Rate

«Step 1: Rhythm

Step 3:Conduction intervals (PQ, QRS, QT, QTc)»

What is the heart rate? To answer this question, determine the time between two QRS complexes. Previously, the ECG was registered on a paperstrip transported through an ECG writer at the speed of 25 mm/second. Nowadays, digital ECG registration is common however, the method of determining the frequency remains the same. The ECG paper has a grid with thick lines 5 mm apart (= 0,20 second) and thin lines 1 mm (0,04 second).

The width of a square on the ECG represents time

The count method to determine the heart frequency. The second QRS complex is between 75 and 60 beat per minute. This heartbeat is between that, around 65 beats per minute.

There are three simple methods to determine the heart rate (HR)

The square counting method
The square counting method is ideal for regular heart rates. Use the sequence 300-150-100-75-60-50-43-37. Count from the first QRS complex, the first thick line is 300, the next thick line 150 etc. Stop the sequence at the next QRS complex. When the second QRS complex is in between two lines, take the mean of the two numbers from the sequence or use the fine-tune method listed below.

Use a calculator
Count the small (1mm) squares between two QRS complexes. Hense, the ECG paper runs with 25 mm/sec through the ECG writer, therefore: This method works well in case of tachycardia (>100 beats/minute)

The marker method
Non regular rhythms are best determined with the "3 second marker method" Count the number of QRS complexes that fit in 3 seconds (some ECG writers register this period on the ECG paper). Multiply this number by 20 and find the number of beats/minute.

The 'square counting' method can be fine-tuned with the following sequence

300

250

214

187

167

150

136

125

115

107

100

94

88

83

79

75

71

68

65

62

60

What changes the frequency of the heart?

A number of factors change the heart frequency including:

• the (para) sympathic nerve system.
  • The sympathic system e.g. epinephrin (=adrenalin) increases the atrioventricular conduction and contractility. (the fight, fright, flight reaction)
  • The parasympathic system (nervus vagus) e.g. acetycholin decreases the frequency and atrioventricular conduction. The parasympathic system effects mainly the atria.
• Cardiac filling increases the frequency.
• Also arrhythmias influence heart rate.