For my project, I spent an entire day with a paramedic who also specializes in specifically reading EKG monitors, and learned just the basics in how to read a heart monitor and diagnosis.
A heart monitor, also known as an EKG, ECG or electrocardiogram, displays the electrical activity of the heart. Doctors, nurses and other professionals are required to spend about a weeks worth of training in EKG interpretation prior to using a monitor to check vitals, administer, adjust or prescribe treatments.
Step 1 Determine which lead to read. The wave forms are different in each lead so it is important to choose the correct one. In a standard 12-lead EKG, leads II, III and aVF look at the back and lower aspects of the heart. Leads V1, V2, V3 and V4 look at the front of the heart. Leads V5, V6 and aVL look at the sides of the heart. When diagnosing a patient in conductivity, you read lead II.
Step 2
After printing the strip of a patients EKG, look specifically at the grid. Horizontal lines indicate time with each little box being 0.04 seconds and each larger box being 0.2 seconds in length. Five larger boxes equal one full second. The vertical lines indicate the voltage with each box equaling 0.1 mV.
Step 3
Find and label the P-wave, which is often most noticeable on lead I. Most P-waves are small bumps that come just before the main complex. However, the P-wave can dip down instead of up, occur multiple times in a row, and can be difficult to detect depending on the heart rhythm. Everyone's EKG looks different so it's important to know exactly what to look for in diagnosing.
Step 4
Find and label the QRS complex or main wave form. Q-waves are rare but if present, dip below the baseline at the beginning of the QRS complex. The R-wave is next and is typically a tall, spiky wave. This is followed by the S-wave which goes below the baseline, sometimes in a long, sharp spike.
Step 5
Locate the T-wave and label it. The T-wave is generally a small bump that follows the QRS complex. The T-wave can be difficult to find in some patients due to flattening, inversion or confusion with P-waves from the following complex.
Reading Results
Step 1
Locate the P-wave. This is where the sinoatrial node fires causing electricity to move through the atria. Each P-wave should be followed by a QRS complex. The normal interval between the P-wave and R-wave is 0.12 to 2.0 seconds. Anything longer may indicate conduction abnormalities. More than one P-wave or P-waves that seem to flutter can indicate atrial fibrillation or flutter--conditions in which the atria do not effectively contract.
Step 2
Look for any Q-wave formations. If present it may indicate a previous heart attack or damage. The ventricles discharge and contract at the QRS complex. Count the number of big boxes between two R-waves to determine heart rate. Divide 300 by that number. Determine a heart rate with irregular heartbeats by counting the R-waves on a 6-second strip and multiplying it by 10. Rates greater than 100bpm are considered tachycardia and slower than 60bpm are considered bradycardia. QRS complexes that occur close together without P-wave formation are an indication of ventricular fibrillation which can be life threatening.
Step 3
The space between the S-wave and the T-wave is known as the ST segment. Elevations in the ST segment can indicate an acute myocardial infarction, or heart attack.
My Diagnosis
I was given a few strips from patients specifically showing leads I, II, and III. This is an example of one of the strips of lead II I was given. Before printing this strip, its obvious there is a wide gap between the ending T wave to the starting P wave of the next complex. To diagnose this patient, you print the strip and count the boxes, as explained before. This is a strip of lead II with a heart rate of about 50. In adults, bradycardia (slow heart rate) is defined as a rate of under 60 beats per minute. This patient has bradycardia.