The Normal

Electrocardiogram
By:
Steffan Anthony C. Libarnes,
M.D,

Outline
What is an ECG?
A review of the anatomy and physiology of
the heart
The standard ECG set-up
The basic deflections and intervals
Leads and vectors
Normals

Electrocardiogram

Graphic recording of the electrical activity

of the heart
Activity reflects cardiac muscles as it
depolarizes during the cardiac cycle

Electrical activity precedes mechanical

activity
Depolarization of the heart initiating
event for contraction

Electrical activity generated by three

components
Pacemaker cell
Specialized conduction tissue
Cardiac muscles

Pathway of conduction

ECG record the electrical activity by

means of electrodes placed on the body

Standard ECG paper and recording

speed
Divided into squares 1mm in height and
width
Large square = 5 small squares
ECG recording speed: 25mm/s
1 small square=0.04 seconds
1 large square=0.20 seconds

Standard calibration 1mv=10mm

Deflections (Waves)

Leads and Vectors

Difference between the potentials of two
electrodes are recorded as leads
Standard ECG: 12 leads

Extremity leads
Frontal plane
Bipolar leads (3 )
Difference between electrode of two limbs

Unipolar leads (3)

voltage at one locus relative to an electrode
(indifferent electrode)

Limb leads and vectors

Precordial leads
Horizontal plane
All unipolar leads ( 6 )
R precordial leads
13 lead ECG V3R
14 lead ECG V4R

Precordial Lead placement and

vectors

In the ECG,
Impulses going towards the vector will be
positive and record as an upward deflection in
the ECG
Impulses going away the vector will be
negative and record as a downward deflection
in the ECG

Normals

P wave
Atrial depolarization
Smooth and rounded
Duration: < 0.10 sec
Height: 0.5 to 2.5mm
Impulses from R to L
Upright: I, II, aVF
Inverted in aVR
Biphasic, upright or
inverted in III, aVL and
V1

PR interval
Time between atrial
and ventricular
depolarization
Beginning of P wave
to beginning of QRS
complex
Duration: 0.12 sec to
0.2 sec

QRS complex
Ventricular depolarization
Duration: <0.10 secs
if initial deflection is negative Q wave
1st positive deflection R wave
Negative deflection after an R wave S
wave

ST segment
Isoelectric
Slight elevations
Not more than 1 mm in
the limb leads
Not more than 2 mm in
the precordial leads

Slight depressions
Less than 0.5 mm

T wave
Ventricular repolarization
Direction
Upright: I, II, V3 to V6
Inverted: aVR
Upright or inverted:III, aVL, aVF, V1, V2

Height:
Limb leads: 5 mm
Precordial leads: 10 mm

QT interval
Duration of ventricular depolarization and
repolarization
Beginning of QRS complex to end of T
wave
Rate dependent
QT/ square root of RR <0.44secs

Rate
Normal Rate: 60 to 100 bpm
Six second method
Count the no. of complexes within 6 seconds
(30 large boxes)
Multiply no. by 10

RR methods
RR method (large boxes)
# of large squares between two R waves / 300
= Rate

RR method (small boxes)

# of small boxes between two R waves / 1500
= Rate

Rhythm
Must be regular
PP intervals and RR intervals are equal
Variations of up to 0.12 seconds may be
acceptable

Sinus Rhythm
P waves upright in lead II
Every P is followed by a QRS, every QRS
preceded by a P
PR interval > 0.12 seconds

Axis

Axis
Lead I

Lead aVF

normal

positive

positive

RAD

negative

positive

LAD

positive

negative

indetermin negative
ate

negative

Thank you