A couple days back I discussed the beginning phases of reading the EKG.

If you missed that, you can

check that out here.

Like we said before, Dr. Finney recommends you look at both the rate and rhythm simultaneously.

So, let's talk a bit about the various components of the EKG and rhythm.

A normal PR interval is about .12 to .2 seconds. That's really equivalent to three to five small boxes.

It should be one of those things you can quickly look at and tell whether or not you're within three to
five small boxes.

If it's not normal, it signals to you that there's some degree of AV conduction difficulty. Difficulty getting
the electricity from the atria to the ventricle.

The QRS reflects the rate of speed down both bundle branches. It’s important in bundle branch blocks.
The normal width in a normal adult is .06 to .09 seconds. That’s about 1.5 to two small boxes.

If it starts getting wider than that, it means that it’s taking more time to go down both bundle branches.
In other words, the QRS will widen out because it's taking more time on the horizontal axis. If it's .1 to
.11 seconds, so still below three boxes wide, three tiny boxes wide, that's an incomplete bundle branch
block.

If it's three or more or .12 seconds wide, that's a complete bundle branch block.

QT is a little bit different. What you have to keep in mind is QT is recovery. It's diastole. Essentially, it
reflects the fact that when you depolarize, you must repolarize in order to have the next QRS.

It's variable with heart rate just like diastole is very variable with heart rate.
The slower the heart rate, the longer the QT normally. The faster the heart rate, the shorter the QT
normally.

You should probably keep in the back of your mind that a normal QT interval and a normal heart rate in
an adult is going to run 60 to 100. At the low end of heart rate, at the heart rate of 60, the QT interval
will be about .36 to .44 wide.

In other words, averaging .4. It just so happens, .4 is two large boxes wide. Over .44 is considered to be a
prolonged QT.

But, before even looking at the above, first look to see if it’s regular or irregular. That can be done
quickly.

Next, you need to know if the normal conduction system is being used.

Dr. Finney teaches to look for the 6 p wave questions:

“Are there P waves?” Sinus rhythm must have P waves.

“Is there one P wave for every QRS?”

“Does the P come before each QRS?”

“Do all the P waves look alike?”

“Does the P to P interval match the QRS to QRS interval?”

P waves from the normal sinus node are usually upright in Leads 1, 2, 3, avF.. If they're not, then it's
from somewhere else in the atria and not the sinus node.

If all the answers are "yes", then this is sinus rhythm.

If not, then you have a problem and it's probably not sinus rhythm.