Waveforms & Intervals

Electrocardiography

P- < 0.10., t I, II; ~

eVR PR- 0.12 -0.20.

ScyMed.com

QRS-

6111 ED

-+
.,"

0.05 - 0.10.

anterior leads height < 27mm

I, II, V5, V6; J. aVR. V1

t! V3, eVl, eVF, 111

T-t I, V6;! eVR;

0.12-0.200
(sec)
Lorge o<Iuli:
0.17-0.21.
Smalladul;
0.16-O.20s
14-17
0.15-0.19s
7-13 yeo",:
0.14-O.18s

QRS: "I = -30" -> +100"

Left Axis Dev - -30" -> -90'
Right Axis Dev= +100" _,

may invert: III, aVF, aVl. V1

Q_
(oI>nonnal) ">0.045. >25% of height of following R
QT- 0.34$ - 0.42. (40% 01R-R)
60 bpm - 0.33 - 0.43 (tHR .... .jQT)
70 bpm - 0.31 - 0.41
60 bpm - 0.211- 0.38
80 bpm - 0.28 - 0.36
100 bpm - 0.27 - 0.35

+1800

(extreme)

-900 _, -1800

P Wave = +30" _, +600

Assess: I and aVF, then find

)'08'"

isoeleclric lead and QRS

axis is at 90'.

'"

::0

..
- 9 ..
s
0

::0

Q>
:>
OJ

1.':

Q.

- ;

'"

-. . '-.-".
'"
- -
~

HEXAXIAL SYSTEM (Frontal plane)

Nonnal HR. 8Ot2Obpm
EKG Paper speed - 25mm/sec
smaI box. O.04sec .1mm
iarge box. O.2Osec Smm

Pacemakers:
SA Node
Atrium
AV Node
601mln
Ventricular

Left
It

~~O&

-aVF

-lll

.60 -100lm1n
75/mln
40 -

+120+90"

+111

+30
-aVR ..

+11

~1ft

+1

+60"

+aVF

-+

30 401mln

'I

~o~

m
l>

~
~

::0

-;

::0

!;

m is

I\)

e
+Vl +V2

+V3

*The positive paCe of aaet) lead axis appesl'&

in boldface, the negative Is lighter.

RHYTHMS
NSR- (60 -fOO/mln) stable
poP, R-R Intervals.
Sinus Tach = > 100/mln.
Sinus Brad = < 6OIm1n.
APO= (atrial premature depolarizatlon).
pr9C9ded by P wave, followed
bynl QRS.
VPO- (vent premature depolarization).
premature QRS >O.12s.

no P wave, T wave ts large.

opposije 10QRS.
On normal subjects and Heart 02).
Multlfocat PVC's- dlff PVC's In same
strip.
PAT= (paroxysmal atrial tachycardia).
Identifiable P,narrow QRS,
1S0-2S0/mln.
MAT= (multifocal atrial tachycardia).
~ 3 dtff ectopic P waves, val)'lng
PR, nl QRS, 100-200/mln.
In COPO. hypoxia, digitalis,
amlnophytlne Intox, ASHD.
SVT= (supravontricular tachycardia).
1S()'2S0/mln. QRS usually nannal.
wide QRS with BBB or WPW.
a)AV Node Reenby:
retrograde P buried In QRS.
RP <50% RR Interval.
b) Orthodromic SVT wfih ace
pa"': eccentric, retrograde P
wave RP <50% RR Interval.
Negative P wave In I.
c) Intra-atrial r.enby:
+ P wave In leads It, III,
aVF. RP >50% RR InteMiI.

II

'(i
e
d) Sinus Node reenby;

"

a
0'
a"o

P wave same as sinus rhythm.

RP >50% RR interval.
e)Automatic Atrial Tach:
tor! P wave in 1t,III,
aVF. RP >50% RR
interval.
Atrial Flutter= atrial rete 2~min,

Vent rete varies with AV blOck 2;1

Saw tooth pattern (II, til, aVF. Vl).
Atrial Fib- Highly hTeg, irreg,
No Pwaves.
vent response; t60-200/min.
Bigeminy- ooupled beat.

sinus beat-+PVC-+sinus beat-+PVC

8
3

g:
IE

~
~

CJ

.,:!l
!ji

(II

3
3

0;-

!!l

,~

Trigeminy; sinus-tsinus-+PVC

-+sinus-+sinus-+PVC

ECIopic !;seepes- follow sinus pause.

V Tach- (ventnc..lar tachycardia).
;, 3 wide QRS (~O.t2.9)
IOte: 100-2501min.
ST and T wave change
direction. AV dlsscc, LAO, RBBe.
Suotain~ (>30$), nQ<ustained,
Torsad .. des Pointes=
is a V tach. 160-2S01min,
twioting of QRS, prolonged QT,
V Fib: (ventticular fibrillatiOn).

IS

4-1

O:l

....J._-I

very irregular baseline

with cardiac arresl and BP- 0

AlVR- (ace. idiovenlMcular rhytllm),
Rate: SO-IOO/min
wide QRS (Inferior wall MI),