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Schematic representation of a normal sinus rhythm ECG wave. Diagram showing how the polarity of the QRS complex in leads I, II, and III can be used to estimate the heart's electrical axis in the frontal plane. The QRS complex is the combination of three of the graphical deflections seen on a typical electrocardiogram (ECG or EKG). It is usually ...
A normal heart should have a normal sinus rhythm, this rhythm can be identified by a ventricular rate of 60-100 bpm, at a regular rate, with a normal PR interval (0.12 to 0.20 second) and a normal QRS complex (0.12 second and less).
Normal sinus rhythm produces the prototypical pattern of P wave, QRS complex, and T wave. Generally, deviation from normal sinus rhythm is considered a cardiac arrhythmia . Thus, the first question in interpreting an ECG is whether or not there is a sinus rhythm.
The sinus node should pace the heart – therefore, P waves must be round, all the same shape, and present before every QRS complex in a ratio of 1:1. Normal P wave axis (0 to +75 degrees) Normal PR interval, QRS complex and QT interval. QRS complex positive in leads I, II, aVF and V3–V6, and negative in lead aVR. [3]
The first finding is that junctional rhythms are regular rhythms. This means that the time interval between beats stays constant. The next normal finding is a normal QRS. Since the impulse still travels down the bundle of His, the QRS will not be wide. Junctional rhythms can present with either bradycardia, a normal heart rate, or tachycardia. [9]
To determine a true LAD, examine QRS in lead II. If the QRS complex is positive in lead II, then this is a normal axis. On the other hand, if QRS complex is negative in lead II, then this is a LAD. Another method of determining LAD is called the Isoelectric lead, which allows for a more precise estimation of the QRS axis. [3]
This refers to the appearance of leads I and II. If the QRS complex is negative in lead I and positive in lead II, the QRS complexes appear to be "reaching" to touch each other. This signifies right axis deviation. Conversely, if the QRS complex is positive in lead I and negative in lead II the leads have the appearance of "leaving" each other.
P waves: Upright, consistent, and normal in morphology and duration. PR interval: Between 0.12 and 0.20 seconds in duration. QRS complex: Less than 0.12 seconds in width, and consistent in morphology. [7] Taking a thorough medical history and physical exam by healthcare providers can also help with narrowing differential diagnosis.