Understanding PQRS on an ECG

Introduction

Electrocardiography (ECG) is a vital tool in diagnosing heart conditions. The PQRS complex represents different phases of the cardiac electrical cycle and provides critical information about heart rhythm, conduction, and potential pathologies.

Breakdown of the PQRS Complex

1. P Wave

  • Represents atrial depolarization, meaning electrical activity moving through the atria.
  • Normal duration: <120 ms (3 small ECG squares).
  • Abnormalities:
    • Peaked P wave may indicate right atrial enlargement.
    • Broad/notched P wave suggests left atrial enlargement.

2. PR Interval

  • Measures from the start of the P wave to the start of the QRS complex.
  • Normal duration: 120–200 ms (3–5 small squares).
  • Abnormalities:
    • Prolonged PR may indicate first-degree heart block.
    • Short PR suggests pre-excitation syndromes (e.g., Wolff-Parkinson-White Syndrome).

3. QRS Complex

  • Represents ventricular depolarization, crucial for evaluating heart function.
  • Normal duration: <120 ms (3 small squares).
  • Abnormalities:
    • Widened QRS (>120 ms) may indicate bundle branch block or ventricular origin beats.
    • Deep Q waves may be a sign of previous myocardial infarction.

4. ST Segment and T Wave (not part of PQRS but important)

  • ST segment: Evaluates ischemia and infarction.
  • T wave: Represents ventricular repolarization. Peaked T waves may suggest hyperkalemia.

Clinical Significance

  • Arrhythmias can often be detected by changes in the PQRS pattern.
  • Myocardial infarction, conduction blocks, electrolyte imbalances can all be suspected based on PQRS abnormalities.
  • Regular ECG monitoring helps in early diagnosis and treatment of cardiovascular diseases.

Conclusion

Understanding the PQRS complex on an ECG can help both medical professionals and patients recognize potential heart problems early. If you ever see an abnormal ECG, consult a cardiologist immediately.

Source recommendations

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

  1. https://www.acc.org/Guidelines
  2. https://www.ahajournals.org/doi/10.1161/circulationaha.108.191095
  3. https://pubmed.ncbi.nlm.nih.gov/19281932/
  4. https://www.ahajournals.org/doi/10.1161/circulationaha.108.191098
  5. https://pubmed.ncbi.nlm.nih.gov/17322457/

2. European Society of Cardiology Guidelines on Cardiac Rhythm Disorders

  1. https://www.escardio.org/
  2. https://www.hrsonline.org/guidance/clinical-resources/2009-guidelines-diagnosis-and-management-syncope
  3. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines
  4. https://www.hrsonline.org/guidance/clinical-resources
  5. https://academic.oup.com/eurheartj/article/34/29/2281/401445

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