STEPS IN ECG INTERPRETATION

* NORMAL SINUS RHYTHM

CRITERIA
• Rhythm: Regular
• Heart rate: 60 – 100 / minute
• QRS: less than 0.10 seconds
• P wave: only one precedes each
QRS, all have same size, shape
and deflection
• PR interval: 0.12 - 0.20 seconds
Observe the T wave
 • The T represents repolarization
(recovery) of the ventricles and should be
upright in Lead II and appear after the
QRS segment.

• Any variations in the T waves are • Note

The any
normalectopic beatshas
QRS segment three
important to note. graphical deflections

• Inverted T waves could be due to a lack • the first negative wave (Q wave); the
of oxygen to the heart; too much • An ectopic beat is a change in a heart
positive wave above the isoelectric line (R
potassium (hyperkalemia) could cause rhythm caused by beats arising from
wave) and the negative wave after the
peaked T waves; flat T waves may be due fibers
positive wave (S wave) — and the normal
to too little potassium and a raised ST • time duration
outside the SA is 0.04-0.10
node, seconds.
the normal impulse-
segment which is the end of the QRS generating system of the heart. If you
segment to the beginning of the T wave, • If QRS segment is prolonged, it might be
might be due to a heart attack. • due toectopic
notice a bundle branch
beats, blockifwhich
determine could
they are
be relatively
premature atrialbenign or a sign
contractions of underlying
(PACs);
heart disease.
• premature junctional contractions (PJCs)
or premature ventricular contractions
(PVCs).

• Also, note how many ectopic beats are

Learn and Play more about ECG, present in the ECG, the interval at which
visit SkillStat they are appearing, their shape, and if
they arise singularly or in groups.

•
 Lesson #2 CARDIOVASCULAR PHYSICAL ASSESSMENT
INSPECTION
- General appearance: thin, obese, level of
alertness, skin color, turgor, texture,
temperature, and diaphoresis.
- Observe mucus membranes for pallor and
extremities for clubbing of fingers and cyanosis.
- While the patient is sitting or lying flat, observe
pulsations, retractions, heaves. Locate the point
of maximal impulse normally found in the left
intercoastal space, medial to the left
midclavicular line, displacement to the left can
indicate an enlarged heart.
- Examine extremities to assess arterial or venous
disorders and symmetry, noting skin color,
hemosiderin staining, edema, lesions, scars, or
clubbing, and pattern and distribution of body
hair
- Examine the blood vessels in the neck. The
carotid artery should have a local, brisk
pulsation that does not decrease when the
patient is upright or inhales, or during palpation.
Note for jugular veins distension, this indicates
blood volume and pressure in the right side of
the heart.
PALPATION
- Palpate over the precordium to find the apical
impulse. Also note any thrills, heaves, or fine
vibrations, carotid, brachial, radial, femoral,
popliteal, posterior tibial, and dorsalis pedis
pulses using the pads of the index and middle
fingers. All pulses should be regular in rhythm
and equal in strength.
- Palpate the patient’s leg and arms to assess skin
temperature, texture, turgor and edema.
PERCUSSION
- Percussion is not as useful as other methods of
assessment in evaluating the cardiovascular
system, but it may help locate the cardiac
borders.
AUSCULTATION
- Listening for heart sounds. S1 (lub) and S2
(dub) are normal heart sound.
- A third heart sound, S3, is commonly heard in
patients with a high cardiac output and in
children. It is called a ventricular gallop when it
occurs in adults.
- S3 may be a cardinal sign of a heart failure. S3
is best heard at the apex when the patient is
lying on his left side.
- S4 is considered an adventitious sound and is
called an atrial gallop (or presystolic gallop). It
is heard best over the tricuspid or mitral areas
with the patient on his left side. It may be heard
in patients who are elderly, those with
hypertension, aortic stenosis, or a history of
myocardial infarction.
- Listening for Murmurs. Murmrs occur when
there is turbulent blood flow caused by
structural defects in the heart’s chambers or
valves. Note the characteristics of the assessed
murmurs have various characteristics, low,
medium, and high-pitched.
 Common
Diagnostic
Diagnostic Assessment

Non-invasive:
Electrocardiogram
(ECG) &
Echocardiography
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