Normal ECG: Rate and Rhythm - Eastern Illinois University

Normal ECG: Rate and Rhythm - Eastern Illinois University

Normal ECG: Rate and Rhythm Read chapters 4 and 22 ECG Interpretation* Standardization

Rate 1. RR interval 2. Heart rate Rhythm 3. PP interval

4. P wave width, height, shape, etc. 5. PR interval 6. QRS

width (and height) axis R wave progression abnormal Q waves ST segment T waves

QT interval U waves *See Chapter 22 ECG Interpretation

Univ. of Wisconsin Medical School http://www.fammed.wisc.edu/pcc/ecg/

The Normal ECG Normal = normal sinus rhythm Rate 1. R-R interval

Is it regular? 2. What is the heart rate? 300, 150, 100, 75, 60, 50 300 / (# of large boxes)

1500 / (# of small boxes) Count the number of cardiac cycles in 10 seconds and multiple by 6. Rate

Bradycardia less than 60 bpm Tachycardia greater than 100 bpm Rate

3. P-P interval Rhythm 4. P wave 5. PR interval

6. QRS 4. P Wave Lead II and aVR Positive in II

Negative in aVR < 2.5 mm in amplitude < 0.12 sec. in width Normal P Wave Normal direction of

atrial depolarization aVR? II? Figures 4-2 and 4-3

Abnormal P Wave Direction of atrial depolarization with junction rhythm

This is an example of a retrograde conduction aVR?

II? P wave The same direction as QRS Only one P wave in front of QRS

Do all the P waves look alike? 5. PR interval 0.12 - 0.20 seconds 6. QRS Complex

What is the width? (less than 0.10 seconds) Do all the QRS waves in the same lead look alike? R wave progression Axis Abnormal Q waves (infarction)

QRS Complex Q waves Normal QRS

Two phases brief phase; depolarization of ventricular septum longer phase; depolarization of both ventricles but the left is larger

First Phase Depolarization of ventricular septum

Second Phase Depolarization of both ventricles but the left is larger

Precordial Leads V6 V1

Normal QRS V 6? V 6?

V 1? Fig. 4-6 V 1? Normal QRS

V1 V6 Normal QRS

Septal r wave Septal q wave 6. QRS Complex

R wave progression Normal R Wave Progression

Transition Zone? R Wave Progression Transition Zone?

Transition Zone Figure 4-7 V1

Early & Delayed Transition V2 V3

V4 Figure 4-7 V5

V6 6. QRS Complex What is the electrical axis? normal

left axis deviation right axis deviation extreme axis deviation 7. St Segment

ST segment elevation or depression (see chapters 8 & 9) 8. T Wave Normally positive where QRS wave is positive

V3- V6 and II, but negative in aVR Abnormally tall T waves Practice ECG Library

http://www.ecglibrary.com/ecghome.html ECG: The Art of Interpretation http://www.12leadecg.com/full/ Normal

Not normal PR interval Mobitz Type II block Not normal LAD, R wave progression RBB w/inferior MI

Not normal First degree block, left atrial enlargement, left bundle branch block, & inferior MI Not normal Atrial fibrillation

Normal Not normal Junctional rhythm Not normal

LAD, late R wave progression Acute MI Not normal Premature ventricular contractions

Not normal Ventricular tachycardia: note fast rate and wide bizarre QRS. Normal Not normal

Second degree AV block - type II Not normal RAD, R wave progression Not normal

Third degree AV block Not normal Right bundle branch block. Note the wide QRS waves Normal

Not normal Left bundle branch block. Note the wide QRS waves a. yes b. vertical

c. V3 d. yes e. yes f. yes 2. No. Although there are P waves, they are

negative. negative P waves indicate a retrograde conduction likely coming from the AV junction.

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