PRACTICE SET
ECGs
STEPS
• Rate
• Rhythm
• Interval
• Axis
• Chamber enlargements
• Ischemia/Infarct
• Other
REVIEW: Normal Values
Heart rate: 60 to 100 beats per min
Sinus rhythm
Regular
REVIEW: Normal Values
P wave Duration: <0.12 s
Amplitude:
<0.25 mV in limb leads
<0.1 mV terminal negative
deflection in lead V1
PR interval 0.12 – 0.20 s
QRS <0.12 s
duration
T wave Amplitude: 0.5 – 1.0 mV
QTc <0.44 (females)
<0.48 (males)
REVIEW: Axis
Axis
If I is negative,
adjust the axis by
adding 90°
Sample Cases
CASE
R.V., a 53-year-old widower comes to your office for a
routine checkup. He is new to your practice and has not seen a
doctor since 10 years ago. No specific complaints were noted.
Routine physical examination is unremarkable, except that you find
his blood pressure is 170/110 mm Hg. He is unaware of being
hypertensive. You would like to know if his hypertension is
longstanding or of recent onset. Your laboratory assessment
includes measurement of serum electrolytes, creatinine, and
blood urea nitrogen; urinalysis; chest x-ray; and the ECG shown on
the next page.
Is the ECG helpful?
NORMAL
ECG
NORMAL ECG
Regular sinus rhythm
(65 bpm)
Normal axis
Within normal limits
Abnormal tracings
Sinus tachycardia
Sinus bradycardia
Right atrial enlargement, right axis deviation
Left atrial enlargement, left axis deviation
RSR, LAD, LVH (V1 and V5)
RAD, RAE, RVH with strain, cRBBB
Premature atrial complex
Premature ventricular complexes in quadrigeminy
Premature ventricular complexes in bigeminy
Supraventricular tachycardia
Atrial fibrillation
Atrial flutter
Ventricular tachycardia (monomorphic)
Torsades de pointes (polymorphic VT)
Ventricular fibrillation
First degree AV block
Type 1 second degree AV block
Type 2 second degree AV block
Third degree AV block
cRBBB, left anterior hemiblock
LAE, LBBB
Old
inferior
wall MI
Acute
high lateral
wall MI
Acute anterior wall MI
Acute posterior wall MI
Pericarditis (diffuse ST elevation)
Hyperkalemia
