ELECTROCARDIOGRAM

BY
Dr. Ayesha AR

NORMAL ECG WAVES

ECG PAPER
Paper speed: 25mm/sec (5 big squares)
VERTICAL AXIS:
One small square = 1mm
One big square = 5mm
HORIZONTAL AXIS:
One small square = 0.04 sec
One big square = 0.2 sec

NORMAL WAVES
P wave : < 2.5mm
PR interval : B/w 3 and 5 small sq. (0.12 and 0.2 sec)
QRS complex : 3 small sq. (0.12 sec)
QT interval : usually b/w 0.35 to 0.45 sec (>2 big
sq.)
cQT : QT/ R-R interval.
NORMAL: 0.40-0.44s in children >6 months

0.45-0.47 in first 6 months.

HEART RATE
145 (90Newborn 180)
6
145(105months
185)
1 year 132(105170)
4 years 108 (72135)
14
85 (60years
120)

CONTINUED
If Bradycardia or irregular rhythm :
o Mark 6 sec interval on ECG strip
oCount the cycles coming in b/w this interval
oNumber of cycles x 10 = Heart rate.
oOr count 15 big sq.(3 sec interval)
oCount the cycles in between.
oNumber of cycles x 20 = Heart rate.

ECG LEADS
LIMB LEADS :
BIPOLAR : I,II,III
UNIPOLAR : aVR, aVL, aVF

CHEST LEADS
CHEST LEADS :
V1, V2, V3, V4, V5, V6.

AXIS
Age

Mean(Rang
e)

1 wk-1 month +110(+30 to

1- 3 months
3 mo- 3 yr
Older than 3
yr
Adult

+180)
+70 (+10 to
+125)
+60 (+10 to
+110)
+60 (+20 to
+120)
+50 (-30 to

AXIS
LIMB LEADS :
Lead I, II, III, aVL, aVF : Upward deflection
Lead aVR : Downward deflection.
CHEST LEADS :
V1, V2 : Downward deflection
V3, V4 : Up and down
V5,V6 : Upward deflection.

Continued

Continued

Continued

HYPERTROPHY
RIGHT ATRIAL HYPERTROPHY :

P-wave in lead II and V1 : >2.5mm (P-pulmonale )

LEFT ATRIAL HYPERTROPHY :
P-wave in lead II and V1 : Wide and notched >0.09s
BIATRIAL HYPERTROPHY :
Combination of increase amplitude and duration.

ATRIAL HYPERTROPHY

VENTRICULAR
HYPERTROPHY
RIGHT VENTRICULAR HYPERTROPHY
V1 & V2 :R greater than S after 1 year.
LESS THAN ONE YEAR :
sV6 greater than 15mm at 1 week.
sV6 greater than 10mm at 6 months.
sV6 greater than 5mm at 1 year.

RVH

LEFT VENTRICULAR
HYPERTROPHY
sV1 + rV6 greater than 30mm to 1 year.
sV1 + rV6 greater than 40mm after 1 year.