HEART RATE ON ECG

BY
Dr.Kashif
 CALCULATION OF HEART RATE
After checking the label, speed and ECG standard
move to the rate and rhythm lead ( lead II ) which is
given as a long strip at the end.

Determine whether the rhythm is regular or irregular

by noticing the distance between successive QRS
complexes.
If distance is equal between all QRS complexes
rhythm is regular and if distance between QRS
complexes is unequal rhythm is irregular.

There are separate methods for regular rhythm and

irregular rhythm
 RULE OF 1500 FOR REGULAR RHYTHM
Heart Rate = 1500
No: of small boxes between two QRS complexes

Heart Rate = 1500 / 32 = 46 beats per minute

RULE OF 300 FOR REGULAR RYTHM

Heart Rate = 300
No: of large boxes between two QRS complexes

Hear rate = 300 / 6.2 = 48 beats per minute

 The Rule of 300

It may be easiest to memorize the following table:

# of big boxes Heart Rate

Between QRS
complexes
1 300
2 150
3 100
4 75
5 60
6 50
Q. CALCULATE THE HEART RATE USING RULE
OF 300
 HEART RATE IN IRREGULAR RYTHM
First mark the distance between two QRS complexes. This
distance should be equal between all QRS complexes. If it is
unequal it means rhythm is irregular & following methods
are used to calculate heart rate.

A. RULE OF 10 SECOND

H.R = Number of QRS complexes in 10 seconds x 6

B. RULE OF 6 SECONDS

H.R = Number of QRS complexes in 6 second strip x 10

C. RULE OF 3 SECOND

H.R = Number of QRS complexes in 3 second strip x 20

 Q. CALCULATE THE HEART RATE USING 6 SECOND
RULE

1. 6 second strip is selected between two red arrows

2. Number of QRS complexes counted in 6 seconds is 14
3. Heart rate= 13 x 10 = 130 beats per minute
Q. CALCULATE THE HEART RATE USING 3 SECOND
METHOD
 SINUS RHYTHM
Normal rhythm of heart is called as Sinus rhythm

As the impulse normally originates from Sinus node so

it is called Sinus rhythm

Heart rate is between 60 ---- 100 beats per minute

NORMAL ECG AND SINUS RHYTHM
 Arrhythmias

Disorders of rhythm
 SINUS TACHYCARDIA
In this the impulse originates in SA node so it is also
sinus rhythm.
But the firing rate of SA node is increased to more than
100. So the heart rate is more than 100 beats per minute.
There is no other abnormality in ECG except the fast
heart rate.
SINUS TACHYCARDIA
 SINUS BRADYCARDIA
In this rhythm also the impulse originates from SA NODE
SO IT IS Sinus rhythm.
Firing rate of SA node is decreased below 60. So heart rate
is also less than 60 beats per minute.
There is no other abnormality in ECG except heart rate less
than 60 beats per minute
Sinus bradycardia
 SINUS ARRYHTYHMIA
Rhythm strip of ECG shows variation in rhythm with
different phases of respiration
During inspiration the heart rate is increased while during
expiration heart rate is decreased.
Therefore during inspiration rhythm is fast and during
expiration rhythm is slow. This variation in ECG rhythm
with respiration is called as Sinus arrhythmia

Expiration inspiration
Sinus Arrhythmia

Inspiration Expiration
 PREMATURE BEATS OR EXTRASYSTOLES
Any part of heart other than SA node may discharge an
occasional impulse This part is called as ectopic focus and
beat which is produced by it is called as premature beat.
TYPES OF PREMATURE BEATS

TYPE FOCUS P WAVE QRS Compensatory

COMPLEX pause

APC Atria present normal present

JPC AV node absent normal present

VPC ventricle absent Wide & Present /

bizarre absent
APC

JPC

VPC
THANK YOU