Normal ECG:

Rate and Rhythm

Read chapters 4 and 22
 ECG Interpretation*
Standardization

Rate

1. RR interval

2. Heart rate

Rhythm

3. PP interval

4. P wave

width, height, shape, etc.

5. PR interval

6. QRS *See Chapter 22

width (and height)
 ECG Interpretation

Univ. of Wisconsin Medical School

http://www.fammed.wisc.edu/pcc/ecg/
 The Normal ECG

Normal = normal sinus rhythm

 Rate

1. R-R interval

Is it regular?

2. What is the heart rate?

300, 150, 100, 75, 60, 50

300 / (# of large boxes)

1500 / (# of small boxes)

Count the number of cardiac cycles in 10 seconds

and multiple by 6.
 Rate

Bradycardia

less than 60 bpm

Tachycardia

greater than 100 bpm

 Rate

3. P-P interval
 Rhythm

4. P wave

5. PR interval

6. QRS
 4. P Wave

Lead II and aVR

Positive in II

Negative in aVR

< 2.5 mm in amplitude

< 0.12 sec. in width

 Normal P Wave

Normal direction of atrial

depolarization aVR?

II?

Figures 4-2 and 4-3

 Abnormal P Wave

Direction of atrial depolarization

with junction rhythm aVR?

This is an example of II?

a retrograde
conduction
 P wave

The same direction as QRS

Only one P wave in front of QRS

Do all the P waves look alike?

 5. PR interval

0.12 - 0.20 seconds

 6. QRS Complex

What is the width? (less than 0.10 seconds)

Do all the QRS waves in the same lead look alike?

R wave progression
Axis
Abnormal Q waves (infarction)
QRS Complex

Q waves
 Normal QRS

Two phases

brief phase; depolarization of ventricular septum

longer phase; depolarization of both ventricles but

the left is larger
 First Phase

Depolarization of
ventricular septum
 Second Phase

Depolarization of both
ventricles but the left is
larger
Precordial Leads

V6

V1
 Normal QRS

V6?
V6?

V1? V1?

Fig. 4-6
 Normal QRS

V1
V6
 Normal QRS

Septal r wave

Septal q wave
 6. QRS Complex

R wave progression
Normal R Wave Progression

Transition Zone?
R Wave Progression

Transition Zone?
 Transition Zone

Figure 4-7
 Early & Delayed Transition

V1 V2 V3 V4 V5 V6

Figure 4-7
 6. QRS Complex

What is the electrical axis?

normal

left axis deviation

right axis deviation

extreme axis deviation

 7. St Segment

ST segment elevation or depression

(see chapters 8 & 9)

 8. T Wave

Normally positive where QRS wave is positive

V3- V6 and II, but negative in aVR

Abnormally tall T waves

 Practice

ECG Library

http://www.ecglibrary.com/ecghome.html

ECG: The Art of Interpretation

http://www.12leadecg.com/full/
Normal
Not normal PR interval -
Mobitz Type II block
 Not normal
LAD, R wave progression
RBB w/inferior MI
 Not normal -
First degree block, left atrial enlargement, left bundle branch
block, & inferior MI
 Not normal
Atrial fibrillation
Normal
 Not normal
Junctional rhythm
 Not normal
LAD, late R wave progression
Acute MI
 Not normal
Premature ventricular contractions
 Not normal
Ventricular tachycardia: note fast rate and wide bizarre QRS.
Normal
 Not normal
Second degree AV block - type II
 Not normal
RAD, R wave progression
 Not normal
Third degree AV block
 Not normal
Right bundle branch block. Note the wide QRS waves
Normal
 Not normal
Left bundle branch block. Note the wide QRS waves
a. yes
b. vertical
c. V3
d. yes
e. yes
f. yes
2. No. Although there are P waves, they are negative.
negative P waves indicate a retrograde conduction likely
coming from the AV junction.