ECG Cookbook: Answer Diagnosis
ECG Cookbook: Answer Diagnosis
ECG Cookbook: Answer Diagnosis
2. Heart rate Estimate heart rate: 300/number of large boxes between heart rate in beats per min
two QRS complexes
3. P waves a) Large P-wave amplitude (>2.5 mm in II, III, or aVF) right atrial enlargement
4. PR interval a) >0.2 s (if PR interval constant for all beats and each P I° AV block
wave is followed by a QRS complex)
5. QRS axis Determine the axis according to leads I, II, and aVF normal axis
left axis deviation
right axis deviation
northwest axis
b) >0.1 s and <0.12 s with typical bundle branch block incomplete bundle
appearance (notching) branch block
7. Rotation Rotation is defined according to the heart’s transition transition zone at V5-V6:
zone. Normally the transition zone is located at V4, which clockwise rotation
means that right ventricular myocardium is located at V1-
V3 and left ventricular myocardium is at V5-V6. transition zone at V1-V3:
counterclockwise rotation
8. QRS amplitude a) QRS amplitude <0.5 mV in all standard leads low voltage
9. QRS infarction signs abnormal Q waves, QS waves, missing R-wave progression myocardial infarction;
localization according to
affected leads
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10. ST-T segment
hyperkalemia,
QRS normal vagotonia
probably ischemia
QRS normal (DD: digitalis)
nonspecific repo-
larization abnor-
QRS normal
mality
acute ischemia,
QRS normal perimyocarditis,
variant angina
STEMI/
QRS normal perimyocarditis in
resolution
STEMI subacute,
NSTEMI,
QRS normal
perimyocarditis
left ventricular
QRS: left ventricular
hypertrophy
hypertrophy with abnormal
repolarization
In these situations
an ST-segment
deviation is almost
QRS: right ventricular
always present and
hypertrophy, bundle
branch block, or WPW
cannot be interpre-
syndrome ted in and of itself.
It has to be left out
in the
ECG report
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