Electrical conduction

of the heart
and
Ecg interpretation
Prepared by: SUHA BALLOUT, PhD, RN
 Review of the heart

• This 4 min video presents a

review of the anatomy and
function of the heart.

• https://www.youtube.com/
watch?v=oHMmtqKgs50
 Conduction system

• This 4 min video

explains the electric
activity of the heart
and its interpretation
on the ECG:

• https://www.youtube.c
om/watch?v=RYZ4da
FwMa8
 Electrical
conduction
 Understanding an
Ecg strip
Black marks at the top
indicate 3 secs intervals

Each box is 0.2 secs

• This is a 6 seconds ECG strip that is The smallest

usually taken and read to look for boxes are 0.04
electric abnormalities in the heart. secs

• It is important to learn the times

indicated by each box to be able to
understand and analyze ECGs.
 A normal ecg
• P wave is the first
• T wave is
upward (positive)
normally a
deflection waveform.
modest
• It indicates atrial
upwards
depolarization
waveform.
• It representing
ventricular
• QRS complex follows the P repolarization
wave.
• Normally, it begins with a
downward deflection, Q; a
larger upwards deflection, R;
and then a downwards S • U wave indicates the
wave. recovery of the Purkinje
• The QRS complex represents conduction fibers.
ventricular depolarization and • This wave component
contraction. may not be observable.
 Reading ecg
How to read an ECG strip?

An 8 step procedure is
followed:

1. Rate
2. Rhythm
3. P Wave
4. PR Interval
5. QRS Interval
6. T Wave
7. QT Interval
8. ST Segment
 rate

Counting R waves:

Count the number of R waves

in a 6 second rhythm strip,
then multiply by 10.
Or
Count the number of R waves
in a 10 second rhythm strip,
then multiply by 6.
Counting boxes: 300 - 150 - 100 -
75 - 60 - 50
Count the number 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.

Normal: 60 – 100 bmp

 rhythm
P-P Interval R-R Interval

• For ventricular rhythm, examine the R-R intervals. Are

they regular?

• For atrial rhythm, observe the P-P intervals. Are they

regular?
 P Wave
P waves: atrial rhythm

R waves: ventricular
rhythm

How to determine the rhythm?

• Are P waves present?

• Is there a P wave before every QRS complex and a QRS

complex after every P wave?

• Do P waves look alike? (smooth, rounded and upright)

 Example
PR Interval P wave P waves and QRS

• Are P waves present? YES ( )

• Is there a P wave before every QRS complex and a QRS

complex after every P wave? YES and YES ( )

• Do P waves look alike? YES

 Pr interval
• Does the PR-Interval fall
within the norm of 0.12-0.20
seconds?

• Is the PR-Interval constant

across the ECG tracing?

P-R interval: measure the interval

from where the P wave begins until
the beginning of the QRS complex.

Normal PR interval: 0.12 to 0.20 s

(3 - 5 small squares)
 Qrs Interval
The QRS complex indicates
ventricular depolarization that
triggers contraction of the ventricles.

• Does the QRS interval fall within

the range of 0.08-0.12 seconds?

• Are the QRS complexes similar in QRS interval: measure the QRS
appearance across the ECG interval from the end of the PR
tracing? interval to the end of the S wave.

Normal QRS interval is 0.06 to

0.12 seconds (1.5 to 3 boxes).
 T wave
• The T wave indicates the
repolarization of the
ventricles.
• T waves which have a
downward (negative)
deflection or of T waves
with tall, pointed peaks
should be looked into.
• The U-wave is a small
upright, rounded bump.
When observed, it follows
the T-wave.
 Qt interval
• The QT interval represents
the time of ventricular
activity (both
depolarization and
repolarization).
• QT interval: measured from
the beginning of the QRS
complex to the end of the T
wave.
• Normally, the QT interval
is 0.36 to 0.44 seconds (9-11
boxes).
St segment
• The ST segment represents
the early part of ventricular
repolarization.
• The ST segment is the line
that from the end of the
QRS complex to beginning
of the T wave.
• Normally the ST segment is
flat, being neither positive or
negative relative to the
baseline.
 Example
What is the heart rate?

60

90
 example
What is the rhythm? Regular or Irregular?

Regular

Irregular
 example
How are the P waves?

Normal

P wave shape
varies
 example
How are the PR intervals?

Normal

Long PR interval
 example
How are the QRS intervals?

No QRS, bizarre rhythm

Wide QRS, bizarre appearance

 example
How are the QT intervals?

Normal

QT intervals are short