What is an ECG?

Depolarisation of the heart

Relating the ECG wave form to

electrical activity within the heart
ELECTRICAL
ACTIVITY

student led
tutorials
 ECG

S
R
P T
Q

student led
tutorials
 ECG

S
R
P T
Q

student led
tutorials
 ECG

S
R
P T
Q

student led
tutorials
 ECG

S
R
P T
Q

student led
tutorials
Normal ranges for ECG intervals

PR interval

QRS

QT interval
 Remember these values!

Interval Normal range (per ms) Pathology

P-R 120-200 Long – heart block (drugs,

electrolytes)
QRS 80-120 Long – conduction
abnormalities e.g. bundle
branch block
QT (varies with heart rate) >450 can Long – repolarisation
lead to ventricular tachycardia abnormalities, ion
channelopathies e.g. long
QT syndrome
Working out your intervals

LEARN THIS!

TASK – Work out

the PR interval in
this ECG
 Remember these values!

Interval Normal range (per ms) Pathology

P-R 120-200 Long – heart block (drugs,

electrolytes)
QRS 80-120 Long – conduction
abnormalities e.g. bundle
branch block
QT (varies with heart rate) >450 can Long – repolarisation
lead to ventricular tachycardia abnormalities, ion
channelopathies e.g. long
QT syndrome
 Rate
Normal range: 60 – 100 bpm
Working out the rate (bpm)
Rhythm
 Rhythm

The heart pumps blood at a fixed rate

(feel your own pulse)

This maintains a constant cardiac output

Recall that each P-QRS-T cycle = systole

(one beat)
 Rhythm

Regular Irregular
pulse pulse

Irregularly-Irregular Regularly-Irregular
pulse pulse

Atrial Sinus 2nd Degree

fibrillation arrhythmia Heart block
(Wenkebach)
Rhythm example

Atrial
fibrillation
Heart Block
 Heart block
A blocking of the depolarisation wave spreading through the heart

Heart block

Type 1 Type 3 / Complete

PR interval > P wave and QRS
0.2 seconds Type 2 dissociation

Mobitz type 1/ Wenkebach

Progressive PR prolongation,
then dropped beat Advanced Block
Mobitz type 2
Fixed ratio of P: QRS complex
Some P waves not
conducted, PR interval fixed
Interpreting an ECG
Student led tutorial 1
 Appendix 1 – Rate calculations

The simple method:

1. Find a QRS complex
2. Find the next QRS complex along
3. Find the R wave in both
4. Count how many big boxes there are in between each
R wave
5. With a calculator do:
• 300 / (number of big boxes)
6. You can make this exact as you like ie 3.4 boxes

22
 Appendix 2 – Rhythm
Method:
1. Grab a piece of paper
2. Line it up horizontally across ECG lead 2 tracing
3. Make sure you can see the tips of each R wave
4. Make a vertical mark on the paper for the first 2 R waves
5. Line up 1st mark with 2nd R wave
6. Does the 2nd mark line up with 3rd R wave?
7. Carry on repeating this.

Interpretation
If the heart rate is regular then the distance between each QRS should be
regular, and thus your marks will line up
If the heart rate is irregular, then the distance between each QRS will
vary, and your marks will not always line up
Appendix 3 – Clinical information
heart block
Aetiology:
Congential
Acquired
1. Idiopathic fibrosis
2. Myocardial infarction
3. Inflammatory process
1. Acute
2. Chronic
4. Drugs
Clinical features
Type 1 – Rarely symptoms
Type 2 –
• Wenkebach usually not a problem and may be normal in athletes/ asleep
• Mobitz 2 usually a sign of severe disease and syncope may occur. Treated with
a pace maker
Type 3/complete – Syncope or stokes-adams attacks may occur. Also
treated with pacemaker