Five-Step Approach for EKG Interpretation
Step 1 – Heart Rate
Measured by looking at “R to R” waves
Normal = 60-100bpm
o Bradycardia = <60bpm
o Tachycardia = >100bpm
Step 2 – Heart rhythm/regularity
Determine whether heart rate is regular:
o Measure the intervals between R-to-R (ventricular
rhythm)
o Measure the intervals between P-to-P (atrial rhythm)
Step 3 – P wave
Are P waves present?
Are all QRS complexes preceded by a P wave?
Are the P waves occurring regularly?
Are the P waves smooth, rounded, and upright in appearance?
Do all the P waves look similar?
Step 4 – PR interval
Are PR intervals greater than 0.20 seconds?
Are the PR intervals constant across the EKG strip?
Step 5 – QRS complex
Is the QRS complex greater or less than 0.12 seconds?
Are the QRS complexes similar in appearance across the strip?
à At completion = evaluate overall appearance
o Evaluate ST segment for elevation or depression
o Evaluate T waves if negative, peaked, or upright
, Sinus Bradycardia Sinus Tachycardia
HR <60 BPM due to sinus node creating impulse HR is 100-120 BPM due to sinus node creating
slower than normal. Normal in well-conditioned impulse at a faster than normal rate. This does not
athletes. start or stop suddenly.
Causes: Causes:
Medications: calcium channel blockers, beta Stimulants: caffeine, cocaine, pre-workout, etc.
blockers, or any medication w/ inotropic effects. Exercise r/t demand increase
Vagal stimulation Hypovolemia r/t shock
Hypovolemia Medications: albuterol, atropine, epinephrine
Hypoxia MI, CHF
AMI, IICP Infection; Fever r/t increased oxygen demand
Hypoglycemia Pain, Fear/Anxiety
Hypo/Hyperkalemia Management:
Management: Resolve causative factors
Resolve causative factors Vagal stimulation; Trendelenburg position
Atropine 0.5mg IV, max dose 3mg; Epi works too! Narrow QRS = Beta-Blockers, CCB
Emergency transcutaneous pacing Wide QRS = Adenosine, Sotalol, Amiodarone
Clinical Manifestations: Increased fluids/Sodium (ex: POTS)
SOB, Decreased LOC Clinical Manifestations
Hypotension Reduced cardiac output resulting in poor perfusion,
Angina r/t heart becoming ischemic leading to hypotension, syncope, or acute
pulmonary edema
Step 1 – Heart Rate
Measured by looking at “R to R” waves
Normal = 60-100bpm
o Bradycardia = <60bpm
o Tachycardia = >100bpm
Step 2 – Heart rhythm/regularity
Determine whether heart rate is regular:
o Measure the intervals between R-to-R (ventricular
rhythm)
o Measure the intervals between P-to-P (atrial rhythm)
Step 3 – P wave
Are P waves present?
Are all QRS complexes preceded by a P wave?
Are the P waves occurring regularly?
Are the P waves smooth, rounded, and upright in appearance?
Do all the P waves look similar?
Step 4 – PR interval
Are PR intervals greater than 0.20 seconds?
Are the PR intervals constant across the EKG strip?
Step 5 – QRS complex
Is the QRS complex greater or less than 0.12 seconds?
Are the QRS complexes similar in appearance across the strip?
à At completion = evaluate overall appearance
o Evaluate ST segment for elevation or depression
o Evaluate T waves if negative, peaked, or upright
, Sinus Bradycardia Sinus Tachycardia
HR <60 BPM due to sinus node creating impulse HR is 100-120 BPM due to sinus node creating
slower than normal. Normal in well-conditioned impulse at a faster than normal rate. This does not
athletes. start or stop suddenly.
Causes: Causes:
Medications: calcium channel blockers, beta Stimulants: caffeine, cocaine, pre-workout, etc.
blockers, or any medication w/ inotropic effects. Exercise r/t demand increase
Vagal stimulation Hypovolemia r/t shock
Hypovolemia Medications: albuterol, atropine, epinephrine
Hypoxia MI, CHF
AMI, IICP Infection; Fever r/t increased oxygen demand
Hypoglycemia Pain, Fear/Anxiety
Hypo/Hyperkalemia Management:
Management: Resolve causative factors
Resolve causative factors Vagal stimulation; Trendelenburg position
Atropine 0.5mg IV, max dose 3mg; Epi works too! Narrow QRS = Beta-Blockers, CCB
Emergency transcutaneous pacing Wide QRS = Adenosine, Sotalol, Amiodarone
Clinical Manifestations: Increased fluids/Sodium (ex: POTS)
SOB, Decreased LOC Clinical Manifestations
Hypotension Reduced cardiac output resulting in poor perfusion,
Angina r/t heart becoming ischemic leading to hypotension, syncope, or acute
pulmonary edema
