DR. ELENITA C.
MANRIQUE - ARREGLO
BASIC ECG READING
CARDIAC ANATOMY
CARDIAC ANATOMY
CARDIOPHYSIOLOGY
THE ELECTROCARDIOGRAPH
▪ GRAPHIC REPRESENTATION OF CARDIAC ACTIVITY
WILLEM EINTHOVEN
THE FIRST ECG
THE LEADS
LEADS CAPTURING IMPULSES
LEADS
▪ 12 LEAD VIEWS OF THE HEART
▪ LATERAL WALL – I,AVL, V5,V6
▪ INFERIOR WALL – II, III, AVF
▪ ANTERIOR WALL – V1, V2, V3, V4
▪ SEPTUM – V1, V2
▪ POSTERIOR WALL – RECIPROCAL CHANGES IN V1, V2
(SOMETIMES V4)
EVOLUTION
NEW GENERATION
MOST COMMON
ECG WAVES
ECG TRACING
ECG READING
▪ P WAVE
LOCATION : PRECEEDS QRS COMPLEX
AMPLITUDE : 2 – 3 mm
DURATION : 0.06 – 0.12 sec
CONFIGURATION : ROUNDED AND UPRIGHT
▪ P – R INTERVAL
LOCATION : FROM BEGINNING OF P TO THE BEGINNING OF
QRS
DURATION : 0.12 – 0.20 sec
▪ QRS COMPLEX
LOCATION: FOLLOWS P – R INTERVAL
AMPLITUDE : 5 – 30 mm high
DURATION: 0.06 – 0.10 sec
ECG READING
▪ ST SEGMENT
LOCATION: EXTENDS FROM THE S WAVE TO THE
BEGINNING OF THE T WAVE
DEFLECTION : USUALLY ISOELECTRIC
▪ QT INTERVAL
▪ FROM THE START OF THE Q TO THE END OF THE T
WAVE
▪ 0.36 TO 0.44 SECOND
▪ T WAVE
LOCATION: FOLLOWS THE S WAVE
AMPLITUDE: 0.5 mm IN LEADS I, II, III up to 1o mm in precordial
leads
CONFIGURATION: ROUND AND SMOOTH
DEFLECTION: USUALLY UPRIGHT IN I, II, V3 TO V6
INVERTED IN AVR, VARIABLE IN OTHER LEADS
▪ U WAVE
LOCATION : FOLLOWS T WAVE
CONFIGURATION: UPRIGHT AND ROUNDED
DEFLECTION: UPRIGHT
▪ INDICATIONS
CORONARY ARTERY DISEASE
MYOCARDIAL INFARCTION
CARDIOMEGALY
CARDIOMEGALY
Electrolyte imbalances
Heart rhythm and rate
NORMAL ECG READING
NORMAL SINUS RHYTHM
VENTRICULAR & ATRIAL RATE
60 – 100 PER MINUTE
RHYTHM – REGULAR
QRS SHAPE NORMAL &
DURATION < 0.12 SEC
PR INTERVAL – 0.12 – 0.20 sec
P:QRS RATIO - 1
ECG TRACING
ECG
ECG
ECG
ECG
Sinus tachycardia
Rhythm :Regular
Rate :Fast (> 100 bpm)
P Wave :Normal may merge with T wave at very fast rates
PR Interval :Normal (0.12-0.20 sec)
QRS:Normal (0.06-0.10 sec)
Notes :QT interval shortens with increasing heart rate
ECG
Sinus bradycardia
Rhythm :Regular
Rate :Slow (< 60 bpm)
P Wave :Normal
PR Interval: Normal (0.12-0.20 sec)
QRS:Normal (0.06-0.10 sec)
Sinus arrhythmia
Rhythm :Irregular, varying with respiration
Rate :Normal (60-100 bpm) and rate may increase during inspiration
P Wave :Normal
PR Interval : Normal (0.12-0.20 sec)
QRS:Normal (0.06-0.10 sec)
Notes :Heart rate frequently increases with inspiration, decreasing with
expiration
FIRST DEGREE AV BLOCK
• Atrial and ventricular rhythms regular
• PR interval > 0.20 second
• P wave precedes QRS complex
• QRS complex normal
• P : QRS ratio 1:1
First degree heart block
Rhythm :Regular
Rate :The underlying rate
P Wave :Normal
PR Interval :Prolonged (>0.20 sec)
QRS:Normal (0.06-0.10 sec)
Notes : A first degree AV block occurs when electrical impulses moving
through the Atrioventricular (AV) node are delayed (but not blocked). First degree
indicates slowed conduction without missed beats.
