ECG

The electrocardiogram (ECG) is one of the most useful diagnostic tests in

emergency medicine.
It is an easy and inexpensive test.
Used routinely in the assessment of patients with;
1) Chest Pain.
2) Cardiac Ischemia.
3) Myocardial Infarction.
4) Used for Making Decisions about Eligibility for Thrombolytic Therapy.

The 12 lead ECG

The Standard ECG used now a days are 12 Lead ECG.

The 12 lead ECG is made up of;

1) Three Standard Limb Leads (I, II and III),

2) Three Augmented Limb Leads (aVR, aVL and aVF) and
3) Six Precordial Leads (V1, V2, V3, V4, V5 and V6).
Waves and complexes
 Intervals and Segments

PR Interval: From the start of the P wave to the start of the QRS complex.
PR Segment: From the end of the P wave to the start of the QRS complex.
J Point: The junction between the QRS complex and the ST segment.
QT Interval: From the start of the QRS complex to the end of the T wave.
QRS Interval: From the start to the end of the QRS complex.
ST Segment: From the end of the QRS complex (J point) to the start of the T wave.

Normal values
Heart rate 60 - 100 bpm
PR interval 0.12 - 0.20 s
QRS interval ≤ 0.12 s
QT interval < half RR interval (males < 0.40 s; females < 0.44 s)
Q wave < 0.04 s (1 mm) and < 1/3 of R wave amplitude in the same lead
 Determine the Heart Rate

There are a number of strategies for determining the Heart Rate.

A simple, quick technique is to;

 Find a QRS Complex that Falls on a Major Vertical Grid-Line (1),

 Then Count the Number of Large Squares to the Next QRS Complex (2).
 Dividing this Number into 300 gives you the Heart Rate.

In the ECG below, there are 2 Large Squares Between QRS Complexes. i.e. 300/2
gives a heart rate of 150 beats per minute.