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How To Count Heart Rate On Ecg

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Ecg Heart Rate Calculator

EKG Rhythm | How to Count the Heart Rate on EKG strip 6 (six) Second Rule

With this calculator, you will be able to acquire your patient’s heart rate from an ECG. You will only need to measure the distance between two R wave peaks the RR interval. You can use either a ruler or a caliper and type in the result in millimeters or quantity of ECG boxes, you choose! But remember! If RR intervals between at least two ECG complexes are different, your patient might have an arrhythmia, and our calculator may give you a false result. Don’t forget to check it! In the following text you will learn:

  • how to calculate heart rate with our calculator or by yourself using some easy-to-remember methods

  • a method to estimate heart rate in a patient with an arrhythmia using the 6 second ECG method

  • a way to use our calculator differently in order to get your patient’s expected RR interval based on his or her heartbeat.

Please note that using this calculator is by no means equivalent to a consultation with a specialist. If the result you obtained is troubling you, make sure to visit your physician! If you are interested in cardiology, don’t forget to check out our cardiac output and stroke volume calculators!

Ecg Heart Rate Calculation

There are just a few steps ahead of you to get your patients heart rate using our calculator:

  • Get a ruler or a caliper:
    • With the ruler: measure the distance between two R wave peaks. R wave, part of QRS complex , is defined as the first upward deflection after the P wave . While measuring, try to put your ruler parallelly to the horizontal lines on the ECG paper.

    • With the caliper: place each of measuring tips of your caliper on peaks of subsequent R waves. Then, without changing the angle between the arms of the caliper, put one of the tips on an intersection of ECG paper lines and the other tip on the same horizontal line. Count the number of ECG boxes between the tips of your caliper. A small box represents 1 millimeter while the big box measures 5 millimeters.

  • Check the lengths of some other RR intervals. If there are differences, your patient might have an arrhythmia! This calculator is not suitable for calculating the heart rate of patients with irregular heart rhythm. For more information, check out the 6 second ECG paragraph!

  • Put the result of your measurement to the corresponding field: RR interval for length in millimeters, number of boxes for length in boxes.

  • If you chose to measure RR interval in boxes, select the type of boxes.

  • Choose the ECG paper speed. The standard is 25 mm/s, but sometimes a 50 mm/s option is preferred.

  • Read the ECG heart rate in beats per minute!

  • Calculating Heart Rate From An Ekg

    Remove a strip from the EKG. Youll note that the rhythm is printed on graph paper which generally measures time using a scale of 25 millimeters representing 1 second. There will also be marks at the bottom or top of the telemetry strip which will indicate intervals of either 1 second or 3 seconds.

    Use the Six Second Count method. According to, this is the most common method to determine heart rate. Multiply the number of QRS complexes found over six seconds by 10. This will give you the number of QRS complexes in 60 seconds, or 1 minute. This is the patients heart rate. For example, if there are 8 QRS complexes in a 6-second period, multiply it by 10 and you have a heart rate of 80.

    Use the Triplicate Method. This method can be used only with a regular rhythm. Consider that each large square on the telemetry strip is equal to 5 millimeters, or one-fifth of 1 second. Start by locating an R wave falling on a thick vertical line. Now find the next R wave and the R waves following that. Start with a heart rate of 300 and divide it by the number of large telemetry squares between the R waves. If each one occurs with only one large square between them, then the heart rate is 300. If there are 4 large squares, the heart rate is 75.



    • If the patient has an irregular rhythm, the most accurate method of measuring heart rate is the 6 Second Method.


    • American Heritage Dictionary: Telemetry

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    Of Calculating Heart Rate

    The 1500 method is very similar to the 300 method for calculating heart rate on ECG. However, this is exceptionally useful when none of the R waves coincide with a vertical line on the ECG. This is the most accurate method to calculate heart rate.

    Unlike the previous method, this one counts the number of small squares that are in the RR interval. Then this amount is divided by the number 1500 to get the heart rate. It is important to mention that this method, like the previous one, only works if the rhythm is regular.

    In figure 3 you can see an ECG in which none of the R waves coincide with a vertical line.

    If you look closely, you can count 2 small squares after the first R wave. Next there are a total of 2 large squares, remember that each large frame has a total of 5 small squares.

    Before the next R wave there are 3 more small squares giving a total of 15 small squares between both R waves.

    To calculate the heart rate then 1500 is divided between the 15 small squares. In this example the heart rate is 100 beats per minute.

    The 300 And 1500 Rule

    How to Calculate Heart Rate from ECG: 8 Steps (with Pictures)

    What if there is no Internet and you are not able to use our fantastic ECG heart rate calculator? How to calculate heart rate facing such conditions? Don’t worry. We have a solution! You can use the 300 or 1500 rule:

  • With your caliper, count the number of big or small boxes between two R wave peaks.

  • Divide 300 by the number of big boxes or 1500 by the number of small boxes.

  • You have your patient’s heart rate!

