BASIC ECG

READING
DR. ELENITA C. MANRIQUE - ARREGLO
CARDIAC ANATOMY
CARDIAC ANATOMY
CARDIAC ANATOMY
CARDIOPHYSIOLOGY
THE
ELECTROCARDIOGRAPH
 GRAPHIC REPRESENTATION OF CARDIAC ACTIVITY
WILLEM EINTHOVEN
THE FIRST ECG
THE LEADS
LEADS CAPTURING
IMPULSES
LEADS

 12 LEAD VIEWS OF THE HEART

 LATERAL WALL – I,AVL, V5,V6
 INFERIOR WALL – II, III, AVF
 ANTERIOR WALL – V1, V2, V3, V4
 SEPTUM – V1, V2
 POSTERIOR WALL – RECIPROCAL
CHANGES IN V1, V2 (SOMETIMES V4)
EVOLUTION
NEW GENERATION
MOST COMMON
ECG WAVES
ECG TRACING
ECG READING
 P WAVE
 LOCATION : PRECEEDS QRS COMPLEX
 AMPLITUDE : 2 – 3 mm
 DURATION : 0.06 – 0.12 sec
 CONFIGURATION : ROUNDED AND
UPRIGHT
 P – R INTERVAL
 LOCATION : FROM BEGINNING OF P TO
THE BEGINNING OF QRS
 DURATION : 0.12 – 0.20 sec
 QRS COMPLEX
 LOCATION: FOLLOWS P – R INTERVAL
 AMPLITUDE : 5 – 30 mm high
 DURATION: 0.06 – 0.10 sec
ECG READING
 ST SEGMENT
 LOCATION: EXTENDS FROM THE S WAVE
TO THE BEGINNING OF THE T WAVE
 DEFLECTION : USUALLY ISOELECTRIC
 QT INTERVAL
 FROM THE START OF THE Q TO THE END OF
THE T WAVE
 0.36 TO 0.44 SECOND
 T WAVE
 LOCATION: FOLLOWS THE S WAVE
 AMPLITUDE: 0.5 mm IN LEADS I, II, III up
to 1o mm in precordial leads
 CONFIGURATION: ROUND AND
SMOOTH
 DEFLECTION: USUALLY UPRIGHT IN I, II,
V3 TO V6 INVERTED IN AVR, VARIABLE
IN OTHER LEADS
 U WAVE
 LOCATION : FOLLOWS T WAVE
 CONFIGURATION: UPRIGHT AND
ROUNDED
 DEFLECTION: UPRIGHT
 INDICATIONS
CORONARY ARTERY
DISEASE
MYOCARDIAL INFARCTION
CARDIOMEGALY
CARDIOMEGALY
Electrolyte imbalances
Heart rhythm and rate
NORMAL ECG READING

NORMAL SINUS RHYTHM

VENTRICULAR & ATRIAL RATE
60 – 100 PER MINUTE
RHYTHM – REGULAR
QRS SHAPE NORMAL &
DURATION < 0.12 SEC
PR INTERVAL – 0.12 – 0.20 sec
P:QRS RATIO - 1
ECG TRACING
ECG
ECG
Sinus tachycardia

Rhythm :Regular
Rate :Fast (> 100 bpm)
P Wave :Normal may merge with T wave at very fast rates
PR Interval :Normal (0.12-0.20 sec)
QRS:Normal (0.06-0.10 sec)
Notes :QT interval shortens with increasing heart rate
Sinus bradycardia

Rhythm :Regular
Rate :Slow (< 60 bpm)
P Wave :Normal
PR Interval: Normal (0.12-0.20 sec)
QRS:Normal (0.06-0.10 sec)
Sinus arrhythmia

Rhythm :Irregular, varying with respiration

Rate :Normal (60-100 bpm) and rate may increase during
inspiration
P Wave :Normal
PR Interval : Normal (0.12-0.20 sec)
QRS:Normal (0.06-0.10 sec)
Notes :Heart rate frequently increases with inspiration,
decreasing with expiration
FIRST DEGREE AV BLOCK

