Basic ECG

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Basic ECG /
Roy E. Garrido, M.D.
Basic ECG

Indications for Ordering an ECG

ECG Components
Heart Rate Determination

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Basic ECG /
Roy E. Garrido, M.D.
Indications for Ordering an ECG

to determine cardiac rate

to accurately define cardiac rhythm
to diagnose old or new myocardial infarction
to identify intracardiac conduction disturbances
to aid in the diagnosis of ischemic heart
disease, pericarditis, myocarditis, electrolyte
abnormalities, and pacemaker malfunction
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Basic ECG /
Roy E. Garrido, M.D.
ECG Components

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Basic ECG /
Roy E. Garrido, M.D.
P Wave

atrial depolarization
composed of both RA and
LA contraction
upright in most leads
duration of P wave
0.05 to 0.08 s
amplitude of P wave
0.5 to 2.5 mm
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Basic ECG /
Roy E. Garrido, M.D.
P Wave

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Basic ECG /
Roy E. Garrido, M.D.
Q Wave

septal depolarization
direction is from L R
small amount of conduction
travels opposite the main
conduction
duration of Q wave
< 0.04 s
amplitude of Q wave
< 25% of amplitude of R wave
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Basic ECG /
Roy E. Garrido, M.D.
R Wave

main portion of ventricular

depolarization

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Basic ECG /
Roy E. Garrido, M.D.
S Wave

depolarization of Purkinje
fibers

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Basic ECG /
Roy E. Garrido, M.D.
QRS Complex

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Basic ECG /
Roy E. Garrido, M.D.
ST Segment

indicator for both

myocardial ischemia and
necrosis

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Basic ECG /
Roy E. Garrido, M.D.
T Wave

ventricular repolarization
upright in most leads
duration of T wave
0.10 to 0.25 s
amplitude of T wave
< 5 mm

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Basic ECG /
Roy E. Garrido, M.D.
T Wave

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Basic ECG /
Roy E. Garrido, M.D.
U Wave

repolarization of Purkinje
fibers
upright
amplitude of U wave
< 2 mm
occur with electrolyte
imbalance (K+)

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Basic ECG /
Roy E. Garrido, M.D.
ECG Intervals

PR Interval
0.12 to 0.20 s
QRS Complex
0.08 to 0.12 s
QT Interval
0.35 to 0.43 s

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Basic ECG /
Roy E. Garrido, M.D.
Heart Rate Determination

Six Second count

simplest and most
common method
multiply the number of
QRS over 6 s by a factor of
10
works with regular or
irregular rhythms

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Basic ECG /
Roy E. Garrido, M.D.
Heart Rate Determination

Triplicate Method
useful for measuring HR
over short periods (< 3 s)
useful for HR
determination during
rapid tachycardias
not very accurate
works with regular
rhythm only

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Basic ECG /
Roy E. Garrido, M.D.
Heart Rate Determination

Caliper Method
measures the exact rate
by counting the number of
mm across the RR interval
calipers are used
HR = 1500/RR interval
(mm)
works with regular
rhythm only

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Basic ECG /
Roy E. Garrido, M.D.
Heart Rate Determination

Square Method
HR = 300/# big squares between RR interval
HR = 1500/# small squares between RR interval

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Basic ECG /
Roy E. Garrido, M.D.
Axis Determination

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Basic ECG /
Roy E. Garrido, M.D.
Axis Determination

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Basic ECG /
Roy E. Garrido, M.D.
Axis Determination

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Basic ECG /
Roy E. Garrido, M.D.