Basic Principles of

Normal ECG
Prepared by:
Ben Ryan Jucay Sauce MN, USRN, RM, EMT
Lecturer
Conduction System of the
Heart
Electrical discharge for each cycle
normally starts in Right Atrium - SA
Node
Depolarization then spreads
through atrial muscle fibers
There is a delay while the
depolarization spread through
another special area in the atrium
the - AV Node (to ensure atria have
injected their blood to ventricle first
before the ventricles contract)
Bundle of His or AV Bundle
Right and Left Bundles
Purkinje Fibers - Ventricular
depolarization and contraction
 Depolarization versus
Depolarization
Normally, Our cell plasma membrane has difference in
charge between the inside and outside due to difference of
electrolyte concentration, These differences called
Polarization.
Depolarization from positive to negative (outside), from
negative to positive (inside).
Repolarization change back to resting state, from negative
to positive (outside), from positive to negative (inside)
Basic Shape of Normal
ECG
Interpreting a Rhythm Strip
 Determining the Rhythm
Atrial Rhythm - measures the P-
P Intervals
Ventricular Rhythm - measures
the R-R Intervals
Then compare intervals in
several cycles
Note: the intervals between
consecutive P or R waves should
occur regularly with only small
variations (0.04 second difference )
 Determining the Rate

Atrial Rate - two consecutive P waves

Ventricular Rate - two consecutive R waves
60-100 BPM
Bradycardia, Tachycardia, Supraventricular
Tachycardia
Practice Test
Practice Test
Practice Test
 Evaluating the P wave

Are P waves present?

all have similar size
and shape?

Is there one P wave

for every QRS
complex?
 Determining the duration of the PR
Interval

Count the small

squares between P
wave and start of the
QRS complex, then
multiply the number of
squares by 0.04

0.12 to .20 seconds?

Constant?
 Determining the duration of the QRS
complex

Count the small squares

between beginning and end
of the QRS complex, then
multiply the number of
squares by 0.04

0.06 to .10 seconds?

Constant in shape and size?

QrS appears after P wave?

 Evaluating the T wave

T waves are present?

Normal shape,
amplitude ?
 Determining the duration of the QT
Interval

Count the small squares

between beginning a of the
QRS complex and end of the
T wave, then multiply the
number of squares by 0.04

0.36 to 0.44 seconds?

Constant in shape and size?

QrS appears after P wave?

End