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Normal ECG:

Rate and Rhythm


Read chapters 4 and 22

ECG Interpretation*
Standardization
Rate
1. RR interval
2. Heart rate

Rhythm
3. PP interval
4. P wave

width, height, shape, etc.


5. PR interval
6. QRS

width (and height)


axis
R wave progression
abnormal Q waves
ST segment
T waves
QT interval
U waves

*See Chapter 22

ECG Interpretation

Univ. of Wisconsin Medical School

http://www.fammed.wisc.edu/pcc/ecg/

The Normal ECG

Normal = normal sinus rhythm

Rate
1. R-R interval

Is it regular?
2. What is the heart rate?

300, 150, 100, 75, 60, 50


300 / (# of large boxes)
1500 / (# of small boxes)
Count the number of cardiac cycles in 10 seconds and
multiple by 6.

Rate

Bradycardia
less than 60 bpm
Tachycardia
greater than 100 bpm

Rate
3. P-P interval

Rhythm

4. P wave
5. PR interval
6. QRS

4. P Wave
Lead II and aVR
Positive in II
Negative in aVR
< 2.5 mm in amplitude
< 0.12 sec. in width

Normal P Wave
Normal direction of
atrial depolarization

aVR?

II?
Figures 4-2 and 4-3

Abnormal P Wave
Direction of atrial
depolarization with junction
rhythm

This is an example of a
retrograde conduction

aVR?

II?

P wave

The same direction as QRS


Only one P wave in front of QRS
Do all the P waves look alike?

5. PR interval
0.12 - 0.20 seconds

6. QRS Complex
What is the width? (less than 0.10 seconds)
Do all the QRS waves in the same lead look alike?
R wave progression
Axis
Abnormal Q waves (infarction)

QRS Complex

Q waves

Normal QRS

Two phases
brief phase; depolarization of ventricular septum
longer phase; depolarization of both ventricles but
the left is larger

First Phase

Depolarization of
ventricular septum

Second Phase

Depolarization of both
ventricles but the left is
larger

Precordial Leads

V6

V1

Normal QRS

V6 ?

V6 ?

V1 ?
Fig. 4-6

V1 ?

Normal QRS

V1

V6

Normal QRS

Septal r wave

Septal q wave

6. QRS Complex

R wave progression

Normal R Wave Progression

Transition Zone?

R Wave Progression

Transition Zone?

Transition Zone

Figure 4-7

Early & Delayed Transition


V1

V2

V3

V4

Figure 4-7

V5

V6

6. QRS Complex
What is the electrical axis?
normal
left axis deviation
right axis deviation
extreme axis deviation

7. St Segment

ST segment elevation or depression


(see chapters 8 & 9)

8. T Wave

Normally positive where QRS wave is positive


V3- V6 and II, but negative in aVR
Abnormally tall T waves

Practice

ECG Library
http://www.ecglibrary.com/ecghome.html
ECG: The Art of Interpretation
http://www.12leadecg.com/full/

Normal

Not normal PR interval Mobitz Type II block

Not normal
LAD, R wave progression
RBB w/inferior MI

Not normal First degree block, left atrial enlargement, left bundle branch
block, & inferior MI

Not normal
Atrial fibrillation

Normal

Not normal
Junctional rhythm

Not normal
LAD, late R wave progression
Acute MI

Not normal
Premature ventricular contractions

Notnormal
Ventriculartachycardia:notefastrateandwidebizarreQRS.

Normal

Notnormal
SeconddegreeAVblocktypeII

Not normal
RAD, R wave progression

Notnormal
ThirddegreeAVblock

Notnormal
Rightbundlebranchblock.NotethewideQRSwaves

Normal

Notnormal
Leftbundlebranchblock.NotethewideQRSwaves

a. yes
b. vertical
c. V3
d. yes
e. yes
f. yes

2. No. Although there are P waves, they are negative.


negative P waves indicate a retrograde conduction
likely coming from the AV junction.