ECG : Step-by-Step Guide to Assessing Cardiac Rhythm

Electrical Conduction System: The heart’s electrical conduction system controls the heart rate and rhythm. It includes the sinoatrial (SA) node, atrioventricular (AV) node, bundle of His, right and left bundle branches, and Purkinje fibers.

Normal Sequence: The electrical impulse originates in the SA node, causing atrial contraction. It then travels to the AV node, pauses to allow ventricular filling, and proceeds down the bundle of His, the bundle branches, and the Purkinje fibers, resulting in ventricular contraction.

Step 1: Get an Overview of the Electrical Activity of the ECG

Objective Ensure the presence of electrical activity to confirm the ECG is capturing cardiac signals.

1. Check for the Presence of Waveforms:

   • Verify the existence of P waves, QRS complexes, and T waves across multiple leads.
   • Ensure that these waveforms are visible and consistent.

1. Identify the Baseline:

   • Determine the isoelectric line (baseline) where there is no electrical activity.
   • Use this as a reference point for identifying deviations in the ECG waveforms.
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2. Assess the Rhythm Strip:

   • Examine a rhythm strip (usually lead II or V1) to quickly gauge the overall rhythm.
   • Ensure that waveforms are consistently recorded without large gaps, which might indicate pauses in electrical activity or...