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8 Steps in ECG Reading

This 8-step method helps interpret an ECG rhythm strip by evaluating different elements of the waveform. Step 1 evaluates the P wave for size, shape and location. Step 2 determines the atrial rhythm by measuring P-P intervals. Step 3 calculates the atrial rate by counting small squares between P waves. Step 4 measures the PR interval between the P wave and QRS complex. Step 5 evaluates the ventricular rhythm by measuring R-R intervals. Step 6 calculates the ventricular rate by counting small squares between R waves. Step 7 measures the duration of the QRS complex. Step 8 calculates the QT interval between the QRS complex and T wave.

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Hosanna Gabrielle Dominguez-Abella
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2K views

8 Steps in ECG Reading

This 8-step method helps interpret an ECG rhythm strip by evaluating different elements of the waveform. Step 1 evaluates the P wave for size, shape and location. Step 2 determines the atrial rhythm by measuring P-P intervals. Step 3 calculates the atrial rate by counting small squares between P waves. Step 4 measures the PR interval between the P wave and QRS complex. Step 5 evaluates the ventricular rhythm by measuring R-R intervals. Step 6 calculates the ventricular rate by counting small squares between R waves. Step 7 measures the duration of the QRS complex. Step 8 calculates the QT interval between the QRS complex and T wave.

Uploaded by

Hosanna Gabrielle Dominguez-Abella
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 RTF, PDF, TXT or read online on Scribd
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Interpreting an EKG rhythm strip: An 8 step

method
You can master the interpretion of an ECG rhythm strip through practice. By
developing a consistent approach you will be sure to include all the pertinent data in
your analysis. This 8-step method will help you
An ECG waveform has three basic elements: the P wave, the QRS complex, and the
T wave. These elements can be further divided into a PR internal, U wave, ST
segment, and QT interval.

Step I
Evaluate the P wave. The P wave represents the depolarization of the atria.
(Depolarization occurs as the impulse passes through the muscle tissue.) Observe
the P wave's size, shape, and location in the waveform. If the P wave consistently
precedes the QRS complex, the SA (sino-atrial) node is initiating the electrical
impulse.

Step II
Evaluate the atrial rhythm The P wave should occur at regular intervals, with only
small variations associated with respiration. Using calipers, you can easily measure
the interval between P waves, or the P-P interval. Compare the P-P intervals.

Step III
Determine the atrial rate For a quick count, add the number of P waves in two

3-second segments and multiply by 10. To be more accurate, count the small
squares between the apexes of two P waves. Each small square equals 0.04
second; 1,500 squares equal 1 minute. Divide 1,500 by the number of squares you
counted to get the atrial rate.

Calculate the duration of the PR interval.

Count the small squares between the beginning of the P wave and the beginning of the QRS complex. Multiply that number by 0.04 second. The normal interval is between 0.12 and 0.20 second, or between three and five small squares wide.
If the interval is wider, there is a delay in conduction of the impulse to the ventricles.

5 Evaluate the ventricular J rhythm


Use calipers to measure the R-R intervals. Place the calipers on the same point
of the QRS complex. If the R-R intervals remain consistent, the ventricular rhythm is
regular.

6 Determine the ventricular rate


J Use the same formula for calculating the atrial rate (Step 3), but count the small
squares between the two R waves. Also check that the QRS complex is: shaped
appropriately for the lead you're monitoring.

7 Calculate the duration of the QRS complex

Count the squares between the beginning and the end of the QRS complex and
multiply by 0.04 second. A normal QRS complex is less than 0.12 second. Some
references specify 0.06 to 0.10 second as the normal duration for the QRS complex.

8 Calculate the duration of the QT interval


Count the number of squares from the beginning of the QRS complex to the end of
the T wave. Multiply this number by 0.04 second. The normal range is 0.36 to 0.44
second, or 9 to 11 small squares wide.

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