ECG

INTERPRETATION
Dr. Sumit Verma
Director, Clinical Practice

Dec 2022
 SESSION STRUCTURE

BASIC INTERMEDIATE ADVANCED

CLASSROOM RULES
Confused much?
 > 300,000,000
ECGs done
annually

Holst, H., Ohlsson, M., Peterson, C., & Edenbrandt, L. (1999). A confident decision support system for interpreting electrocardiograms. Clinical
Physiology, 19(5), 410-418.
PERFORMING AN ECG
PERFORMING AN ECG
10 electrodes and 12 views of the heart?
Einthoven’s triangle
Einthoven’s triangle
ELECTRICAL ACTIVITY IN THE HEART – A review
An ECG complex
A HEART BEAT
A HEART BEAT ON ECG
 FANCY WORDS

• Wave: A positive or negative deflection from baseline that indicates a specific electrical
event. The waves on an ECG include the P wave, Q wave, R wave, S wave, T wave and
U wave

• Interval: The time between two specific ECG events e.g. PR interval, QRS
interval(duration), QT interval and RR interval

• Segment: The length between two specific points on an ECG that are supposed to be at
baseline amplitude ( not negative or positive). The segments on an ECG include the PR
segment, ST segment and TP segment

• Complex: The combination of multiple waves grouped together. The only main complex
on an ECG is the QRS complex

• Point: There is only one point on an ECG termed the J point, which is where the QRS
complex ends and ST segment begins
 STEP-BY-STEP APPROACH

1. Rate – Normal, Bradycardia, Tachycardia? Regular or Irregular

2. Rhythm – Sinus/Non-Sinus :
is every p followed by a QRS and is every QRS preceded by a P?
3. Axis (the major direction of electrical activity in the heart)
3. – Normal, LAD, RAD, Extreme RAD?
4. Intervals – Durations of PR Interval, QRS complex, QTc interval,
5. P wave – presence/absence, shape and amplitude
6. QRS complex: abnormalities?
7. ST segment: abnormalities?
8. T wave: abnormalities?
9. Other Considerations – BBB, HB, U , Delta & Epsilon waves, Abnormal
Patterns etc.
10. SO WHAT? Keep Patient History & Physical Exam in context
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 THANKS!
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Glossary of Abnormalities