BASIC ECG

INTERPRETATION &
PROCEDURE
•BY:
•AHMAD HAFIZ BIN ALIAS
•UNIVERSUTY LECTURER
•UNISZA
 Learning objective

At the end of this lecture, students should be able to :

 Understand the physiology of electrical conduction in the heart

 Read and interprate normal ECG
 Calculate heart rate based on ECG
 Know methods of doing ECG
Normal Impulse Conduction

Sinoatrial node
AV node
Bundle of His
Bundle Branches
Purkinje fibers
 The “PQRST”

• P wave – Atrial depolarization

QRS – Ventricular
depolarization

 T wave – Ventricular
repolarization
The PR interval

Atrial depolarization
+
delay in AV junction
(AV node/Bundle of His)

 (delay allows time for the atria to contract before

the ventricles contract)
 Pacemaker of the heart

SA Node - Dominant pacemaker with an intrinsic rate

of 60 - 100 beats/minute.

AV Node - Back-up pacemaker with an intrinsic rate

of 40 - 60 beats/minute.

Ventricular cells - Back-up pacemaker with an

intrinsic rate of 20 - 45 bpm.
 Action Effect

Depolarization The electrical charge of a cell

is altered by a shift of
electrolytes on either side of
the cell membrane, this change
stimulates muscle fiber to
contract

Repolarization Chemical pumps re-establish

an internal negative charge as
the cells return to their resting
state

Clinical tap :- Mechanical and electrical functions of the heart are influenced by proper electrolyte
balance. Important components of this balance are sodium, calcium, potassium, and magnesium
 Interpreting the ECG

Check : -
 Name & IC
 Time & date
 Indication
Calibration :-
 Height – 10mm = 1mV
 Paper speed – 25mm/s = 25 mm
(25 small squares / 5 large
squares) equals 1 sec.
 The ECG paper

 Horizontally
 One small box - 0.04 s
 One large box - 0.20 s

 Vertically
 One large box - 0.5 mV
• Every 3 seconds (15 large boxes) is marked by a vertical line.
• This helps when calculating the heart rate.
 NOTE: the following strips are not marked but all are 6 seconds long.
  Step 1 : Calculate rate.
 Step 2 : Determine regularity.

Rhythm analysis  Step 3 : Assess the P waves.

 Step 4 : Determine PR interval.
 Step 5 : Determine QRS duration
  Option 1

Step 1 : calculate  Count the of R waves in a 6 second (30 big boxes) rhythm
strip, then multiply by 10. ( suitable for irregular rhythm)
rate  Reminder: all rhythm strips in the Modules are 6 seconds in
length.
 Find a R wave that lands on a bold line.
 Count the of large boxes to the next R wave.
 If the second R wave is 1 large box away the rate
is 300, 2 boxes - 150, 3 boxes - 100, 4 boxes -
75, etc.
 Memorize the sequence:
 300 - 150 - 100 - 75 - 60 - 50

 Formula : 300/RR interval (big box) @ 1500/RR

(small box)
  Look at the R-R distances (using a caliper or markings on a
Step 2: Determine pen or paper).

Regularity  Regular (are they equidistant apart)? Occasionally irregular?

Regularly irregular? Irregularly irregular?
  Are there P waves?
Step 3 : Assess the  Do the P waves all look alike?

P waves  Do the P waves occur at a regular rate?

 Is there one P wave before each QRS?
 Step 4 : Determine PR
P R interval

 Normal: 0.12 - 0.20 seconds.

 (3 - 5 boxes)
Q
 R

P T
S
Q

 Normal: 0.04 - 0.12 seconds.

Step 5 : QRS duration 1 - 3 boxes)
  Rate – 90 – 95 bpm

Rhythm  Regularity - regular

 P waves - normal
Summary  PR interval- 0.12 s
 QRS duration - 0.08s
 • Etiology: the electrical impulse is formed in the SA node
and conducted normally.
Normal sinus
rhythm (NSR / SR) • This is the normal rhythm of the heart; other rhythms that do
not conduct via the typical pathway are called arrhythmias.
 • Rate 60-100 bpm
• Regularity regular
SR Parameters • P waves normal
• PR interval 0.12 – 0.20
• QRS duration 0.04 – 0.12
 aVR – Rt. Sided V1 - ANT V4 - Antero-
I - Lateral
&Posterior septal

II - Inferior V2 - ANT V5 - Lateral

aVL - Lateral &Posterior

III - Inferior aVF - Inferior V6 - Lateral

V3 - Antero-
septal
TQ