ECG

Q is not necessarily need to be presented

U wave occur in slow heart in lead 2 and 4

› Patients name, DOB and date of ecg.
ECG
Callibration: 10mm/mv
paper speed: 25mm/seconds
Rhythm
› Is the rhythm regular?
To check for rate and rhythm, see the lead 2
Atrial flutter

Check the rhythm by calculating whether R

to R wave is the same along the way or
notdistance
Rate
For regular rhythm
› 1. 60/(duration of R-R interval in seconds)
› 2. 300/(number of big boxes) For regular rhythm

› 3. Count the number of QRS complex

between 2 tick marks (6 seconds, or 30
big boxes) and multiply by 10 For irregular rhythm
8 QRS complex in 30 big boxes x 10 = 80 bpm
P waves
› The P-waves is always positive in lead II during
sinus rthythm
› The Pwaves is virtually always positive in leads
aVL, aVR, I, V4, V5 and V6
› The P-waves is negative in lead aVR
› The P-waves is frequently biphasic in V1
(occasionally in V2). Negative deflection is
normally less than 1mm
› P-waves duration should be ≤ 0.12s
› P-waves amplitude should be <2.5mm in the
limb leads.
› Sinus bradycardia < 60 bpm

› Sinus tachycardia > 100 bpm

PR interval
› 3-5 small boxes
› 0.12-0.2 s
› Indicate conducting impulse through the
AV node
Aka heart block
First degree heart block

v QRS complex still present between P wave

v >2-5 small boxes
v Changes are constant
Second degree
type 1 mobitz

v PR interval longer
v There might be no QRS
complex between P
wave (drop beat)
Second degree HB (type 2
mobitz)
Third degree Block

v Patient may
present with
syncope/
sudden death
v No QRS
complex at all
after p wave
1st degree heart block
v QRS complex still present between P wave
v >2-5 small boxes
v Changes are constant
Second degree type 1 mobitz
v Increase PR interval
v There is drop beat
Third degree heart block
Complete dissociation between atrial and ventricular activity
QRS complex
› Normal 0.07-0.1 seconds
› Wide >0.10 seconds but to diagnose a bundle
branch block needs a QRS >0.12 seconds
Wide QRS: impulse arise from the ventricular
› Narrow QRS
› Rapid activation of the ventricles via the normal
Purkinje system
› Originates from within or above the His Bundles
(supraventricular tachycardia) eg atria, Sinus
nodes, Av node, His Bundle or combination.
Narrow QRS
WIDE QRS
Height
› High voltage:
› Tall complexes: LVH or body habitus

› Low voltage:
› Small complexes
› <5mm in the limb leads
› <10mm in the chest leads
Q waves
Indicate silent MI
Pathological Q waves
› Q waves > 25% of the R waves that follows
it
› >2mm height, 2 small box
› >40ms width (>1mm) 1 small box
› Seen in leads V1-3
St depression
ST and T waves changes

LBBB RBBB

Seen in MI Seen in
hypokalae
mia
Changes in a myocardical
infarction
Areas of Myocardial infarction
AXIS DEVIATION
› Right Axis Deviation:
› Right ventricular hypertrophy
› Acute right ventricular strain
› Lateral STEMI
› Chronic lung disease
› Hyperkalemia
› Sodium channel blockade eg TCA
› WPW syndrome
› Dextrocardia
› Ventricular ectopy
› Left Axis Deviation
› Left Ventricular Hypertrophy
› Left Bundle Branch Block
› Inferior MI
› Ventricular pacing/ectopic
› WPW Syndrome
› Left anterior fascicular block

› Extreme Axis Deviation

› Hyperkalemia
› Ventricular rythms eg VT
› Severe right ventricular hypertrophy
Examples
AF
› Prolonged HTN, prev ischemic event,
electrolyte imbalance
› P wave not there

› Causes : HTN, valvular, PE, pulm HTN, pneumo,

pheochromocytoma, alcohol

› Can cause cardiogenic shock, strokeà stasis

of blood in heart at left atrial appendage
› HASVAC score
› amiodorone