1. ECG Rhythm Interpretation
How to Analyze a Rhythm

3. The ECG Paper Horizontally Vertically One small box - 0.04 s
One large box s
Vertically
One large box mV

4. Rhythm Analysis Step 1: Calculate rate. Step 2: Determine regularity.
Step 3: Assess the P waves.
Step 4: Determine PR interval.
Step 5: Determine QRS duration
Step 6: ST -T

5. 300/No of large square between 2 R waves= 90 bpm
Step 1: Calculate Rate
300/No of large square between 2 R waves= 90 bpm

6. Step 2: Determine regularity
Look at the R-R distances (using a caliper or markings on a pen or paper).
Regular (are they equidistant apart)? Occasionally irregular? Regularly irregular? Irregularly irregular?
Interpretation?
Regular

7. Step 3: Assess the P waves
Are there P waves?
Do the P waves all look alike?
Do the P waves occur at a regular rate?
Is there one P wave before each QRS?
Interpretation?
Normal P waves with 1 P wave for every QRS

8. Step 4: Determine PR interval
Normal: seconds.
(3 - 5 boxes)
Interpretation?
0.12 seconds

9. Step 5: QRS duration Normal: 0.04 - 0.12 seconds. (1 - 3 boxes)
Interpretation?
0.08 seconds

10. Step 6: ST -T
ST Start from S wave till the beginning of T wave

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12. ST depression IHD *Subendocardial ischemia NON-ISCHEMIC CAUSES
*Non q wave MI
*Reciprocal changes in acute MI
NON-ISCHEMIC CAUSES
*VH, BBB, digoxine,
hypokalemia, MVP, CNS diseases

14. ST elevation ST Elevation convex upward *Acute MI
*Prinzmetal angina
*Ventricular Aneurysm
*Normal variant
ST Elevation concave upward
*Pericarditis
OTHER CAUSES (LBBB,hyperkalemia)

15. ST elevation

16. Abnormalities of T wave
T INVERSION
*MI
*Ischemia
*Pericarditis
*Myocarditis
*CNS dis
*VH (strain pat.)
*Digoxine
*MVP
PEAKED T WAVE
*Anxiety
*Hyperkalemia

17. Rhythm Summary Rate 90-95 bpm Regularity regular P waves normal
PR interval s
QRS duration s
ST -T isoelectric
Interpretation? Normal Sinus Rhythm

18. Reading 12-Lead ECGs
The best way to read 12-lead ECGs is to develop a step-by-step approach (just as we did for analyzing a rhythm strip). In these modules we present a 6-step approach:
Calculate RATE
Determine RHYTHM
3. Calculate INTERVALS
4. Determine QRS AXIS
5. Assess for HYPERTROPHY
6. Look for evidence of INFARCTION
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19. QRS AXIS
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26. HYPERTROPHY
LVH Sv1+Rv6>35 mm
RVH Rv1/Sv1 >1

27. LVH
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28. RVH
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