ECG Basics | ECG Rhythm interpretation|

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ECG rhythm evaluation To analyze the heart rhythm, focus on the rhythm strip. In a 12-lead ECG, this is usually a 10-second recording from Lead II.
Check other leads to confirm your findings. A longer rhythm strip, possibly recorded at a slower speed, can also be useful.
7 step approach to ECG rhythm analysis
1. Rate
Tachycardia or bradycardia?
Normal rate is 60-100/min.
2. Pattern of QRS complexes
Regular or irregular?
If irregular is it regularly irregular or irregularly irregular?
3. QRS morphology
Narrow complex: sinus, atrial or junctional origin.
Wide complex: ventricular origin, or supraventricular with aberrant conduction.
4. P waves
Absent: sinus arrest, atrial fibrillation
Present: morphology and PR interval may suggest sinus, atrial, junctional or even retrograde from the ventricles.

5. Relationship between P waves and QRS complexes
AV association (may be difficult to distinguish from isorhythmic dissociation)
AV dissociation
complete: atrial and ventricular activity is always independent.
incomplete: intermittent capture.
6. Onset and termination
Abrupt: suggests re-entrant process.
Gradual: suggests increased automaticity.
7. Response to vagal manoeuvres
Sinus tachycardia, ectopic atrial tachydysrhythmia: gradual slowing during the vagal manoeuvre, but resumes on cessation.
AVNRT or AVRT: abrupt termination or no response.
Atrial fibrillation and atrial flutter: gradual slowing during the manoeuvre.
VT: no response.
Category
Cardiology
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