Table Info

Table 3.

Criteria used for electrocardiograms, which was applicable to 12 lead electrocardiograms with standard gain (10 mm/mV)

Electrocardiogram measures		Criteria
Sinus rhythm		Determined by P waves preceding each QRS complex and P waves upright in leads I, II, and aVF
Rate		Determined by measuring the RR interval Heart rate is calculated by dividing 60,000 by measured cycle length in ms
P-axis		Mean frontal P wave axis is 60 degrees
QRS axis	Normal axis	Lead I positive and Lead aVF positive
	Right axis deviation	Lead I negative and lead aVF positive
	Left axis deviation	Lead I positive and lead aVF negative
	Northwest axis	Lead I negative and lead aVF negative
PR interval		Measured in lead II Measured from the onset of P wave to the Q wave or R wave if no Q wave is present Normal values: 80–110 ms in neonates and infants and 120–200 ms in adolescents
QTc interval		Measured in lead II and calculated by Bazett’s formula QTc = QT interval divided by the square root of the preceding RR interval QTc is prolonged if > 460 ms in females and > 450 ms in males QTc is decreased if < 380 ms
QRS duration		Measured from the beginning of Q wave to the end of S wave Normal values: upper limit is 120 ms
Right atrial enlargement	Frontal plane	Axis: P wave axis shifter to right of + 60 degree; P waves tall and peaked measuring > 2.5 mm in leads II, III, or aVF; and P3 > P1 Contour: P wave peaked and pointed Amplitude: height of P wave > 2.5 mm in leads II, III, and aVF Duration: not prolonged
Right atrial enlargement	Horizontal plane	Lead V1: P wave inverted Initial upright portion may be peaked or pointed and slightly taller than normal
Left atrial enlargement	Frontal plane	Axis: P waves tall in leads I; and P1 > P3 Contour: P wave bifid or M shaped seen in leads I, II, aVF, V5, and V6 Amplitude: height not increased Duration: width of P wave is increased > 2.5 mm
Left atrial enlargement	Horizontal plane	Lead V1: P wave inverted Inverted portion measures ≥ 1 mm in depth and ≥ 1 mm in duration
P terminal force		Derived from multiplying the depth of terminal P wave deflection in mm by duration in s and expressed in mm/s If the P terminal forces exceed 0.03 mm/s it constitutes left atrial enlargement
BBB	Left BBB	Wide QRS duration > 140 ms Lateral lead shows a tall notched R wave and V1 shows wide notched QS or Rs complex
BBB	Right BBB	Wide QRS duration > 140 ms V1 shows tall wide notched R (Rsr’ pattern) and lateral leads (lead I, V5, and V6) show notched wide S wave
Right ventricular hypertrophy (pressure overload)	QRS complexes	RAD ≥ 90 degree qR in V1 R wave in V1 ≥ 7 mm R wave taller than S wave in V1 (R/S ratio ≥ 1) Delayed onset of intrinsicoid deflection in V1 > 0.03 rS complex in V1 to V6 with RAD S1, S2, and S3 pattern in adults
	P wave	Right atrial abnormality
	ST segment and T wave	ST segment depression in V1 and V2 T wave inversion in V1 and V2
Right ventricular hypertrophy (volume overload)		Characterized by prolonged PR interval and right bundle branch block
Left ventricular hypertrophy (pressure overload)	QRS complexes	R wave in any limb leads measuring ≥ 20 mm S wave in any limb leads measuring ≥ 20 mm R wave in aVL > 11 mm R wave in lead I + S in III > 25 mm S wave in V1 or V2 ≥ 30 mm R wave in V5 or V6 ≥ 30 mm R wave in V5 or V6 > 26 mm S wave in V1, V2, and V3 ≥ 25 mm R wave in V4, V5, and V6 ≥ 25 mm SV1 + RV5 or V6 > 35 mm Tallest S + tallest R in V1 to V6 > 45 mm R wave in V6 > R wave in V5 R wave in aVL + S wave in V3 > 20 mm in females and > 28 mm in males QRS voltage from all leads > 175 mm Duration of QRS ≥ 0.09 s Delayed onset of intrinsicoid deflection ≥ 0.05 s in V5 or V6
	P wave	Left atrial abnormality
	ST segment and T wave	ST segment depression T wave inversion
Sokolow Lyon index		R in V5 or V6 + S in V1 ≥ 35 mm R in aVL > 11 mm
Romhilt Estes score		3 points each P wave from LA abnormality Any increase in voltage of the QRS complex R or S in limb lead ≥ 20 mm S in V1 or V2 ≥ 30 mm R in V5 or V6 ≥ 30 mm ST-T abnormalities-any shift in ST segment 2 points each LAD ≥ 30 degrees 1 point each Slight widening of the QRS complex of 0.09 s Intrinsicoid deflection in V5 or V6 of ≥ 0.05 s ST-T wave abnormalities Score of ≥ 5 is suggestive of LVH and score of 4 points is suggestive of probable LVH
Cornell voltage criteria		R in aVL + S in V3 ≥ 28 mm in males and ≥ 20 mm in females
Left ventricular hypertrophy (volume overload)		Characterized by prominent Q waves in leads with tall R waves in V5 or V6 accompanied by tall rather than inverted T waves
Biventricular hypertrophy		Characterized by tall biphasic complexes in mid-precordial leads R + S wave in V4 > 60 mm (Katz Wachtel criteria)
ST segment	Elevated	ST segment > 1.0 mm
ST segment	Depressed	ST segment < 0.5 mm

aVF: augmented vector foot; aVL: augmented vector left; BBB: bundle branch block; LAD: left axis deviation; LVH: left ventricular hypertrophy; QTc interval: corrected QT interval; RAD: right axis deviation

Supplementary materials

The supplementary material for this article is available at: https://www.explorationpub.com/uploads/Article/file/1001210_sup_1.pdf

Declarations

Acknowledgments

The authors acknowledge the in-kind support provided by the Philanthropy Nepal (Paropakari Nepal) Research Collaboration.

Author contributions

Romila C: Conceptualization, Data curation, Formal analysis, Writing—original draft. GK: Conceptualization, Data curation. KR: Conceptualization, Formal analysis, Writing—original draft. Ritesh C: Formal analysis, Writing—original draft. RA and KSD: Conceptualization. NA: Conceptualization, Data curation. All authors critically reviewed the original draft. All authors have read and agreed to the published version of the manuscript.

Conflicts of interest

The authors declare no conflicts of interest.

Ethical approval

The study was conducted in accordance with the Declaration of Helsinki, and approved by the Institutional Ethics Committee, Devki Devi Foundation (Reference No: RS/MSSH/DDF/SKT-2/IEC/PED-CARDIO/20-44).

Consent to participate

Patient consent was waived as the data were collected retrospectively from the hospital records.

Consent to publication

Not applicable.

Availability of data and materials

The data used to support the findings of this study are available from the corresponding author upon request.

Funding

Not applicable.

Copyright

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