BASIC ECG

INTERPRETATION
Compiled and presented by: Dr.
Annemarie van Wyk
School of Nursing Science
North West University
WAVES OF A NORMAL ECG
 • Normally the first wave present before the QRS complex
• Represent the atrial depolarization
THE P-WAVE • Best seen in STD II and V1
• Must be present in all leads
• Round in shape
 QRS-COMPLEX

• Upward and downward strokes

• Represents ventricular depolarization
• Combination of waves, can be 3, 2 or 1
• Labeling is not easy
• Q wave= if the first deflection of the QRS-complex is negative
• R-wave = all positive deflections
• S-wave = all negative deflections after the R-wave
• Normal: 0.06 – 0.10 sec
• Longer: indicating a block in the RBB or LBB
 THE T-WAVE

• Represents the resting phase of the

ventricles
• Follows the QRS-wave
• In other words: repolarization
• Upright in all leads
• Inverted indicates oxygen deficiency to the
myocardium or hypokalemia
• Peaked = hyperkalemia
SEGMENTS OF
THE NORMAL
ECG
THE PR-SEGMENT
• Represent the period between atrial
depolarization and ventricular
depolarization
• Measured from end of the p-wave to
the beginning of the QRS-complex
• Period where the electrical impulse
spread to the AV-node, bundle and
branches
THE ST-SEGMENT
• This segment extends from the
end of the S-wave until the
beginning of the T-wave
• Should be on the iso-electric line
• Inspected if a myocardial injury
or ischemia are suspected
• Elevated ST-segment 1 mm
above line: injury
• Depressed ST-segment
1mm/more below the line:
ischemia
INTERVALS OF
THE NORMAL
ECG
 PR-INTERVAL

• Represents the time between the

SA node discharge and the
beginning of ventricular
depolarization
• Indicator of AV-node function
• When prolonged: AV-block
• Normal: 0.12 – 0.20 sec
• Measurement made from the
beginning of the P-wave to the
beginning of the QRS-complex
 THE QT-INTERVAL
• Measured from the beginning of the QRS-
complex to the end of the T-wave
• Represents ventricular depolarization and
ventricular repolarization
• Affected by heart rate
• The slower the heart rate, the longer the
interval
• Faster heart rate, shorter the interval
• Normal: 0.35 – 0.45sec
CARDIAC RHYTHM, RR-
INTERVAL AND HEART RATE
RHYTHM AND RR-
INTERVAL

• Normal rhythm = regular

• Regular = RR intervals must be the
same distance
• Inspect the rhythm strip to
determine rhythm
• If RR interval is not equidistant =
rhythm is irregular
• Regularly irregular rhythm = pattern
exists
• Irregularly irregular = no pattern
exists
 HEART RATE
• Only look at the rhythm strip
• Measure the distance in mm between the
R-waves ( one block = 1mm)
• Divide into 1500
• Answer = heart rate
• If an irregular rhythm exists measure all
the RR-intervals:
• Measure the shortest and the longest RR
interval divide into 1500 = heart rate will be
between two values
BASIC
CARDIAC
RHYTHMS
 CRITERIA
• Rate is regular
• 60 - 100 beats per minute
1. NORMAL SINUS RHYTHM
• PR-interval is normal
• After each P-wave is a QRS-complex
• P-waves are constant and upright
 CRITERIA
• Due to an increase in the automaticity of the
sinus node
2. SINUS TACHYCARDIA • Compensatory response to a decrease in
blood pressure
• Same criteria as for sinus rhythm
• 100 – 150 beats per minute
 CRITERIA
• Decrease in automaticity of the SA-node
3. SINUS BRADYCARDIA • SA-node remains the dominant pacemaker
• All the criteria of sinus rhythm but rate is slower
than 60 per minute
8. ASYSTOLE