ECG Normal

Dr. David D. Ariwibowo SpJP, FIHA

The 10 rules for a normal ECG
I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

.2
 Rule 1

I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

The P waves should be upright in I, II, and V2 to V6

 Rule 2

1.0 R

PR
interval
0.5
T
PR interval should be 120
Millivolts

P to 200 milliseconds or 3 to
Q
0 5 little squares

-0.5 S

0 200 400 600

Milliseconds
 Rule 3

I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

There should be no Q wave or only a small q less

than 0.04 seconds in width in I, II, V2 to V6
 Rule 4

1.0 R

0.5
T
The width of the QRS
Millivolts

P complex should not exceed

Q
0 120 ms, less than 3 little
squares
-0.5 S
QRS

0 200 400 600

Milliseconds
 Rule 5

I II III aVR aVL aVF

The QRS complex should be

dominantly upright in leads I
and II
 Rule 6

I II III aVR aVL aVF

QRS and T waves tend to have

the same general direction in
the limb leads
 Rule 7

P All waves are negative in lead aVR

Q S
 Rule 8
V6
V5
V4
V3
V2
V1

The R wave in the precordial leads must grow from V1 to at

least V4
 Rule 9

I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

The ST segment should start isoelectric except in V1

and V2 where it may be elevated
 Rule 10

I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

The T wave must be upright in I, II, V2 to V6

Thank You