PAPULAR CARDIOLOGISTS IN HEBBALA
ECG interpretation: points to remember
1 ECG reports should be short and based on clinical information where possible.
2 Check that the patient’s name is on the ECG and that the paper speed and
calibration markers are correct.
3 Measure or estimate the heart rate—3 large squares = 100/minute.
4 Establish the rhythm. Look for P waves (best seen in L2). Are the P waves followed
by QRS complexes? Look for anomalously conducted or ectopic beats.
5 Measure the intervals: PR, QRS duration and QT interval (for the latter, consult
tables, but normal is less than 50% of the RR interval).
6 If the QRS complex is wide (> 3 small squares) consider the possibilities: LBBB,
RBBB, WPW or ventricular rhythm or beats. If the pattern is of LBBB, there is
no need in most cases to attempt further interpretation.
7 Estimate the QRS axis. In LAD, L1 and aVF diverge and L2 is predominantly
negative. In RAD, L1 and aVF converge, while L2 matters little. Indeterminate
axis is diagnosed when all six frontal leads are (more or less) equiphasic.
8 Check whether the criteria for LAHB or LAFB have been met.
9 Look for pathological Q waves. In general these are longer than 0.04 seconds
and are more than 25% of the size of the following R wave.