ECG Interpretation Checklist

Rate
(300/big squares or 1500/ Small Squares)
- bradycardia/tachycardia? (n: 60-100/minute)

Rhythm
- regular/irregular?
- sinus rhythm? (regular P preceding QRS)
- nodal rhythm? (normal QRS, absent P)
- ventricular rhythm? (P follows QRS, QRS length >0.12s/3 small Boxes)
- atrial fibrillation? QRS irregularly irregular, No discernible P.
- atrial flutter? Sawtooth appearance. Regular QRS

Axis
(I 0deg; II +60deg; aVF +90deg; III +120deg; aVR -150deg; aVL -30deg)
- Mean frontal axis? At 90deg to isoelectric complex.
- Left axis deviation? -30deg to -90deg.
- Right axis deviation? +90deg to +180deg.

P-wave (Positive in I,II,aVF, V4-V6)
- Sinoatrial block? Complete/partial
- Left atrial hypertrophy? Bifid P. "P mitrale"
- Right atrial hypertrophy? Peaked P. "P pulmonale"

P-R interval
(start of P to start of QRS)
- Delayed AV conduction? (>0.2s/5 squares)
- Accessory conduction? (<0.12s/3 squares)

QRS Complex
- Ventricular conduction defect? (>0.12s/3 squares.)
- Ventricular hypertrophy? (large QRS)

QT Interval
(start of QRS to end of T. Corrected QTc=QTC = QT / √ RR)
Trick: normal QT interval is less than half the preceding RR interval. e.g. if RR interval is 5 small square than QT must be less than 2.5 squares. if it is more than 5 small squares, it suggests QT prolongation.

 - Prolonged QT interval is caused by: AMI, bradycardia (incl drug induced), myocarditis, U&E imbalance, Hypocalcemia

ST Segment
(normally isoelectric)
- Infarction? (Elevation >1mm)
- Ischaemia? (Depression >0.5mm)

T wave
(positive in I, II, V4, V5, V6. negative in opposite leads aVR, V1, V2.)
- Hyperkalemia? Peaked.
- Hypokalemia? Flattened.
- Ischemia? Inverted
- NSTEMI? Arrow head t wave inversion

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