QRS complex

The QRS complex is a name for the combination of three of the graphical deflections seen on a typical electrocardiogram (EKG or ECG). It is usually the central and most visually obvious part of the tracing. It corresponds to the depolarization of the right and left ventricles of the human heart. In adults, it normally lasts 0.06–0.10 s; in children and during physical activity, it may be shorter. The Q, R, and S waves occur in rapid succession, do not all appear in all leads, and reflect a single event, and thus are usually considered together. A Q wave is any downward deflection after the P wave. An R wave follows as an upward deflection, and the S wave is any downward deflection after the R wave. The T wave follows the S wave and, in some cases, an additional U wave follows the T wave.

Depolarization of the heart ventricles occurs almost simultaneously, via the Bundle of His and Purkinje fibers. If they are working efficiently, the QRS complex is 80 to 120 ms in duration. This is represented by three small squares or less at the standard paper speed of 25 mm/s.

Any abnormality of conduction takes longer and causes "widened" QRS complexes. In bundle branch block, there can be an abnormal second upward deflection within the QRS complex, in this case such a second upward deflection is referred to as R' (pronounced "R prime"). This would be described as an RSR' pattern.

Ventricles contain more muscle mass than the atria, therefore the QRS complex is considerably larger than the P wave. The QRS complex is often used to determine the axis of the electrocardiogram, although it is also possible to determine a separate P wave axis.

The duration, amplitude, and morphology of the QRS complex are useful in diagnosing cardiac arrhythmias, conduction abnormalities, ventricular hypertrophy, myocardial infarction, electrolyte derangements, and other disease states.

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