Reading ECG Paper
Reading ECG Paper
Paper divided into small sguares:
Graph paper allows a - Width :l millimeter {mm)
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visual measurement I
* Time interval = 0,04 seconds
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of: - I small square. 0-04 seconds
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' TIME (rate|-
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Darkerlines divide paper into every 5th square vertically
meosured on the
and horirontally:
horizontal llne
- AMPLITUDE - Large squares measure 5 mm in height and width.
- Represents time intervalof 0.20 semnds
(voltagel - meosurcd
en the verticdl llne - 25 small squares in each large square
* 1 large squar€ = 0.20 secondr
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F- ---. .05b! -"..- -t
Reading ECG Paper Terminologies
Waveform " movement awaY from the
baseline whether posltlve or negatlve
a Segrnent - a line between waveforms
lnterval- a waveform and a segrnent
a Complex - consists of several waveforrns
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Normal ECG Waveform Normal ECG Waveform
P wave
FR lnterval
QRS Complex
T wave
U wave
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goflctlon Numal ECG Waveform
Ar.l.l FWrra P Wave (Atrial Delolarizotion\
tLFolidrlrlon
* (+! deflection as impulse activates the atria
Eal.y.t lrh ar'gm**t well contoui'ed, smooth, uPright
AV Fao{c -
* eiuration:0.06 " 0.12 sec
Vsntdcular
Dca6tr:trrtao. *&^* oFl$
Qomptrx
PR lnterval lDelay ot AV Nadel
VcnldEUirt T l rrrra of QaS
f?apcrlrrurll{rn - begins at the onset of P'* to the beginnir:g
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- durationr 0.12 ' 0.20 sec
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Normal tCG Waveform
N*rrnal ECG Waveform
, T Wave lve:ntttcular ffepolaiizatianl
. QRS Complex (Ventricular Depolarizationl * represents r€frectory Period
* contains 3 waves * LeisurelYwnle
r' Qw- first regative deflection
r' Rw- first positive deflection
. U Wave
r' Sw-firstnegatiw deflection afterthe Rw -
notalw€vs seen
typica$y small, follows tha Twave
-
- Duration: 0.04 - Q.10 seq *
representPurkinje FiSers repolarizatlon
' ST Segment (stort o/ve:ntriculor repotorirution\ . QT lnterval
- lsoeieetile; slightly elevated or depressed {< l" rnrn) -
Ventricular activitY
- C.36 : 0.44 sec
- I point: marks the start of the ST and end of the QRS
Systematic Analysis of a Rhythm Strip Systematic Analysis of a Rhythm Strip
Make initial . WHAT I$THE RHYTHM?
5uruey
t Rhythm 1. Crinpare intervals of two consecutive {tRS
R"R
complexes [ventticutEf rhdhm) 0r twe ccnsecutive
P-
t P wave
P (atrialrWthm)
* PR lnterval
QRS Ccmplex 2- A variation of up to 0' 12 sec {3 small squares}
is
a T wave acceptable. The slower the heart rate, the more
accePtable the variation.
I Rate
Systernatic Andlysis of a Rhythm Strip Systematic Analysis of a Rhythm Strip
. IS TI{ERE A P WAVE BEFORE EACFI QRS? 15 THE PR INTERVAL WITHIN f,IORMAL LIMITS?
1. ls the PR interval less than 0.12 or more than 0.?0
1. Arethey unifsrm in appearance secontJ?
2, Does it vary with each b,eat?
Z. Are all QR$ preceded by. a p wave?
HOW'S THE QRs?
3. Doeratrial astivity occur so rapidly ttlrt there are 1. What is the duration?
more atrial beats than QRS complexes? 2. Do they occur uniformly throughout the strip?
Systematic Analysis of a Rhythm Strip $ystematic Analysis of a Rhythm Strip
. Ventricular ftate
' WHAT IS THE fiATE?
