ECG reading

*25mm/sec

horizontal: 0.04s vertical: 0.1mV

1. rhythm : every P wave is followed by QRS complex, RR interval same. Sinus Rhythm, Sinus
Tachycardia(>100), Sinus Bradycardia(<60).
AF : Not every QRS is followed by P wave.
AF NVR (Normo ventricular response) : 60-100
AF RVR (Rapid ventricular response) : >100
AF SVR (slow ventricular response) : <60
2.QRS rate : 300/large sq 1500/small sq
3. QRS axis : -30 -- +90

AF : count 6s/ 30 large sq Then x10

Left Axis Deviation : <-30

Right Axis Deviation : >90

Lead I and Lead aVf, occasionally if on Lead II -ve, LAD

4. P wave: 0.08 - 0.10s / <2.5 small sq

Pmitral -->LAE Ppulmonal RAE

5. PR interval : Early P to early QRS

0.12-0.20 s

* First degree Heart Block : PR interval >0.20s, RR interval same

* Second degree of Heart Block type I : Prolonged PR interval not constant, gradually increased, some
P wave is not followed by QRS complex
* Second degree of Heart Block type II : Prolonged Print constant, not all Pwave is followed by QRS
* Third degree of Heart Block : there is no association between P and QRS
6. QRS complex : 0.06-0.10s
LBBB : seen on V4-V6, rSR
RBBB : seen on V1-V3, rSR
7. ST changes
8. Q pathology
9. VES (ventricular extra systole) : morphology QRS different from the other, absent P wave
V1 : Right sternal edge, 4th intercostal space
V2 : Left sternal edge, 4th intercostals space
V3 : half way between V2 and V4
V4 : 5th intercostals space, midclavicular line
V5 : anterior axillary line
V6 : mid axillary line
V1 - V4
V5 - V6 , I , aVL
II, III, aVf
V7 - V9
V3R , V4R

: Anterior / Anteroseptal
: Lateral
: Inferior
: Posterior
: Right Ventricle
Cardiovascular Examination

1. General Inspection : Well / ill

Alert / Confuse

Color (pale, cyanosed, flushed)

SOB/pain

2. Hands : Nail clubbing (cyanotic congenital heart disease), Splinter hemorrhage ( subacute Infective

Endocarditis)

erythematous palm pulp)

dyslipidemia)

, Osler node (tender red nodules) and janeway lesion (non tender maculopapular

, Tobacco stain, tendon xanthoma (raised yellow lesion - suggest

3. Pulse : radial (rate, rhythm), radio-radial delay (palpate pulse bilaterally simultaneously, coarctation of aorta),
radiofemoral delay (palpate ipsilateral pulse simultaneously), collapsing pulse (hold pulse with fingers of one
hand, wrap the fingers of other hand around the forearm, check any pain in arms/ shoulder?, lift arm up
straight collapsing pulse, felt as waterhammer pulsation in forearm)
4. BP : Hyper / hypotensive

Pulse Pressure narrowed : AS

Wide : AR

5. Neck :
JVP : locate inline with sternocleidomastoid muscle, measure in cm from the sterna angle to the upper border
of pulsation.
Hepatojugular reflux : apply pressure to the liver, in healthy individual, this should last no longer than 1-2
heartbeats (it should then fall), >4cm --.> Right Heart Failure
Face
6. Eyes : Conjunctiva pallor , corneal arcus (yellowish/grey ring surround the iris - hypercholesterolaemia),
xanthelesma (yellow rasied lesion around the eye - hypercholesterolaemia)
7. Mouth : Central cyanosis (lips/underneath tongue), angular stomatitis (inflammation around the corner of
mouth- Fe/B12 deficiency)
8. Closed inspection of chest : scar : lateral thoracotomy (mitral valve), midline stenotomy (CABG), clavicular
(pacemaker)
Chest wall deformities : pectus excavatum (sunken chest), pectus carinatum
(protrusion chest), visible pulsation may be seen at the apex (HT, ventricular hypertrophy)
9. Palpation of chest : Apex Beat (5th intercostal space, midclavicular line -lateral displacement suggest
cardiomegaly), Heave and thrill (place the heel of the hand flat on the chest to the left and then right of the
sternum). Heave : sustained, thrusting usually felt as left sternal edge. Thrill (palpable murmur felt as vibration
beneath your hand)
10. radiation of murmur : Aortic Stenosis : radiate to the carotid

Mitral Regurgitation : radiating to axilla