ECG: Reading the Waves

An electrocardiogram (ECG), seen on the right, represents

movement of electrical current (depicted in green) through
the heart during a heartbeat. The first wave of the ECG,
designated P, represents initiation of the heartbeat in the
upper chambers of the heart (atria); the QRS complex
represents movement of the electrical current through the
lower chambers of the heart (ventricles); and the T wave
represents the recovery phase, in which the electrical current
spreads back over the ventricles in the opposite direction. The
heart, seen on the left, is beating in time with the ECG.
Oxygen-depleted (blue) blood is pumped from the heart to the
lungs, which supply oxygen; oxygen-enriched (red) blood
returns from the lungs to the heart and is pumped throughout
the body.
ECG Waves and Intervals
P wave: the sequential activation (depolarization) of the
right and left atria

QRS complex: right and left ventricular depolarization

(normally the ventricles are activated simultaneously)

ST-T wave: ventricular re polarization

U wave: origin for this wave is not clear - but probably

represents "after depolarizations" in the ventricles

PR interval: time interval from onset of atrial

depolarization (P wave) to onset of ventricular
depolarization (QRS complex)
QRS duration: duration of ventricular muscle
depolarization

QT interval: duration of ventricular depolarization

and repolarization

RR interval: duration of ventricular cardiac cycle

(an indicator of ventricular rate)

PP interval: duration of atrial cycle (an indicator

or atrial rate)
Conduction Analysis
"Normal" conduction implies normal sino-atrial (SA), atrio-ventricular (AV), and intraventricular (IV) conduction.
The following conduction abnormalities are to be
identified if present:

• SA block: 2nd degree (type I vs. type II)

• AV block:1st, 2nd (type I vs. type II), and 3rd degree

• IV blocks: bundle branch, fascicular, and nonspecific

blocks

• Exit blocks: blocks just distal to ectopic pacemaker

site
Wave form Description
Carefully analyze the 12-lead ECG for abnormalities in
each of the waveforms in the order in which they
appear: P-waves, QRS complexes, ST segments, T
waves, and... Don't forget the U waves.
• P waves: are they too wide, too tall, look funny (i.e.,
are they ectopic), etc.?
• QRS complexes: look for pathologic Q waves,
abnormal voltage, etc.
• ST segments: look for abnormal ST elevation and/or
depression.
• T waves: look for abnormally inverted T waves.
• U waves: look for prominent or inverted U waves.