• Atrial and ventricular rhythms regular

• PR interval > 0.20 second
• P wave precedes QRS complex
• QRS complex normal
• P : QRS ratio 1:1
SECOND DEGREE BLOCK
TYPE 1

• Atrial rhythm regular

• Ventricular rhythm irregular
• PR interval progressively, but only slightly, longer with each
cycle until QRS complex disappears (dropped beat); PR
interval shorter after dropped beat
P:QRS ratio 3:2, 4:3, 5:4
SECOND DEGREE HEART
BLOCK TYPE 2

• Atrial rate regular

• Ventricular rhythm regular or irregular, with varying degree of
block
• P-R interval constant
• QRS complexes periodically absent
• P:QRS RATIO 3:1, 4:1, 5:1 And so forth
Third degree heart block

Rhythm: Regular, but atrial and ventricular rhythms are independent

Rate :Characterized by Atrial rate usually normal and faster than
ventricular rate
P Wave :Normal shape and size, may appear within QRS complexes
PR Interval: Absent: the atria and ventricles beat independently.
QRS:Normal, but wide if junctional escape focus
ATRIAL FLUTTER
Atrial flutter

Rhythm :Regular or irregular

Rate :Fast (250-350 bpm) for Atrial, but ventricular rate is often
slower
P Wave :Not observable, but saw-toothed flutter waves are
present
PR Interval :Not measureable
QRS:Normal (0.06-0.10 sec)
Atrial fibrillation

Rhythm :Irregular
Rate :Very fast (> 350 bpm) for Atrial, but ventricular rate
may be slow, normal or fast
P Wave :Absent - erratic waves are present
PR Interval :Absent
QRS:Normal but may be widened if there are conduction
delay
PVC

Rhythm :Irregular
Rate :The underlying rate
P Wave :Absent
PR Interval :Not measurable
QRS:Wide (> 0.10 sec), bizarre appearance
Notes Two PVCs together are termed a couplet while three
PVCs in a row with a fast rhythm is ventricular tachycardia
PVC QUADRIGEMINY

Rhythm :Irregular
Rate :The underlying rate
P Wave :Absent
PR Interval :Not measurable
QRS:Wide (> 0.10 sec), bizarre appearance
Notes :PVC appears every fourth beat
PVC TRIGEMINY

Rhythm :Irregular
Rate :The underlying rate
P Wave :Absent
PR Interval :Not measurable
QRS:Wide (> 0.10 sec), bizarre appearance
Notes :PVC appears every third beat
PVC BIGEMINY

Rhythm :Irregular
Rate :The underlying rate
P Wave :Absent
PR Interval :Not measurable
QRS:Wide (> 0.10 sec), bizarre appearance
Notes :PVC appears every second beat
VENTRICULAR
TACHYCARDIA

Rate: Usually between 100-250 bpm

P wave: obscured
QRS: wide and bizarre
Conduction: as with PVCs
Rhythm: three or more ventricular beats in a row, may
be regular or irregular
May stop or start suddenly
VENTRICULAR
TACHYCARDIA
Monomorphic

Rhythm Regular
Rate Fast (100-250 bpm)
P Wave Absent
PR Interval Not measurable
QRSWide (>0.10 sec), bizarre looking
VENTRICULAR
TACHYCARDIA
Polymorphic

Rhythm :Regular or irregular

Rate :Fast (100-300 bpm)
P Wave :Absent
PR Interval :Not measurable
QRS:Normal or wide (>0.10 sec), bizarre looking
VENTRICULAR
TACHYCARDIA
Torsade de pointes

Rhythm :Irregular
Rate :Fast (200-250 bpm)
P Wave :Absent
PR Interval :Not measurable
QRSWide (>0.10 sec), bizarre looking
VENTRICULAR FIBRILLATION

Ventricular rhythm rapid and chaotic

QRS complex wide and irregular, no
visible P waves
VENTRICULAR FIBRILLATION

Rhythm :Highly irregular

Rate :Unmeasurable
P Wave :Absent
PR Interval :Not measurable
QRS:None
Notes EKG tracings is a wavy line
ASYSTOLE
Dr. Manrique - Arreglo