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    Regular Or Irregular Heart Rhythm

    Determining if the Heart Rhythm is regular or irregular is the first step in analyzing the Heart Rhythm on the ECG.

    To define it, the RR interval is used. Remember that the RR interval is the distance between two consecutive R waves. The most commonly used Lead to analyze the Rhythm is the DII.

    A Regular Rhythm is one in which the distance is similar between each RR interval or QRS complex. Whereas when this interval is not similar between each R wave, the Rhythm is considered to be Irregular.

    In Figure 1 an Electrocardiogram can be seen in which the QRS complexes, more specifically the R waves of these, are separated by 13 small squares . If you look closely, this separation is similar between the different RR intervals. So it is confirmed that this ECG has a Regular Rhythm.

    It is important to remember that each small square on the ECG has a value of 0.04 seconds. So in the previous example, each QRS complex is separated by 0.52 seconds or 520 milliseconds . This value is constant between each R wave, so the Rhythm is Regular.

    In Figure 2 we can see an Electrocardiogram with an irregular rhythm. In the first QRS complexes we can observe a distance of 5 large squares or 1 second. While in the last RR interval it can be seen that the distance is only 4 large squares and 1 small square, that is, 840 milliseconds. This difference between the different RR intervals results in an Irregular Heart Rhythm.

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    How To Read An Ecg

    If youd like to support us and get something great in return, check out ourOSCE Checklist Booklet containing over 120 OSCE checklists in PDF format. Weve also just launched an OSCE Flashcard Collection which contains over 1500 cards.

    This guide demonstrates how to read an ECG using a systematic approach. If you want to put your ECG interpretation knowledge to the test, check out our ECG quiz on the Geeky Medics quiz platform.

    ECG flashcard deck

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    What Will Be The Pulse Rate In A Patient Who Has Ventricular Bigeminy In Ecg

    May 18, 2010 by dr s venkatesan

    What will be the pulse rate in a patient who has ventricular bigeminy in ECG with a heart rate of 90 ?

    A.Exactly Same as HR , ie 90/mt

    B.Exactly half of HR , ie 45/mt

    C.Can be anything between 45 to 90/mt

    D.Any of the above can be true

    The answer is D .

    I have noted ,this simple question in cardiology resident examinations cause great anxiety among students .

    Why is it difficult to arrive at an easy answer to this question ?

    Traditionally , ventricular ectopic beat were also called extrasystole , implying every ectopic beat shall produce a peripheral pulse .Since , we learnt this is not true , we started refering them as VPDs. So , in a patient whose alternate beat is a VPD , things become little complicated.

    What determines a VPD to acquire mechanical energy or simply remain as an electrical event ?

    • Timing of the VPD* .
    • LV residual volume at the onset of VPD
    • Force of contractility of LV
    • Temporal relation to aortic valve opening**

    If the VPD is too early or too late it can not have a mechanical activity . It should be optimally timed midway between two sinus beat to have a good mechnically active VPD. Some refer this as an interpolated VPD .Here, the VPD becomes a true extra systole for that individual. So , in patient with ventricualr bigeminy in ECG the pulse rate is usually half , can be same as HR when the coupling interval is optimal or it can be totally irregular as someof the VPDS gain a mechanical activity and some do not

    Using The Distance Between Qrs Complexes

    Calculating Heart Rate [HR] from an Electrokardiogram [EKG]
  • 1Be aware of how a normal “wave form” looks on an ECG trace.XTrustworthy SourcePubMed CentralJournal archive from the U.S. National Institutes of HealthGo to source This will allow you to determine what area of the ECG represents one heart beat. From the length of a heart beat on the ECG trace, you will be able to calculate the heart rate. A normal heart beat contains a P wave, a QRS complex, and an ST segment. The one you will want to pay particular attention to is the QRS complex, as this is the easiest one to use to calculate heart rate.
  • The P wave is a small semi-circular shape located right before the tall QRS complex. It represents the electrical activity of the atria , which are the two small chambers located at the top of the heart.
  • The QRS complex is the tallest most visible aspect of the ECG trace. It is usually pointy, like a tall, thin triangle and very easy to recognize. It represents the electrical activity of the ventricles , which are the two large chambers located at the bottom of the heart that forcefully pump blood throughout the body.
  • The ST segment directly follows the tall QRS complex. It is actually the flat area prior to the next semi-circular shape on the ECG . The importance of this flat segment , located right after the QRS complex, is that it provides important information to physicians about things such as potential heart attacks.
  • Speak to a physician if the person you are calculating heart rate for appears to have an abnormal value.
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    Video On How To Count Heart Rate With 6 Second Rule

    Here is a diagram to illustrate what Im talking about:

    Important things to note about the squares:

    • Each large block contains 25 squares
    • Each small square represents 0.04 seconds of time
    • 5 small squares equal 0.20 seconds of time
    • When you are trying to calculate the heart rate with the six second rule, you must count out enough LARGE squares to equal 6 seconds. Therefore, 30 large squares would equal 6 seconds.

