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|nextname=Step 3:Conduction intervals (PQ, QRS, QT, QTc)
|nextname=Step 3:Conduction intervals (PQ, QRS, QT, QTc)
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[[Image:ECGpapier.png|thumb|300px| The width of a square on the ECG represents time]]
==What is the heart rate?==
[[Image:Ecgfreq.png|thumb|300px| 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.]]
[[Image:ECGpapier.png|thumb| The width of a square on the ECG represents time]]
'''What is the heart rate?'''
[[Image:Ecgfreq.png|thumb| The countmethod to determine the heartfrequency. The second QRS-complex is between ''75'' and ''60'' beat per minute. This heartbeat is between that, around 65 beats per minute.]]
To answer this question, determine the time between two QRS complexes. Previously, the ECG was printed on a paper strip transported through an ECG writer at the speed of 25 mm/second. Now, digital ECGs are common; however, the method for determining the frequency remains the same. The ECG has a grid with thick lines 5 mm apart (= 0,20 second) and thin lines 1 mm (0,04 second).


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


{| class="wikitable"
!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 between two lines, take the mean of the two numbers from the sequence or use the fine-tuning method listed below.
|}
{| class="wikitable"
!Use a calculator
|-
| Count the small (1mm) squares between two QRS complexes. The ECG paper runs at 25 mm/sec through the ECG printer; therefore:[[Image:HFformule_en.png|none]]This method works well in case of tachycardia (>100 beats/minute)<br>
|}


'''There are three simple methods to determine the hart frquency (HF):'''
{| class="wikitable"
# Count the small (1mm) squares between two QRS-complexes. Hense, the ECG paper runs with 25 mm/sec through the ECG writer, therefore:&nbsp;&nbsp;&nbsp;[[Image:HFformule_en.png]]This method works well in case of tachycardia (>100 beats/minute)<br>
!The marker method
# To determine the frequency of a normal sinus ritme: 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 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 finetune method listed to the right.
|-
# Non regular rhytms 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.  
|
{{clr}}
Non-regular rhythms are best determined with the "3 second marker method". Count the number of QRS complexes that fit into 3 seconds (some ECG writers print this period on the ECG paper). Multiply this number by 20 to find the number of beats/minute.
{| font-size="90%" align="right" border="0"
|}
|- style="text-align:center;background-color:#6EB4EB;"
 
|+'''The 'square counting' method can be finetuned with the following sequence'''
{| class="wikitable" font-size="90%" align="center"  
|+'''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'''
|'''300'''||250||214||187||167||'''150'''||136||125||115||107||'''100'''||94||88||83||79||'''75'''||71||68||65||62||'''60'''
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==What changes the frequency of the heart?==
==What changes the frequency of the heart?==
A number of factors change the heart frequency including:
A number of factors change the heart frequency, including:
* the (para) sympathic nerve system.  
* the (para) sympathic nervous system.  
** The '''sympathic system''' e.g. epinephrin (=adrenalin) increases the atrioventricular conduction and contractility. (the ''fight, fright, flight'' reaction)
** The '''sympathic system''', e.g. epinephrine, (=adrenalin) increases atrioventricular conduction and contractility (the ''fight or flight'' reaction.)
** The parasympathic system (nervus vagus) e.g. acetycholin decreases the frequency and atrioventricular conduction. The parasympathic system effects mainly the atria.
** The parasympathic system (nervus vagus,) e.g. acetycholine, decreases the frequency and atrioventricular conduction. The parasympathic system affects mainly the atria.
* Cardiac filling increases the frequency.
* Cardiac filling increases the frequency.
*  [[arrhythmias]] influence heart rate.
[[Category:ECG Course]]
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