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«Step 1: Rhythm Step 3:Conduction intervals (PQ, QRS, QT, QTc)»

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.

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).

There are three simple methods to determine the heart rate (HR)
  1. 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.
  2. Count the small (1mm) squares between two QRS complexes. Hense, the ECG paper runs with 25 mm/sec through the ECG writer, therefore:
    HFformule en.png
    This method works well in case of tachycardia (>100 beats/minute)
  3. 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.