ECG Interpretation For ACLS

Dr. Mohammad Asif Nazir

What is ECG ?

is a transthoracic (across the thorax or chest)

interpretation of the electrical activity of the
heart over a period of time on a graph paper.
 ANATOMY OF THE HEART
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 ANATOMY OF THE HEART
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 CONDUCTION SYSTEM OF HEART
The conducting system of the heart consists of cardiac muscle
cells and conducting fibers (not nervous tissue) that are
specialized for initiating impulses and conducting them
rapidly through the heart (see the image below). They initiate
the normal cardiac cycle and coordinate the contractions of
cardiac chambers. Both atria contract together, as do the
ventricles, but atrial contraction occurs first.
The conducting system provides the heart its automatic
rhythmic beat. For the heart to pump efficiently and the
systemic and pulmonary circulations to operate in synchrony,
the events in the cardiac cycle must be coordinated
 CONDUCTION SYSTEM OF HEART
SA node

AV node

AV bundle / Bundle of His

Right and left bundle branches

Purkinje fibers
 CONDUCTION SYSTEM OF HEART
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 Impulse Generation And Conduction
Pacemakers of the Heart

SA Node - Dominant pacemaker with an intrinsic rate of 60 -

100 beats/minute.

AV Node - Back-up pacemaker with an intrinsic rate of 40 - 60

beats/minute.

Ventricular cells - Back-up pacemaker with an intrinsic rate of

20 - 45 bpm.
Impulse Generation And Conduction
An Electrocardiogram
 Components of An Electrocardiogram
1- P Wave
2- PR Interval
3- QRS complex
4- ST Segment
5- T wave
An Electrocardiogram
An Electrocardiogram
 An Electrocardiogram
ECG Paper
Horizontally
One small box - 0.04 s
One large box - 0.20 s
Vertically
One large box - 0.5 mV
 An Electrocardiogram
An Electrocardiogram gives informations about
1- Heart Rate
2- Heart Rhythm
3- PR Interval
4- QRS Duration
5- Axis
6- Arhythemias
7-Ischemia
8- Infarction
 An Electrocardiogram
Heart Rate
Normal heart rate ranges between 60 to 100 bpm.
Rate Calculation On ECG
Method -1
Find a R wave that lands on a bold line.
Count the # of large boxes to the next R wave.
If the second R wave is
1 large box away the rate is 300,
2 boxes - 150, R wave
3 boxes - 100, 4 boxes - 75, etc.
 An Electrocardiogram
Heart Rate
Method -2
. 3 sec 3 sec

Count the # of R waves in a 6 second rhythm strip, then

multiply by 10.

Interpretation?
9 x 10 = 90 bpm
 An Electrocardiogram
Rhythm
Normal Rhythm of heart is known as Sinus Rhythm.

Rhythm can be
1- Sinus
2- Regular
3- Irregular ( Regularly Irregular / Irregularly
Regular)
 An Electrocardiogram
Rhythm Determination
Assess the P waves

Are there P waves?

Do the P waves all look alike?
Do the P waves occur at a regular rate?
Is there one P wave before each QRS?
Interpretation? Normal P waves with 1 P wave for
every QRS
 An Electrocardiogram
Rhythm Determination
R R

If there is P wave before each QRS then it is Sinus Rhythm.

Look at the R-R distances (using a caliper or markings on a
pen or paper).
Regular (are they equidistant apart)? Occasionally irregular?
Regularly irregular? Irregularly irregular?
Interpretation?
Regular Sinus Rhthm
 An Electrocardiogram
PR Interval Determination

Normal: 0.12 - 0.20 seconds.

(3 – 5 small boxes)
 An Electrocardiogram
QRS Duration

Normal: 0.04 - 0.12 seconds.

(1 - 3 boxes)
 An Electrocardiogram
Normal Sinus Rhythm Parameters

Rate 60 - 100 bpm

Regularity Regular
P Wave Normal
PR Interval 0.12 Sec - 0.20 Sec
QRS Duration 0.14 Sec – 0.12 Sec
Any deviation from above is Sinus Tachycardia , Sinus
Bradycardia or an Arrhythmias.
 An Electrocardiogram
ST Segment Interpretation

Normally ST Segment touches baseline.

It can be above the baseline or below the baseline
and both changes have significance…
 An Electrocardiogram
ST Segment Interpretation

ST segment Elevation
mostly represents
Myocardial Infarction.
 An Electrocardiogram
ST Segment Interpretation

ST segment Depression mostly

represents
Myocardial Ischemia.
ECG Interpretation