QRS Morphology

«Step 5: P wave morphology

Step 7: ST morphology»

Author(s)	J.S.S.G. de Jong, MD
Moderator	J.S.S.G. de Jong, MD
Supervisor
some notes about authorship

Normal sinus rhythm with normal QRS morphology.

The basic questions in judging QRS morphology are:

• Are there any pathological Q waves as a sign of previous myocardial infarction?
• Are there signs of left or right ventricular hypertrophy?
• Does the QRS complex show microvoltage (roughly QRS < 5mm)?
• Is the conduction normal or prolonged (QRS-interval > 0,12s)?
• Is the R wave propagation normal? Normally R waves become larger from V1-V5. At V5 it should be maximal. If the R wave in V2 is larger than in V3, this could be a sign of a (previous) posterior myocardial infarction. Other causes are noted in the chapter Clockwise and Counterclockwise rotation.

If all these items are normal you can go on to the next step: ST morphology.