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ECG Cheat Sheet

The document provides a 7-step approach to interpreting electrocardiograms (ECGs): 1) Calculate heart rate, 2) Assess rhythm, 3) Determine axis, 4) Examine P waves and PR intervals, 5) Analyze QRS complex, 6) Evaluate ST segment, and 7) Inspect T waves and U waves. Examples of ECG interpretations are then provided for various rhythms and conditions, including myocardial infarction, arrhythmias, conduction abnormalities, and electrolyte imbalances.

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Daanish
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200 views3 pages

ECG Cheat Sheet

The document provides a 7-step approach to interpreting electrocardiograms (ECGs): 1) Calculate heart rate, 2) Assess rhythm, 3) Determine axis, 4) Examine P waves and PR intervals, 5) Analyze QRS complex, 6) Evaluate ST segment, and 7) Inspect T waves and U waves. Examples of ECG interpretations are then provided for various rhythms and conditions, including myocardial infarction, arrhythmias, conduction abnormalities, and electrolyte imbalances.

Uploaded by

Daanish
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
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Step 1: Rate

- 300/number of big squares between R-R intervals (e.g. 300/4 = 75 bpm).


- For accurate calculations, each small square is 0.04 seconds; each big square is 0.2 seconds (= 5 small
squares).
- Normal HR is 60-100 bpm.

Step 2: Rhythm
- Look at lead II, and check if the R-R intervals are constant (regular) or changing (irregular).
- May be regular or irregular.
- May be regularly irregular (i.e. a variable R-R interval with a recurrent pattern) like in 2 nd degree type 1
(Wenckebach) AV block.
- May be irregularly irregular (i.e. completely disorganized) like in atrial fibrillation.

Step 3: Axis
- Significance: indicator of hypertrophy or LBBB.
- Look at the QRS complex in leads I & aVF. If both are positive, axis is normal.
- If lead I is positive, and aVF is negative, then axis is deviated to the left.
- If lead I is negative, and aVF is positive, then axis is deviated to the right.
- If both negative, then axis is extremely deviated to the right.
- If lead aVF is isoelectric (meaning it is neither positive nor negative), look at lead II
as the “tie breaker” since lead II is also an inferior lead.

Step 4: P-waves & PR intervals


- If P-waves are present, its sinus rhythm. If not, it’s probably atrial fibrillation (especially if the rhythm
is irregular).
- If present, is each P wave followed by a QRS complex? In 2 nd degree (Wenckebach) AV block, there may
be 2, 3, or even more P-waves before a QRS, but the ratio (e.g. 2:1 or 3:1) is constant.
- The PR interval should be between 120-200 ms (3-5 small squares).
- Prolonged PR interval (> 0.2 seconds) is a clear sign of AV block.

Step 5: QRS complex


Deep Q waves—indicate
- If QRS complex is > 0.12 seconds, it’s widened. myocardial necrosis (i.e. an old MI).
- A widened QRS complex is a sign of RBBB or LBBB.
AF is often described as having
Step 6: ST segment 'rapid ventricular response' once
- Depression = NSTEMI or just myocardial ischemia in general. the ventricular rate is > 100 bpm.

- Elevation = myocardial necrosis (i.e. usually a STEMI).


Step 7: T-waves & U- waves
- T waves represent repolarization of the ventricles.
- Hyperkalemia can cause peaked T-waves.
- Inverted T-waves are a sign of myocardial ischemia.
- Hypokalemia can cause flattened T-wave with a prominent U-wave.

4: hyperkalemia (peaked T wave).

12: sinus bradycardia due to LBBB with signs of ST changes (MI).

25: hypokalemia (sinus bradycardia with T wave flattening and prominent U waves).

112: Monomorphic ventricular tachycardia (VT) with RBBB.

120: inferior/posterior/right STEMI pattern w/ q waves.

204: inferior-lateral ST depressions (MI) w/ left axis deviation + P mitrale in lead II.

228: AFib with a very rapid ventricular response but ventricular response is highly irregular (“irregularly
irregular”).
254: AV junctional bradycardia (retrograde/no p waves), also a prolonged QT interval.

255: Complete left bundle branch block with secondary T wave changes.

268: Sinus rhythm with 3:1 AV conduction (advanced type 2 2nd degree AV block).

292: Sinus bradycardia with ventricular bigeminy (premature ventricular beat with full compensatory pause).

72: STEMI on lead I + AVL (lateral) w/ ST depression on inferior leads.

37: massive STEMI in V2-V6 (anterior) w/ Q waves in V3-V5.

159: Torsade de pointes polymorphic ventricular tachcyardia associated with long QT(U).

274: monomorphic ventricular tachycardia with a RBBB morphology.

128: STEMI (marked ST elevations and hyperacute T waves in the anterior/lateral leads, including V2-V5, I and
aVL).

21: Sinus rhythm with complete heart AV block (bradycardia).

91: anterior STEMI (V1-V4).

27: infero-lateral and probably posterior MI. Left axis deviation. RBBB is present. 2nd degree AV block.

332: Afib with rapid ventricular response (“irregularly irregular” rhythm). Non-specific ST changes are present in
V2-V3.

257: A single premature atrial complex (PAC) on 7th beat.

335: sinus tachycardia + long QT interval (due to hypocalcemia).

345: Atrial fibrillation with (RV) pacing. No P waves distinguishable, erratic wavy baseline so non-sinus rhythm.
QRS preceded by a spike indicating pacemaker stimulation. With rate 45 bpm (bradycardia). RV pacing produces an
iatrogenic form of left bundle branch block (LBBB).

355: anterolateral STEMI w/ Q waves in V3.

393: Inferior-lateral STEMI.

396: classic AFib pattern (average ventricular response of about 100/min) + Ashman beat in V1.

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