Bas

ic EC
G
 o f a n E C G Tra ci ng
C om p o ne n t s
R
P
T U
J

Q S
QT
PR QRS
interval
interval interval

ST
segment
Norm a l Va l u e s

P wave <0.12 sec

<0.25 mV
<0.1 mV terminal negative deflection in V1
PR interval 0.12-0.20 sec
QRS complex <0.11-0.12 sec
T wave 5-10 mm
QTc = QT/RR <0.48 sec 
<0.47 sec 
Mnemonic

RRAHIM
Rate Rhythm Axis Hypertrophy Ischemia Miscellaneous
R a te
• “Rule of 300”
RR interval 1 2 3 4 5 6
Heart rate 300 150 100 75 60 50

• Formula
1500 300
# of small boxes # of big boxes
R a te
• 10-second rhythm strip (if the rhythm
is irregular)

# of RR intervals x 6
R h y th m
• Sinus P wave?
– Upright in leads I and II
– Followed by a QRS complex
– Inverted in aVR, biphasic in V1
R h y th m
• Atrial fibrillation (AF)

• Atrial flutter
R h y th m
• Supraventricular tachycardia (SVT)
R h y th m
• Multifocal atrial tachycardia (MAT)
R h y th m
• Ventricular tachycardia
R h y th m
• PR interval?
– Shortened in WPW and LGL syndromes
– Prolonged in 1° or 2° AV block
R h y th m
• 1° AV block
– Prolonged PR interval
R h y th m
• 2° AV block
– Type I (Wenckebach)
• Progressively lengthening PR interval
• (+) Dropped QRS complexes

X X
R h y th m
• 2° AV block
– Type II
• Constant PR interval
• (+) Dropped QRS complexes
R h y th m
• 3° AV block
– Independent atrial and ventricular rates (AV
dissociation)
Axis

Lateral

Septal Anterior

Inferior
Axis

I aVF
Normal + +
Left axis + -
Right axis - +
Indeterminate - -
Axis
• Formula

90 (aVF)
|I| + |aVF|

*If I is negative, add 90.

Normal value (PGH): -30 to 100

Normal value (Harrison’s): -30 to 110
Hypertrophy
• Left atrial abnormality (LAA)
– P wave ≥3 mm in II OR
– Terminal segment of P wave >1 small box in
V1
Hypertrophy
Hypertrophy
• Right atrial abnormality (RAA)
– P wave >2.5 mm in II, III or aVF
Hypertrophy
• Biatrial abnormality
Hypertrophy
• Left ventricular hypertrophy (LVH)
– S in V1 + R in V5 or V6 >35 mm OR
– aVL >11 mm OR
– S in V3 + R in aVL ≥20 mm  or ≥28 mm


*LV strain: PLUS significant asymmetric ST
segment depression w/ broad inverted T wave
 LVH w/ strain cannot r/o
concomitant ischemia
Hypertrophy
Hypertrophy
• Right ventricular hypertrophy
(RVH)
– RAD + R/S ratio >1 in V1 + R/S ratio <1 in V6
Hypertrophy
• Biventricular hypertrophy
Ischemia
• Myocardial infarction
– Significant ST elevation ≥1 mm in limb leads
and ≥2 mm in chest leads OR >0.08 sec
– Significant Q waves ≥25% of QRS complex OR
≥0.04 sec
– Reciprocal leads:
• Anterior/anterolateral  inferior
• Inferior  lateral
• Lateral  anteroseptal
Ischemia
• Myocardial infarction
Ischemia
• Ischemia
– T wave inversion ≥5 mm  t/c ischemia
– ST segment depression ≥1 mm in ≥2
contiguous leads  ischemia
Miscellaneous
• Non-specific ST-T wave changes
– T wave inversion <5 mm
– ST segment depression <1 mm
– Flattening of ST segment w/o U waves
• Low-voltage QRS complexes
– <5 mm in limb leads OR
– <10 mm in chest leads
• Poor R wave progression
– R wave <3 mm in V1-V3 AND normal R wave in V4-V6
– Exceptions: LVH, LBBB, WPW, anteroseptal wall MI
(absence of R wave in V1-V3), low-voltage QRS
Miscellaneous
• Prominent U wave + normal T wave  prominent U
wave
• Prominent U wave + flattened T wave  t/c hypokalemia
• ST segment depression + U wave + normal T wave 
cannot r/o ischemia, prominent U wave
• Flattened T wave + normal QRS  NSSTTWCs
• Peaked T waves ≥10 mm in ≥2 contiguous leads  peaked
T waves, t/c hyperkalemia
• Prolonged QT: type 1A anti-arrhythmics, hypokalemia,
hypocalcemia, hypomagnesemia
• NSSTTWCs, prob. digitalis effect: shortened QT,
scooping of ST segment
Miscellaneous
Miscellaneous
• Right bundle branch block (RBBB)
– rsR’ pattern in V1 (R wave >15 mm)
– Slurred S wave in I and V6
Miscellaneous
• Left bundle branch block (LBBB)
– Absent small initial Q waves in LV leads
– Positive R wave in LV leads w/ large
secondary R wave
– Negative QRS in V1
Miscellaneous
• IVCD: wide QRS not typical of
RBBB/LBBB
Miscellaneous
• Early repolarization changes
Miscellaneous
• Premature complexes
Miscellaneous
• Pericarditis
Miscellaneous
• QT interval

QT
√RR

*Compute only if the rate is abnormal.

Miscellaneous
• Left anterior hemiblock (LAHB)
– LAD
– qR complex in I, aVL
– rS pattern in II, III, aVF
Miscellaneous
• Left posterior hemiblock (LPHB)
– RAD
– rS complex in I, aVL
– qR complex in II, III, aVF
T
h an
ky
o u!


meredith