DASAR-DASAR INTERPRETASI EKG

Radityo Prakoso, Hary S Muliawan

Department of Cardiology and Vascular Medicine Faculty of Medicine University of Indonesia National Cardiovascular Center Harapan Kita

Unipolar Precodial (Chest) Leads

Midclavicular line Anterior axillary line Midaxillary line

V6R V5R V4R V3R

V6

V5 V4 V3 V2

V1

Mervin J. Goldman, MD. 11th edition Principles of clinical Electrocardiography. Clinical Professor of Medicine University of California School of Medicine San Francisco @1995-1982

Unipolar Precodial (Chest) Leads

Horizontal plane of V4-6

V7 V8 V9 V9RV8RV7R

Mervin J. Goldman, MD. 11th edition Principles of clinical Electrocardiography. Clinical Professor of Medicine University of California School of Medicine San Francisco @1995-1982

ECG INTERPRETATION
1. 2. 3. 4. 5. 6. RATE RHYTHM AXIS HIPERTROPHIC SIGNS MYOCARDIAL INFARCTION ARRHYTHMIA

1. RATE
Normal heart rate : 60 100 x/minutes > 100 x/minutes : Sinus Tachycardia < 60 x/minutes : Sinus Bradicardia

Determination heart rate (normal paper speed 25 mm/s):

300 Count number of large square (bold boxes in one R R interval) 1500 Count number of small square in one R R intervals Number of QRS complex in 6 seconds, multiply by 10

2. RHYTHM
Normal cardiac rhythm : SINUS rhythm

Sinus rhythm characteristics : Rate 60-100 bpm Constant R R interval Negative P wave in aVR and positive di II P wave is always followed by QRS complex

Gelombang P

12

3. AXIS

Determining Axis: An Example

4. HYPERTROPHIC SIGNS

Atrial Hypertrophy

Atrial Hypertrophy

P Pulmonale: Right (RAH)

P Mitrale: Left (LAH)

5. MYOCARDIAL INFARCTION
Ischemia Injury Necrosis

ANTERIOR INFARCTION

INFERIOR INFARCTION

POSTEROLATERAL INFARCTION

ARRHYTHMIA

Causes of Cardiac Arrhythmias

Disturbed automaticity : this may involved a speeding up or slowing down of areas of automaticity such as the sinus node, the atrioventricular (AV) node, or the myocardium. Abnormal beats (depolarizations) may arise through this mechanism from the atria, the AV junction, or the ventricles. Disturbed conduction : conduction may be either too rapid (as in Wolff- Parkinson-White syndrome) or too slow (as in AV block)

Combinations of disturbed automaticity and disturbed conduction

Sinus Rhythm

First Degree Heart Block

Second Degree Block Type I

Second Degree Block Type II

Third Degree Heart Block

Premature Atrial Contraction

Premature Ventricular Contraction

Atrial Fibrillation

Atrial Flutter

Supraventricular Tachycardia

Ventricular Fibrillation

Ventricular Tachycardia

Torsade de Pointes

Bundle Branch Blocks

Characteristic QRS pattern in lead I, V1, and V6

Left Bundle Branch Block

Right Bundle Branch Block

*

DISCUSSION

Sinus arrhythmia

Limb lead reversal

Early repolarization

Subendocardial ischemia. Anterolateral ST-segment depression

Unstable angina

acute anterolateral myocardial infarction

High lateral infarction

Lateral myocardial infarction

Right ventricular infarction

Acute inferoposterior myocardial infarction

left ventricular aneurysm

Mobitz I

High-grade atrioventricular block

Wolff-Parkinson-White syndrome

Wolff-Parkinson-White syndrome

Atrial fibrillation

Atrial flutter

premature ventricular contraction

Supraventricular tachycardia

Wide complex tachycardia

Ventricular flutter

Idioventricular rhythm