EKG Cheat Sheet

The Waves and Complexes

P waves - atrial depolarization
QRS complexes - ventricular depolarization
a. Q waves -initial negative deflections – if the complex does not start in a
downward direction then there is no Q wave
b. R waves always upward deflections. If two upward deflections occur then the
first is called “R” and the second is “R’”
c. S waves - always negative deflections following R waves
T waves - ventricular repolarization

Heart rate
Regular rhythms: Heart rate = 1500/(# of small boxes from one R to the next R)
Both regular and irregular rhythms
1 - count the number of complexes in a 6 second interval and multiply by 10 - the
very small vertical marks at the very bottom (below the graph) of most ECG’s
mark off 3 second intervals – take two of those to get your 6 second interval.
2 – Most tracings are about 10 seconds long – Count the number of complexes
and multiply by 6
Measurement of Intervals
1 small box = 40 milliseconds = 0.04 seconds
1 large box = 5 small boxes – 200 milliseconds = 0.2 seconds
Count the number of small boxes and multiple by 40 milliseconds per small box
Use limb lead II
PR interval – Beginning of the P wave to beginning of the QRS
Upper limit of normal is 200 msec (0.20 seconds)
May be short in WPW and other pre-excitation syndromes
QRS duration – Beginning of QRS to end of QRS
Upper limit of normal about 100 milliseconds (0.10 seconds)
QT interval – Beginning of QRS to end of T wave
QT duration varies depending upon heart rate
 QT intervals are corrected to a standard heart rate of 60
Upper limit of normal for corrected QT is about 460 msec (0.46 sec)
2. Ventricular (QRS or R) axis
Limb lead I is the left-right lead (strongly positive QRS when the current is running
straight left and strongly negative QRS when current is running straight right)
Limb lead avF is the top-bottom lead (strongly positive QRS when current is running
straight downward and strongly negative QRS when current is running straight upward).
O degrees is arbitrarily defined as straight left, +90 degrees straight down, and -90
degrees straight up
Be able to identify the quadrant of ventricular depolarization:
Normal (0 to +90 degrees, left and down)
QRS in limb lead I – positive, QRS in limb lead avF - positive
Left axis deviation (0 to -90 degrees, left and up)
QRS in limb lead I – positive, QRS in limb lead avF – negative
Right axis deviation (+90 to +180 degrees, right and down)
QRS in limb lead I – negative, QRS in limb lead avF – positive
Extreme right axis deviation (No Man’s Land) (+180 to +270 degrees, right and up)
QRS in limb lead I – negative, QRS in limb lead avF – negative