ECG Tips for the Bedside

CARDIOLOGY, ECG

ECG Tips from an Indian Physician

The Eyeball Technique: 10 Rules for rapid ECG Reading.

  1. Heart Rate: 3 to 5 rule & big box rule
  2. P wave: Lead II taller than I
  3. AV Conduction 1: > one large square rule
  4. AV Conduction 2: Who is related to whom?
  5. QRS duration: Little Box 3 rule?
  6. Wide QRS: Find the Traffic Block – Where are the rabbit ears? Right or left?
  7. QRS Axis: Look at where I and aVF are pointing
  8. QT interval: 50% rule.
  9. R & T wave: Who is taller in V1 or V6?
  10. ST segment: 1mm x 2 rule

 

1. Heart Rate. Normal heart rate falls within a range of 3 to 5 big boxes. That corresponds to 60 to 100 bpm if you use the formula in method #2 above. Use this 3 to 5 big box rule to know if the heart rate is normal or not. If it’s normal, there is no need to calculate it when working on the ward.

  • 1=300
  • 2=150
  • 3=100
  • 4=75
  • 5=60
  • 6=50

In essence, this is an application of method #3 of determining heart rate.

2. P Wave: Is Lead II taller than lead I? I.e. Is the P wave in lead II taller than p wave in lead I? It should be for it to be normal. Why?

QRS axis: Look at where I and aVF are pointing. If they point in the same direction, then the axis is normal. If the point towards each other, then they are Reaching out to each other which is Right axis deviation. If they point away from each other, then they are Leaving each other, which is Left axis deviation.

print