relationship between P
waves and QRS complexes.