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What is ECG interpretation?
What are typical ECG findings?
How do you interpret an ECG?
How do you interpret a 12-lead ECG?
Learn how to assess the morphology, durations and intervals of the P-wave, QRS complex, ST segment and T-wave on the ECG curve. Find out the normal and abnormal variants of these ECG components and how to determine normal sinus rhythm.
- Confirm Details
- Heart Rate
- Heart Rhythm
- Cardiac Axis
- P Waves
- QRS Complex
- St Segment
- U Waves
- Document Your Interpretation
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Before beginning ECG interpretation, you should check the following details: 1. Confirm the name and date of birthof the patient matches the details on the ECG. 2. Check the date and timethat the ECG was performed. 3. Check the calibration of the ECG (usually 25mm/s and 10mm/1mV).
What is a normal adult heart rate?
1. Normal: 60-100 bpm 2. Tachycardia:>100 bpm 3. Bradycardia:<60 bpm
Regular heart rhythm
If a patient has a regular heart rhythm, their heart rate can be calculated using the following method: 1. Count the number of large squares present within one R-R interval. 2. Divide 300 by this number to calculate heart rate.
Irregular heart rhythm
If a patient’s heart rhythm is irregular, the first heart rate calculation method doesn’t work (as the R-R interval differs significantly throughout the ECG). As a result, you need to apply a different method: 1. Count the number of complexes on the rhythm strip (each rhythm strip is typically 10 seconds long). 2. Multiply the number of complexes by 6 (giving you the average number of complexes in 1 minute).
A patient’s heart rhythm can be regular or irregular. Irregular rhythms can be either: 1. Regularly irregular(i.e. a recurrent pattern of irregularity) 2. Irregularly irregular(i.e. completely disorganised) Mark out several consecutive R-R intervals on a piece of paper, then move them along the rhythm strip to check if the subsequent intervals are ...
Cardiac axis describes the overall direction of electrical spreadwithin the heart. In a healthy individual, the axis should spread from 11 o’clock to 5 o’clock. To determine the cardiac axis, you must look at leads I, II and III. Read our cardiac axis guideto learn more.
The next step is to look at the P wavesand answer the following questions: 1. Are P waves present? 2. If so, is each P wave followed by a QRS complex? 3. Do the P waves look normal? – check duration, direction and shape 4. If P waves are absent, is there any atrial activity? 1. Sawtooth baseline → flutter waves 2. Chaotic baseline → fibrillation wa...
When assessing a QRS complex, you need to pay attention to the following characteristics: 1. Width 2. Height 3. Morphology
The ST segment is the part of the ECG between the end of the S wave and the start of the T wave. In a healthy individual, it should be an isoelectric line (neither elevated nor depressed). Abnormalities of the ST segment should be investigated to rule out pathology.
U waves are not a commonfinding. The U wave is a > 0.5mm deflection after the T wave best seen in V2 or V3. These become larger the slower the bradycardia – classically U waves are seen in various electrolyte imbalances, hypothermia and secondary to antiarrhythmic therapy(such as digoxin, procainamide or amiodarone).
You should document your interpretation of the ECG in the patient’s notes (check out our guide to documenting an ECG).
We have several other articles relevant to ECGs: 1. Understanding an ECG: a guide to understanding the underlying concepts of ECGs 2. Cardiac axis explained: a simple guide to the cardiac axis 3. How to record a 12-lead ECG: an OSCE guide to recording a 12-lead ECG 4. How to document an ECG: a guide to documenting your ECG interpretation in the not...
Learn how to read an ECG using a systematic approach and interpret common ECG findings. Find out what is a normal heart rate, how to identify different types of heart block, and how to assess QRS complexes and ST segments.
- Dr Matthew Jackson
Mar 11, 2021 · Learn the features and examples of normal sinus rhythm (NSR), the default heart rhythm with regular, narrow-complex beats. Find out how to distinguish NSR from sinus arrhythmia and bradycardia, and access related topics and resources.
- Rhythm. Assess ventricular (RR intervals) and atrial (PP intervals) rate and rhythm: Is ventricular rhythm regular? What is the ventricular rate (beats/min)?
- P-wave morphology and PR interval. Assess P-wave morphology and PR interval. P-wave is always positive in lead II (actually always positive in leads II, III and aVF).
- QRS complex. Assess QRS duration, amplitudes, Q-waves, R-wave progression and axis. QRS duration must be <0,12 s (normally 0,07-0,10 s). There must be at least one limb lead with R-wave amplitude >5 mm and at least one chest (precordial) lead with R-wave amplitude >10 mm; otherwise, there is low voltage.
- ST segment. Assess the ST segment (morphology, depression, elevation) The ST segment should be flat and isoelectric (at level with the baseline). It may be slightly upsloping at the transition with the T-wave.
Feb 16, 2017 · Normal ECG values for waves and intervals are as follows: RR interval: 0.6-1.2 seconds. P wave: 80 milliseconds. PR interval: 120-200 milliseconds. PR segment: 50-120 milliseconds. QRS...
Learn how to diagnose the normal electrocardiogram by excluding any recognised abnormality. See examples of normal sinus rhythm, P waves, QRS complex, PR interval, QT interval, ST segment and T wave.
Common findings. Sinus rhythm (which is the normal rhythm) has the following characteristics: (1) heart rate 50–100 beats per minute; (2) P-wave precedes every QRS complex; (3) the P-wave is positive in lead II and (4) the PR interval is constant.