SECOND DEGREE BLOCK TYPE 1
• Atrial rhythm regular
• Ventricular rhythm irregular
• PR interval progressively, but only slightly, longer with each
cycle until QRS complex disappears (dropped beat); PR interval
shorter after dropped beat
P:QRS ratio 3:2, 4:3, 5:4
Second degree block type 1
Rhythm :Irregular but with progressively longer PR interval
lengthening
Rate :The underlying rate
P Wave :Normal
PR Interval :Progressively longer until a QRS complex is missed, then
cycle repeats
QRS:Normal (0.06-0.10 sec
SECOND DEGREE HEART BLOCK TYPE 2
• Atrial rate regular
• Ventricular rhythm regular or irregular, with varying degree of
block
• P-R interval constant
• QRS complexes periodically absent
• P:QRS RATIO 3:1, 4:1, 5:1 And so forth
Second degree block type II
Rhythm: Regular (atrial) and irregular (ventricular)
Rate: Characterized by Atrial rate usually faster than ventricular rate (usually slow)
P Wave :Normal form, but more P waves than QRS complexes
PR Interval: Normal or prolonged
QRSNormal or wide
THIRD DEGREE HEART BLOCK
• Atrial rate regular
• Ventricular rate slow and regular
• No relation between P waves and QRS complexes
• No constant PR interval
• QRS interval normal
• P:QRS ratio more P waves than QRS
Third degree heart block
Rhythm: Regular, but atrial and ventricular rhythms are independent
Rate :Characterized by Atrial rate usually normal and faster than ventricular rate
P Wave :Normal shape and size, may appear within QRS complexes
PR Interval: Absent: the atria and ventricles beat independently.
QRS:Normal, but wide if junctional escape focus
Atrial flutter
Rhythm :Regular or irregular
Rate :Fast (250-350 bpm) for Atrial, but ventricular rate is often slower
P Wave :Not observable, but saw-toothed flutter waves are present
PR Interval :Not measureable
QRS:Normal (0.06-0.10 sec)
Atrial fibrillation
Rhythm :Irregular
Rate :Very fast (> 350 bpm) for Atrial, but ventricular rate may be
slow, normal or fast
P Wave :Absent - erratic waves are present
PR Interval :Absent
QRS:Normal but may be widened if there are conduction delay
PVC
Rhythm :Irregular
Rate :The underlying rate
P Wave :Absent
PR Interval :Not measurable
QRS:Wide (> 0.10 sec), bizarre appearance
Notes Two PVCs together are termed a couplet while three PVCs in a
row with a fast rhythm is ventricular tachycardia
PVC QUADRIGEMINY
Rhythm :Irregular
Rate :The underlying rate
P Wave :Absent
PR Interval :Not measurable
QRS:Wide (> 0.10 sec), bizarre appearance
Notes :PVC appears every fourth beat
PVC TRIGEMINY
Rhythm :Irregular
Rate :The underlying rate
P Wave :Absent
PR Interval :Not measurable
QRS:Wide (> 0.10 sec), bizarre appearance
Notes :PVC appears every third beat
PVC BIGEMINY
Rhythm :Irregular
Rate :The underlying rate
P Wave :Absent
PR Interval :Not measurable
QRS:Wide (> 0.10 sec), bizarre appearance
Notes :PVC appears every second beat
Supraventricular tachycardia
Rhythm :Regular
Rate :Fast (150-250 bpm)
P Wave :Merged with T wave
PR Interval :Normal (0.12 sec)
QRS:Normal (.10 sec)
Notes :PR interval can be difficult to measure
VENTRICULAR TACHYCARDIA
Rate: Usually between 100-250 bpm
P wave: obscured
QRS: wide and bizarre
Conduction: as with PVCs
Rhythm: three or more ventricular beats in a row, may be regular or
irregular
May stop or start suddenly
VENTRICULAR TACHYCARDIA
Rhythm :Regular
Rate :Fast (100-250 bpm)
P Wave :Absent
PR Interval :Not measurable
QRS:Wide (>0.10 sec), bizarre appearance
VENTRICULAR TACHYCARDIA Monomorphic
Rhythm Regular
Rate Fast (100-250 bpm)
P Wave Absent
PR Interval Not measurable
QRSWide (>0.10 sec), bizarre looking
VENTRICULAR TACHYCARDIA Polymorphic
Rhythm :Regular or irregular
Rate :Fast (100-300 bpm)
P Wave :Absent
PR Interval :Not measurable
QRS:Normal or wide (>0.10 sec), bizarre looking
VENTRICULAR TACHYCARDIA Torsade de
pointes
Rhythm :Irregular
Rate :Fast (200-250 bpm)
P Wave :Absent
PR Interval :Not measurable
QRSWide (>0.10 sec), bizarre looking
VENTRICULAR FIBRILLATION
Ventricular rhythm rapid and chaotic
QRS complex wide and irregular, no visible P
waves
VENTRICULAR FIBRILLATION
Rhythm :Highly irregular
Rate :Unmeasurable
P Wave :Absent
PR Interval :Not measurable
QRS:None
Notes EKG tracings is a wavy line
SINUS ARREST
Rhythm :Irregular due to pause
Rate :Normal to slow
P Wave :Normal
PR Interval :Normal (0.12-0.20 sec)
QRS:(0.06-0.10 sec)
Notes :Pause time is not an integer multiple of the P-P interval
ASYSTOLE
Thank
you!
Dr. Manrique -
Arreglo
