ECG Basics

Guide in Reading ECG

• Standardization & technique
• Rhythm
• Rate: atrial & ventricular
• P wave morphology & duration
• P-R interval
• QRS complex morphology & duration
• ST segment
• T-wave
• U wave
• Q-T interval
 Normal Intervals

Heart rate 60 - 100 beats/min

bradycardia < 60
tachycardia > 100
PR interval 0.12 – 0.20 sec
QRS < 0.12 sec
QRS axis - 30º to + 110º
QTc < 0.45 sec
ECG Graph paper
Determination of Heart Rate

Heart rate assessment by “rule of 300”

 Measurement of Rate
• Formula 1: 300
# big squares between R-R

• Formula 2: 1500
# small squares between R-R
Standard Locations of Chest
Leads
Determination of Axis

Hexaxial System
QRS axis
P wave morphology
QRS Complex
T wave morphology
Atrial Enlargement
Atrial Enlargement
II V1
B

V1
ATRIAL ENLARGEMENT

II V1
Ventricular Enlargement
 RIGHT VENTRICULAR
HYPERTROPHY
Sokolow-Lyon Criteria:
R in V1 + S in V5-V6 > 11 mm
R in V1 > 7mm
R : S in V1 > 1
RAD > +90 degrees
Additional Criteria:
QR in V1
S1 Q3 pattern
S1 S2 S3 pattern
p pulmonale
Interactive Session
 Criteria for Diagnosis of
Complete Left Bundle Branch Block
• QRS ≥120 msecs
• Broad, notched R with
prolonged, intrinsicoid
deflection in V5, V6 (and
I, aVl)
• Small initial r waves in
V1, V2 followed by deep
S waves
• Absent septal q waves in
left-sided leads
 Criteria for Diagnosis of
Complete Right Bundle Branch Block
• QRS ≥ 120 msecs
• Broad, notched R (rsr’,
rSR’ pattern) in V1, V2
• Wide and deep S
waves in V5, V6
• ST displacement and T
waves opposite in
direction to the terminal
deflection of the QRS
complex
Myocardial ischemia and
infarction
 Myocardial Injury
Criteria:
1. Elevation of the origin of ST
segment at its junction (J point) with
the QRS of:
a. >1.0 mm (0.10 mV) in >2 limb leads
lasting at least 80 msecs
or
b. >2.0 mm (0.20 mV) in >2 precordial
leads
2. Depression of the origin of ST
segment at the J point >1.0 mm
(0.20 mV) in at least 2 leads

*ST segment deviation typically either horizontal or

slope toward the direction of T waves
 Myocardial Infarction
Criteria:
1. Development of new Q waves on
areas overlying the infarct which is:

a. >0.04. secs duration

b. >25% of the height of associated
R wave
Significant Q wave