- Snialls squares (R-R rnterval l 1500)
1. To determine the ventricular rate, measure the - Big squares {R-R intervali / 300
distance hetween 2 consecutive R waves (R-R intervali
?, To determine the atrial rate, measure the distance
between ? consecutive P waves (p"p intervali
Systematic AnalrTsis of a Rhythm $trip Sinus Rhythrns
Normal Sinus fthythrn
INTERPRET THE RHYTHM
* upright P waves that are similar in appearance
* Pft intervals of norrnal duration
1. Speclfythe origin of dysrhythmia, mechsnism and * normal ffiS cornploxes
ventricular rate
* no ventricuiar ahnormalities present
For example, "sinus tachycardis with a ventricular rata of 120
bprn,,
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Sinus Rhythms Sinus Rhythms
' Sinus Bradycardia ' Sinus Tachycardia
* Rate:Slow (<60 bpm); Rhythm: Regular - Rate: Fast (>100 bpm); Rhythm; Regular
* P Wavesl Normal {upright and uniform}
* P Waves; Normal (upriSht and uniform)
- PR lnterval: Normal {0"12-0.20 sec} - PR lnterval: Normal i0.12-0'20 sec)
* QRS: Normal (O.0&{.10 sec) - QRS: Normal(0.06-0.10 sec)
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Sinoatrial Node ArrhYthmias
Sinoatrial Node Arrhythmias Sinus Pause
Sinus A,nhythmia * The SA node faits to discharge and then resumes'
- lrregular Discharge lrom the Sinus Node with an irregular R-R * Eloctrical activity resurnes €ith€r when the SA nod€
resets
ioterval ittelf or when a lower latent pacemaker beglns to discharge'
.. Rat€: Usually nofmal {6}'100 bpm}; JrequentlY lncreases wlth - MB$inB PQRS complex, R-R interval ls within or
plus rninus 2
lnspiration and decreases with erpiration; may be < 60 bpm boxes where a PQRS is supposed to have occurred
-. Rhythm: irregular; varierwlth respiratlon
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Sinoatrial Node Arrhythmias Atrial ArrhYthmias
. Sinus Arrest Atrial TachYcardia
spot in the
-. Transient absence of P waves which may lait{or I seconds to - caurQd by an impulse that originated froni a single
min[tes atrium
- P $rave rs sllghtlY ditferent with sinug
* Rote: 160* 240 bPm, regular rhYthm
Atrial ArrhYthmias
Atrial Arrhythmias
Atrial Fibrillation
. Atrial Flutter - Presence of librallatory wares; usually with irregular
rhythm
- The AVnode conducts impulses tothe ventricles ata 211, 3:1, atrial
- Rapid, erratic electrical dischargecomes from multiple
4:1, or greater ratio (rarelY 1:1) ectoPic foci.
- Rate: Atrial:25&-350 bpm; ventricular: variable l{o organized atrial depolarilation are detectable
-
- P Waves: saw-tooth appearance
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Heart Blocks
Atrial ArrhYthmias . t{Degree AVBlock
" Supraventricular Tachycardia - > 0,2OPR interval
-. P waves maY not be discernable duc to the cxtremely rapid
rate
- f,ate: 150-250 bPm; RtrYthm: Regular
p Wtvesr usually buried in preceding T waves and difflcutt to
-
Heart Blocks Heart tslocks
. ?nd Degree AV ElockType I
. Znd Degree AV Block TYPe ll
- Pr08l€s$iv€ly prolonEilts P'R interyal uilil a drop beat ocrurs
* Fixed P'R interval with a drop beat
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Hea rt Blocks Ve ntricu la r ArrhYth mias
. 3"J Degree AV Block Type il Premature Ventricular Contraction
. * resL;lt lrant an irriiable ventricular fccus
P wiive api:)eal's regularly; QRS appear,s regtriarly -
-- No lelationship between p wave and QR.S
* nray be unifocal (same fornr) or nrr'rltifocal (d
Ventricula n Arrhythm ias Ve ntricu la r ArrhYth m ias
. PVC's in liigenrirrY
. PVC's in TrigeminY
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Ventri cu la r Arrhyth mlas Ventricu la r ArrhYth m ias
. PVC's in Couplets
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Ventrieu lar Anrh$h rnias
" Tcrsades de pointes
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Ventriculan Arrhyth mias
" Ventricular Fibrillation
