ECGs Made Easy!

ECG Basics
1) Atrial depolarization, initiated by the
SA node, causes the P wave.
2) With atrial depolarization complete,
the impulse is delayed at the AV node.
3) Ventricular depolarization begins at
apex, causing the QRS complex. Atrial
Systemic Approach repolarization occurs.
-A recording of the electrical signals created by
actions potentials traveling through the heart.
1) P wave—atrial depolarization.
-PR interval—impulse through atria,
AV node, bundle of His, right/left
bundle branches.
2) PR segment—AV nodal delay. 1
3) QRS complex—ventricular depolarization 2
& atrial repolarization.
4) ST segment—Time ventricles contracting 3
and emptying.
5) T wave—ventricular repolarization.
-QT interval-time for ventricular 4
depolarization and repolarization.
6) TP segment—Ventricles relaxing &
filling.

1) Determine rhythm and rate.

5
2) Look at P wave. QRS
Complex

3) PR interval duration.
4) QRS interval duration. Conduction System of the Heart
5) QT interval duration. 1) SA node in right atrium repeatedly depolarizes
6) Changes in ST segment & T wave? 4) Ventricular depolarization is complete. to threshold spontaneously triggering action
7) Interpret rhythm (ie A. fib). potentials. Action potential propagates through
PR Interval both atria allowing simultaneous atrial contraction.
Pacemaker Rates ST
2) Action potentials slow considerably passing
-Main pacemaker is the SA node at Segment through the AV node (in the intertribal septum).
0-100 BPM. 3) Atrioventricular (AV) bundle or bundle of His
5) Ventricular repolarization begins at
Secondary pacemaker is the AV apex, causing the T-wave. conduct action potential from atria to ventricle.
junction at 40-60 BPM. PR 4) Right and left bundle branches carry signal
through interventricualr septum to apex.
Segment
Last intrinsic pacemaker are the
Purkinje fibres—20-40 BMP. QT Interval
5) Purkinje fibres conduct potentials from apex
upward. Plateau (maintained depolarization) due to Ca inflow
2+
when voltage-gated slow Ca channels open and K
2+
+

QRS Configuration outflow when some K+ channels open.

Wave Intervals 6) Ventricular repolarization is -Q wave—first negative deflection after P wave.
complete. Repolarization due to
-R wave—first positive deflection after P/Q wave.
Wave/Segments Time (sec.)/Form closure of Ca2+ channels
and K+ outflow when
-S wave—first negative deflection after R wave.
P Wave 0.06-0.12 Rapid depolarization due to additional K+ channels
Na+ inflow when voltage- open.

PR Interval 0.12-0.20 -During the plateau period of steady gated fast Na+ channels
open.
QRS Complex 0.06-0.10 depolarization, the ECG tracing is flat. Remember!
ST Segment Isoelectric -Depolarization towards lead QRS=intraventricular conduction time. QRS
without a P wave means impulse may have
T Wave Upright =positive deflection originated in the ventricles, hints
QT Interval 0.35-0.45 -Depolarization away from lead ventricular arrhythmia.
=negative deflection