Interpretation

Steps To Rhythm Interpretation

Step 1: Identify The QRS Complexes

You first need to identify if there are QRS complexes. This will save you a lot of time as well as set you up for good ECG interpretation. This should be the first thing you look for on any ECG scan. Once you locate the QRS complexes look and see if they are all there or if any are missing.

Step 2: Is the rhythm regular, irregular, or regular but interrupted?

Ask and answer the question, "Is the rhythm regular, irregular, or regular but interrupted?" This is going to help you identify the type of rhythm you are dealing with pretty quickly.

  • A regular rhythm is one where you can comfortably anticipate where the next QRS complex is going to land. Regular rhythms are predictable.
  • Irregular rhythms are rhythms that are hard to predict where the next R will land.
  • Regular but interrupted rhythms will have R to R's that are easy to anticipate, but are interrupted by other beats.

Step 3: What is the heart rate?

Ask and answer the question, "What is the heart rate?"

  • If the heart rate is >100bpm the patient has some kind of tachycardia or fast heart rhythm.
  • If the heart rate is <60bpm, the patient has some kind of bradycardia or slow rhythm.


Step 4: Are there P waves?

  • How far is the P wave from the QRS complex? Does it stay locked in or married to the QRS complex or does it move away or closer to the QRS Complex?
  • Are there P waves that don't have a QRS behind them?
  • Are the P waves the same shape?
  • Are the P - P intervals (distance from one p to the next) the same or do they vary?


Step 5: What are the PR and QRS intervals?

  • Do the PR and QRS intervals stay within normal limits or do they go to extremes? That is, do they fall to short or go to long?
  • Are the intervals constant, or do they vary and change?


Depending on which ECG scan you are reading, some of the boxes will appear white, red, blue, green, etc... Also in the video the presenter indicated that there are lines at the top of the ECG showing distances. This may or may not be the case on the ECG scan you are looking at.