Introduction to ECG Interpretation

Introduction

An electrocardiogram (ECG or EKG) is a simple and non-invasive test that records the electrical activity of the heart. It provides valuable information about the heart's rhythm, structure, and possible abnormalities.

Basic Components of an ECG

An ECG consists of several key components: - P wave : Represents atrial depolarization (contraction of the atria). - QRS complex : Represents ventricular depolarization (contraction of the ventricles). - T wave : Represents ventricular repolarization (relaxation of the ventricles). - PR interval : Measures the time taken for electrical impulses to travel from the atria to the ventricles. - QT interval : Represents the total time for ventricular depolarization and repolarization.

How to Analyze an ECG Step by Step

  1. Heart Rate : Normal heart rate ranges from 60 to 100 beats per minute.
  2. Rhythm : Determine if the rhythm is regular or irregular.
  3. Axis : Check the heart’s electrical axis to detect any abnormalities.
  4. P wave Examination : Look for normal or abnormal P waves.
  5. PR Interval : A prolonged or shortened PR interval can indicate conduction issues.
  6. QRS Complex : Check the width and morphology for signs of ventricular conduction disorders.
  7. ST segment and T wave : Any elevation or depression of the ST segment or abnormal T waves might indicate ischemia, infarction, or other issues.
  8. QT Interval : A prolonged QT interval can lead to life-threatening arrhythmias.

Common ECG Abnormalities

  • Atrial fibrillation : Irregular rhythm with no distinct P waves.
  • Ventricular tachycardia : Wide QRS complexes with a rapid heart rate.
  • Myocardial infarction : ST elevation or depression.
  • Heart block : Abnormal prolongation of PR interval.

Conclusion

Interpreting an ECG requires practice and knowledge of normal heart physiology and pathophysiological changes. If an abnormality is detected, further evaluation by a cardiologist is recommended.

Source recommendations

1. American College of Cardiology/American Heart Association ECG Interpretation Guidelines

  1. https://www.ahajournals.org/doi/10.1161/circulationaha.108.191095
  2. https://www.acc.org/Guidelines
  3. https://www.ahajournals.org/doi/10.1161/circulationaha.108.191098
  4. https://pubmed.ncbi.nlm.nih.gov/19281932/
  5. https://www.sciencedirect.com/science/article/pii/S073510970700232X

2. European Society of Cardiology Guidelines on ECG Interpretation

  1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines
  2. https://pubmed.ncbi.nlm.nih.gov/12269267/
  3. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Neonatal-Electrocardiogram-Guidelines-for-the-interpretation-of-the
  4. https://www.jacc.org/doi/10.1016/j.jacc.2017.01.015
  5. https://www.escardio.org/Guidelines

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