ECG

INTERPRETATION
RRAHIM

SDK
 ROAD MAP

• Points to be observe (RRAHIM)

 AIMS
• The aims of this lecture are.

• To make students certain in their interpretation of

normal electrocardiogram (ECG) tracings.

• To make students confident in their interpretation

of ECG tracings with common clinical conditions

that leads to ECG abnormalities.

 OBJECTIVES
• By the end of this Lecture, students should be able to

Ø Identify and list the characteristics of a normal ECG.

Ø Interpret and communicate the appearance of normal ECG.

Ø List and explain common clinical abnormalities that leads to

abnormal ECG recordings.
 INTRODUCTION

• An electrocardiogram (ECG / EKG) is an

electrical recording of the heart.

• It is used in the investigation of heart disease.

RRAHIM
1-RATE

2-RHYTM

3-AXIS

4-HYPERTROPHY

5-ISCHEMIA,INJURY& INFARCTION

6-MISCELENOUS
How to interpret Rhythm strip
 Rate
ØFirst thing that should be examined in the ECG
is:
ØRate
ØRate is calculated as Cycles per minute
The normal heart rate for a normal healthy
person is in between 60-100 b/minute.
How many pacemaker are there in heart
When Heart has different pace maker then why
SA node is the main Pacemaker
 Emergency
SA node is not pacing
 How to Determine Heart Rate
Heart rate can be determined by FOUR ways.
1. Conventional method of 300,150, &100
2. Rule of 300
3. 1500 method
4. 6 seconds strip methods
 1. Conventional Method of 300,150, &100

Remember rule of 300

• In 1 sec strip there are 5 big boxes
1 minute the total big boxes will be 5 x 60 = 300
• 300/1= 300
• 300/2=150
• 300/3=100
• 300/4=75
• 300/5=60
• 300.6=50
 The Rule of 300
It may be easiest to memorize the following table:

# of big Rate
boxes
1 300
2 150
3 100
4 75
5 60
6 50
How To Calculate
How To Calculate
How To Calculate
150 50 25 15
How To Calculate
How To Calculate
Calculate
 Calculate

100 b/ minute
Calculate

60 b/ minute
 Calculate

150 b/ minute
Calculate

75 b/ minute
 2. Rule of 300
ØDivide 300 by the number of big boxes
between two Consecutive R waves.

ØAlthough fast, But this method only works for

regular rhythms.
What is the heart rate?

www.uptodate.com

(300 / 6) = 50 bpm
What is the heart rate?

www.uptodate.com

(300 / ~ 4) = ~ 75 bpm
What Is The Heart Rate?

(300 / 1.5) = 200 bpm

 3. Rule of 1500
• If ECG machine run by speed of 25 mm/sec in 60 sec
it will cover 1500 smallest squares.
60 x 25=1500
How to calculate the heart rate by this method.
1. Count the smallest squares between the two R
waves.
2. Divide 1500 by the total numbers of smallest squares
between the two R
1500/ no of small squares
3. This will be the heart rate.
 Calculate

•Rate: 1500/21= (72 bpm)

•Rhythm: Regular
•P Waves: Normal (upright and uniform)
•PR Interval: Normal (0.12–0.20 sec)
•QRS: Normal (0.06–0.10 sec)
 10

1500/10= 150 / minute

15

1500/15 =100/minute
 4. Six seconds strip methods

• In case of a arrhythmia, heart rate should be

calculated by strip methods.

• Count the number of complete cycle (R to R) in

the 6 second strip and calculate it for one minute.
 Calculate

4 x 10=40bpm
 Calculate

1. -------20-- bpm

2. ------40---- bpm

3. --------50-- bpm
Calculate: Strip is of 10 Second

21 cycle x 6=126 bpm

Calculate: Strip is of 6 Second
 Six-second ECG Rhythm Strip By R
wave count
ØThe best method for measuring irregular heart
rates with varying R-R intervals is to count the
number of R waves in a 6-second (sec) strip
(including extra beats such as PVCs, PACs, and
PJCs) and multiply by 10.
• This gives the average number of beats per
minute.
 Six-second ECG Rhythm Strip

Using 6-sec ECG rhythm strip to calculate heart rate:

7 X 10 = 70 bpm.
 Sinus Rhythm

• NSR
• Sinus Bradycardia
• Sinus tachycardia

• Normal sinus rhythm is a regular rhythm between 60 and 100

beats/min, with a P wave before each QRS complex and a QRS
after each P wave.
• A faster rate defines tachycardia and a slower rate, bradycardia.
 10

1500/10= 150 / minute

15

1500/15 =100/minute
 10

1500 ÷ (10)= 150 / minute

15

1500 ÷ (15)=100/minute
ECG 1
Normal Sinus Rhythm
ECG 2
Sinus Bradycardia
ECG 3
Sinus Tachycardia
ECG 4
 Sinus Arrhythmia

Inspiration --- increase vagal tone------heart rate decrease

Expiration decrease vagal tone----increase heart rate
THE END