An ECG(or electrocardiogram) is usually used together with other tests to help diagnose and observe the conditions affecting the heart. It can be used to figure out signs and symptoms of possible heart issues like chest pain, increasing heartbeat, dizziness, and shortness of breath. A series of ECG tests can also be taken constantly to monitor a patient that has already been diagnosed with a heart condition or taking medication that is known to potentially affect the heart.
An electrocardiogram is an image of electrical conduction in the heart. By examining normal changes on the electrocardiogram, clinicians can identify various cardiac processes. But what is a normal ECG reading? In this article, we’ll be discussing the things you need to know about reading an ECG and identifying a normal ECG.
Why is an ECG reading important?
An electrocardiogram(ECG or EKG) is often used along with other tests to help diagnose and observe conditions affecting the heart. It can be used to detect signs and symptoms of possible heart problems, such as chest pain, fast heartbeat, dizziness, and shortness of breath.
An ECG can help detect your heart rate or heart rhythm problems. It can help doctors tell if you have a serious heart condition, or if you’ve experienced having a condition in the past. An ECG is usually one of the first heart tests you will have. An ECG is a safe procedure. Since the electrodes used do not generate electricity, there is no risk of the shock of any kind during the test. Electrodes track the electrical activity and movement of the heart. The ECG test does have some limitations, so you will usually have one or more other tests as well.
How to identify a normal ECG?
- Wave
Positive or negative deflection relative to the baseline, indicating a specific electrical event. The waves on an ECG include P waves, Q waves, R waves, S waves, T waves, and U waves. T waves are usually rounded and asymmetrical, rising more slowly than falling, and Isolated T-wave inversion in asymptomatic adults is usually a normal variant.
- Interval
The time between two specific ECG events. Intervals commonly measured on an ECG include the PR interval, the QRS interval (also called the QRS duration), the QT interval, and the RR interval. Intervals are usually between 0.12 and 0.20 seconds. The duration of a QT interval is usually less than or equal to 0.40 seconds for men and less than or equal to 0.44 seconds for women.
- Segment
The length between two specific points on the ECG should be the baseline amplitude (not negative nor positive). The segments on the ECG include PR, ST, and TP segments. Segments in any lead typically do not depress more than 0.5mm.
- Complex
A combination of multiple waves grouped together. The only major complex on an ECG is the QRS complex. Duration less than or equal to 0.12 seconds.
- Spot
There is only one spot on the ECG called the J spot, which is where the QRS complex ends and the ST segment begins.
The main parts of the ECG include the following: P wave, QRS complex, and T wave. P waves indicate atrial depolarization. The QRS complex consists of Q, R, and S waves and represents ventricular depolarization. And the T wave appears after the QRS complex, indicating ventricular repolarisation.
Here are the factors that lead to a normal ECG reading:
P wave- P wave amplitudes rarely exceed two and a half squares (0.25 mV). The duration of the P wave should not exceed three small squares (0.12 seconds).
QRS complex- The normal duration (interval) of a QRS complex is between 0.08 and 0.10 seconds, or between 80 and 100 milliseconds. When the duration is between 0.10 and 0.12 seconds, it is intermediate or slightly extended. QRS duration greater than 0.12 seconds are considered abnormal.
T wave- The normal T wave is upright in leads I, II, and V3-V6 and inverted in the AVR. Less than 5 mm in limb leads and less than 10 mm in precordial leads, III, AVL, AVF, and V1-V2 behave differently.
ST-segment- The normal ST segment is usually isoelectric (ie, flat at baseline, neither positive nor negative), but it may be slightly elevated or lowered (usually less than 1 mm) under normal conditions. Some pathological conditions, such as myocardial infarction (MI), produce characteristic abnormal deviations in the ST segment.
QT interval- In general, a normal QT interval is below 400 to 440 milliseconds (ms), or 0.4 to 0.44 seconds. Women have a longer QT interval than men. A lower heart rate also results in a longer QT interval.
PR interval- The normal PR interval is 0.12 to 0.20 seconds or 120 to 200 milliseconds. Various abnormalities of the PR interval – including PR interval prolongation, PR interval shortening, and interbeat changes can occur.
ECG reading process
- There is no need for special preparation for an ECG test, regular intake of food and drinks is allowed.
- You will usually need to remove your shirt or any clothing covering your arms and chest, and they might need to get your chest cleaned and shaved before they attach the electrodes to get more accurate results.
- Once all of the skin sensors are in place, you will be offered a hospital gown to cover the rest of your body.
- Skin patches called electrodes will be placed on your arms, chest, and legs. These electrodes are connected by wires to an electrocardiogram device, which receives the electrical signals that make our heart beat. It does have some limitations, so you’ll usually have one or more other tests as well.
- An abnormal ECG reading doesn’t always mean something is wrong with your heart.
- This test, which usually lasts only a few minutes, is also a harmless, non-invasive test that requires you to remain still in order for the machine to get accurate and stable results.