Normal ECG:

P wave:

Represents atrial contraction So, become multiple in atrial flutter, branch block, tachycardia Absent in atrial fibrillation Large in atrial hypertrophy Inverted in nodal rhythm Represents ventricular contraction So, become amplitude in ventricular hypertrophy Prolonged in bundle branch block Deep Q (no R wave) in infarction . Why? Infarction is a dead area . So, there will be no contraction in that area

QRS complex:

T wave:

Represents ventricular relaxation So, become amplitude in muscular exercise amplitude or inverted in hypoxia

PR interval:

Represents conduction in AV bundle So, become prolonged in delayed conduction ( HB ) , bradycardia Short in rapid conduction as in tachycardia WPW

Notes :

P wave normally +ve in lead 1 & -ve in AVR RS progression R wave begins small in V1 then gradually in size.

S wave begins large in V1 then gradually in size.

Normally

(S in V1 + R in V6) < 7
R=S

V3 & V4 . are transitional zone . i.e

Axis :
( lead 1 & AVF ) QRS lead 1 Normal Right axis deviation Left axis deviation Very rare (odd ) AVF

+ve -ve +ve -ve

+ve +ve -ve -ve

In ECG, we reach the diagnosis through

rate rhythm axis waves

(1)

Rate
By two methods:

A if regular heart rate HR = B if irregular heart rate

= 2.0 30 = 6

(2)
12(1) Type
a)

Rhythm
Type Regularity

In rhythm we should comment on 2 things

Sinus rhythm (normal rhythm) Arises from SA node Normal shape of P wave Nodal rhythm Arises from AV node ( as in cases of heart block ) Inverted P wave

b)

(2)

Regularity

Regular

Regular irregularity

Irregular irregularity

(3) (4)

Axis Waves

* INFARCTION
In infarction, we should answer 3 questions:
1-

Why infarction? Recent or Old?

Present of Q wave in any site except (V5 & V6) means infarction
2-

Elevated ST segment + inverted T wave Recent Inverted T wave without elevated ST segment Old

3-

The site?
Transmural anterior wall myocardial If in (lead I, AVL, V1 V6)

infarction

Transmural inferior wall myocardial If in (lead II, III, AVF)

infarction

Note:
Elevated ST segments in some leads may be associated with reciprocal ST depression in the other leads.

* Wolf Parkinson White $ (WPW)

Criteria:
1- Short PR interval 2- Wide QRS complex 3- Slurred R

* Ventricular Hypertrophy
LT vent. Hypertrophy

RT vent. Hypertrophy

S R in V6 5.5

in V1 4

R/S ratio in V1 1 Deep S in V6

or Summation of Right axis deviation Strain in V1 & V2

both 7 Left axis deviation Strain in V5 & V6 N.B Strain inverted T wave

* Bundle Branch Block

LT. BBB Wide QRS ( all over ECG ) RSR` in V5 & V6 Wide S in V1 & V2 RT. BBB Wide QRS ( all over ECG ) RSR` in V1 & V2 Wide S in V5 & V6

Left axis deviation Left vent. Strain N.B RSR` M-shaped like this

Right axis deviation Right vent. Strain