CHART 384

P Waves

Stepwise Process for ECG Strip Evaluation

Are the P waves regular? Is there one P wave for every QRS and one QRS for every P wave? Is the P wave in front of the QRS or behind it? Is the P wave normal and upright in lead II? Do all the P waves look alike? Are the abnormal P waves associated with ectopic beats? Are all the PR intervals constant? Is the PR interval measurement within normal range (0.12 to 0.20 second)? If the PR interval varies, is there a pattern to the changing measurements? Are all the QRS complexes of equal duration? What is the measurement of the QRS complex size? Is the QRS complex measurement within normal limits (0.06 to 0.12 second)? Do all the QRS complexes look alike? Are the unusual QRS complexes associated with ectopic beats? What is the length of the QT interval? Is it normal or prolonged? Is the patient on a treatment that prolongs the interval? Atrial: how many P waves in 6 seconds times 10. Ventricular: how many R waves in 6 seconds times 10. A second method is to count the number of large boxes between two R waves and divide by 1500. Both methods work best when the rhythm is normal. What is the heart rate? Is it regular? Is it irregular? Are there any patterns to the irregularity? Are there any ectopic beats; if so, are they early or late? Are they present? What are they? How is the patient tolerating them? Do they require treatment?

PR Interval

QRS Complex

QT Interval

Rate

Regularity (also called rhythm)

Ectopic Beats