ECG Interpretation

ECGs

Mark Hall

Clinical Teaching Fellow

Normal ECG

P-Q-R-S-T Complex

Atrial rate = 300 / P-P interval (large squares)Ventricular rate = 300 / R-R interval

Paper rate = 25 mm/sec (Five large squares) Note – may be increased to 50 mm/sec.

Axis Deviation

LV Hypertrophy

Count the small squares in the V lead with max S wave

Count the small squares in the V lead with the max R wave

If the sum is >35 - LVH

Patterns of Ischaemia

Anterior Inferior Lateral Septal Posterior

V1 – V4

II, III, aVF

I, aVL, V5, V6

V3,V4

Mirror image of acute injury in leads V1 - 3 Tall R wave, tall upright T wave in leads V1 -3 usually associated with inferior and/or lateral STEMI

Arrythmias

Narrow QRS Broad QRS

Regular

Supra Ventricular Tachycardia (SVT)

Usually can’t see P wave

Rate >150

Ventricular Tachycardia

(VT)

IrregularAtrial Fibrillation (AF)

No P wave – wavy baselineVentricular

Fibrillation (VF)

Bundle Branch Block

MaRRow RIGHT Bundle Branch Block WiLLiaM LEFT Bundle Branch Block

Bundle Branch Block

Random Assortment

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