12 Lead ECG12 Lead ECG

Rhythm AxisRateBundleBranch

InfarctExtraBeats

Hyper-trophy

Rate: Lead II-Rate: Lead II-Counting Large BlocksCounting Large Blocks

Back

1 32 4 5 6

300150

10075

6058

50

Five small blocks equals one large block – count is from one QRS complex to the next counting: 300, 150, 100, 75, 60, 50. Then decide count between last two numbers

Start

Rhythm: Lead II + allRhythm: Lead II + all

Back

QRSP wave

T wave

PR interval

R to R interval

Lead II first, then scan from left to right – P wave for every QRS?, PR intervals constant?, R to R intervals constant?

Axis Leads I & aVFAxis Leads I & aVF

Back

Positive QRS

Positive QRS

NegativeNegative QRSQRS

Negative Negative QRSQRS

Normal Axis: + +

Left Axis Deviation: + -

Right Axis Deviation: - +

Extreme RightAxis Deviation: - -

I aVF

Bundle Branch: V1, V5 & V6Bundle Branch: V1, V5 & V6

Back

Infarct: All but aVRInfarct: All but aVR

BackLocate Infarct

Inferior – Leads II, III & aVFInferior – Leads II, III & aVF

Q waves presentST segment elevation – new depression – oldT wave inversion

Impacted area of the heart

Back

Anterior – Leads Anterior – Leads V1, V2, V3 & V4V1, V2, V3 & V4

Q waves presentST segment elevation – new depression – oldT wave inversion

Impacted area of the heart

Back

Lateral – Leads I & aVLLateral – Leads I & aVL

Q waves presentST segment elevation – new depression – oldT wave inversion

Impacted area of the heart

Back

Posterior – Leads V1 & V2Posterior – Leads V1 & V2

Large R waveST segment depressionMirror test

Impacted area of the heart(back side)

Back

Extra Beats: AllExtra Beats: All

Check across all leads left to rightCheck P waves for atrial arrythmias, number and shapeCheck QRS complex for ventricular arrythmias, wide and bizzareTop to bottom in a column are the same time frame

Column 1 Column 2 Column 3 Column 4

Back

Hypertrophy: V1, V5, V6Hypertrophy: V1, V5, V6

Back

Atrial – P wave shape in V1 and is it biphasic?Right Ventricular – R wave greater than S wave in V1Left Ventricular – Add depth of S wave in V1 to Height of R wave in V5 or V6 which ever is larger1 small block = 1 mm, 1 large block = 5 mm

R

S

P