Electrocardiogram ECG Interpretation Guide for Medical and Clinical Practice

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Frequently Asked Questions

❓ What is an ECG?
An electrocardiogram (ECG) is a non-invasive test that records the electrical activity of the heart over time to assess heart rhythm, rate, conduction abnormalities, ischemia, and structural heart disease.
❓ What does a normal ECG show?
A normal ECG shows sinus rhythm with a rate of 60–100 bpm, normal P waves before each QRS complex, PR interval 120–200 ms, QRS duration <120 ms, and no significant ST-T abnormalities.
❓ What are the main components of an ECG waveform?
The main components are the P wave (atrial depolarization), PR interval (AV conduction), QRS complex (ventricular depolarization), ST segment, T wave (ventricular repolarization), and QT interval.
❓ How many leads are used in a standard ECG?
A standard ECG uses 12 leads: 6 limb leads (I, II, III, aVR, aVL, aVF) and 6 precordial chest leads (V1–V6).
❓ What does ST elevation on ECG indicate?
ST elevation usually indicates acute myocardial injury, most commonly ST-elevation myocardial infarction (STEMI), but can also be seen in pericarditis, early repolarization, and ventricular aneurysm.
❓ What ECG changes are seen in myocardial infarction?
Typical changes include hyperacute T waves, ST elevation or depression, pathological Q waves, and T wave inversion depending on the stage and location of infarction.
❓ What is the significance of QT interval prolongation?
Prolonged QT interval increases the risk of torsades de pointes, a potentially life-threatening polymorphic ventricular tachycardia.
❓ How is heart rate calculated on ECG?
In regular rhythm, heart rate is calculated as 300 divided by the number of large squares between two R waves. In irregular rhythm, QRS complexes are counted in 10 seconds and multiplied by 6.
❓ What ECG findings suggest atrial fibrillation?
Atrial fibrillation shows an irregularly irregular rhythm with absent P waves and variable R–R intervals.
❓ What is a wide QRS complex and what does it indicate?
A wide QRS complex (>120 ms) suggests abnormal ventricular conduction such as bundle branch block, ventricular rhythm, hyperkalemia, or drug toxicity.
❓ What are common ECG changes in electrolyte abnormalities?
Hyperkalemia causes tall peaked T waves and wide QRS, hypokalemia causes U waves and flat T waves, hypercalcemia shortens QT interval, and hypocalcemia prolongs QT interval.
❓ What is axis deviation on ECG?
Axis deviation refers to abnormal direction of ventricular depolarization. Left axis deviation and right axis deviation are associated with specific cardiac and pulmonary conditions.
❓ What ECG features indicate pericarditis?
Acute pericarditis typically shows diffuse ST elevation with PR segment depression across multiple leads.
❓ Can ECG be normal in heart disease?
Yes, ECG can be normal in early ischemia, stable angina, or some structural heart diseases, so clinical correlation is always required.
❓ Why is ECG important in emergency medicine?
ECG provides rapid diagnosis of life-threatening conditions such as myocardial infarction, ventricular arrhythmias, heart block, and electrolyte disturbances, guiding immediate management.