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Standard ECG assessment

The following ECG tracing was recorded in a 14 y/o male. Well do a step by step assessment.



1) Rhythm

Upright P-waves in inferior leads prior to every QRS complex --> Sinus Rhythm


2) Heart Rate

Counting the boxes between the R-waves of the first and second beat --> 11 boxes

50mm/s strip --> 1 box =100ms, 11 boxes = 1100ms, 60.000/1100 = 55 bpm


3) QRS axis

Inferior leads (II/III/aVF) entirely positive (pure R, no S), lead I more positive than negative (R/S = 2) --> axis +80°


4) Intervals

PR 110ms (short), QT 410ms = QTc 390ms (Bazett formula; normal)


5) QRS duration & morphology

QRS 80ms (normal), no bundle branch block morphology


6) Chest leads

R-wave transition (R-wave gets larger than S-wave) in V4 (normal transition).

Negative T wave in V1, biphasic in V2 (normal for age).

J-point elevation V2-V4 (max. 1.5mV), suggestive of benign early repolarisation (BER) in adolescent patients.


7) PR-segment & ST-segment

No delta-wave, isoelectric PR-segment.

BER, no ischemic ST changes.


8) Arrhythmias / premature beats

No premature ventricular or atrial contractions. No arrhythmia present.


9) Interpretation

Relative sinus bradycardia, BER, short PR suggestive of fast AV nodal conduction. Overall normal ECG in an adolescent.

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