    How To Calculate And Analyze Heart Rate Variability

    How HRV is calculated though is where things can get tricky. Methods work in different ways, and the results from each might not be directly comparable getting it right is therefore critical for your work or research.

    Before we get there though, there are some things to know about the way the monitored ECG signal appears. The image below shows a prototypical heartbeat.

    This is known as the QRS complex, with each letter corresponding to a different part of the hearts action. The important thing to note is that the R of the complex is the area from which the values for analysis are taken. When we have several heartbeats next to each other, then the distance between each R is defined as the RR interval .

    One of the main divisions for the way in which HRV is calculated is by either using time or frequency. In this context, time-domain methods mean that the beat-to-beat amount within an amount of time is used, while frequency-domain methods count the amount of low and high frequency beats that occur. This is explained further in the image below.

    The extent to which the heart rate changes within a set amount of time, or the extent to which it is spread over different frequencies, will determine the amount of HRV.

    There are also other ways in which to analyse the heart rate data, including geometric and non-linear methods. These methods offer new ways of examining the data, yet are not currently as widely employed.

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    Normal Heart Rate Values

    The normal range of the heart rate is between 60 to 100 beats per minute.

    Any value above 100 beats per minute is considered Tachycardia. And any value that is below 60 beats per minute is Bradycardia.

    It is important to mention that Bradycardia and Tachycardia may not be a sign of a disease. Certain drugs like beta blockers can lower your heart rate. In addition, certain substances such as caffeine can cause tachycardia.

    References consulted

    • Dubin, D. . La Frecuencia. En D. Dubin, Interpretacion de ECG . COVER Publishing Company.
    • Uribe, W., Duque, M., Medina, L. E., Marín, J., Velásquez, J. E., & Aristizábal, J. . ELECTROCARDIOGRAFÍA BÁSICA. Sociedad Interamericana de Cardiología, 44-54.
    • YouBiot. . Qué es un electrocardiograma. Obtenido de

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    How To Count Atrial And Ventricular Rate Using The 6 Second Rule

    1.3 Calculating Heart Rate

    Atrial Rate

  • Beginning at the first p-wave start counting 30 large squares.
  • Then count how many p-waves are between the 30 large squares.
  • Take that number and multiple it by 10 and this is your heart rate.
  • Ventricular Rate

  • Beginning at the first r-wave start counting 30 large squares.
  • Then count how many r-waves are between the 30 large squares.
  • Take that number and multiple it by 10 and this is your heart rate.
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    How To Determine Heart Rate


    The calculation of the heart rate of an electrocardiogram is of great diagnostic importance, because determining a tachycardia or bradycardia may make us suspect certain pathologies and their severity.

    The easiest way to calculate the heart rate is⦠to look for the value given by automated analysis of most electrocardiograms.

    Are we kidding? No, many times this heart rate value is an actual one and speeds up the diagnostic process.

    Anyway, every professional must know the different methods to calculate the heart rate, because not always the automatic analysis is real or there are electrocardiogram equipment that do not provide the value of the heart rate.

    Heart Rate In Irregular Rhythms

    The above options are only valid if the rhythm is regular. Soâ¦

    How do we calculate HR is the rhythm is not regular, such as in atrial fibrillation? It may be even easier, like finger counting

    Heart rate: 20 QRS complexes x 6 = 120 bpm

    Usually electrocardiograms record 10 seconds, so all you have to do is count all QRS and multiply by 6.

    If the EKG is not a 10 seconds one, or you are not aware of its duration, count 30 large squares , and multiply the number of QRS complexes on them by 10. The result is an approximate heart rate.

    For example: Count the number of QRS complexes in 30 large squares and multiply by 10. If there are 11 QRS complexes, the heart rate is 110 bpm .

    We hope we have been able to help you. For further details on heart rhythm analysis, click Next.

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    How To Calculate The Heart Rate On Ecg With Regular Rhythm

    Before calculating the heart rate from an electrocardiogram, it is necessary to know whether the heart rhythm is regular or irregular. The RR interval is used for this. If the rhythm is regular, the distance between each R wave should be similar.

    Normally the heart rhythm can be determined just by looking at the ECG. However, if you still have doubts, in this other article we explain in detail how to determine the heart rhythm.

    How To Measure Heart Rate From Ecg:

    ECG basics: Methods of heart rate calculation

    Before going to calculate heart rate from an ecg strip. Lets me give a short introduction to ECG and its leads.


    Graphic recording of electrical potential generated due to transmission of depolarization wave through the heart, and due to its spread into surrounding tissue and body surface. Is called electrocardiogram .

    Father of ECG

    Site of pace-maker is recorded

    Heart. Rate can be calculated

    Rhythm of heart can be recognised

    The voltage produced due to potential changes in the heart can be calculated.

    Helps to diagnose heart diseases.

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