Basic ECG

Interpretation
DR. FIRMAN B. LEKSMONO, SPJP

Cardiology and Vascular Department

Medical Faculty of Indonesian Muslim
University
ER

Decision
Cardiovascular disease are the number 1
cause of death globally
WHO September 2016
Anatomy
 Conduction System
Sinoatrial Node (SA Node)
Rhythmic rate : 60 100 bpm
Internodal Pathway
Anterior, middle, posterior pathways
Atrioventricular Node (AV Node)
Regions: atrionodal (AN), nodal (N),
nodal-His (NH)
Delays the impulse
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 Conduction System
Bundle of His
Rate : 40 60 bpm
Bundle Branches
LBB & RBB
LBB : anterior, posterior, septal fascicles
Purkinje Fibers
Rate : 20 40 bpm

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 Cardiac Cells Properties
Automaticity
Excitability
Conductivity
Contractility

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Action Potential
Conduction System

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ECG

Electrocardiography is a fundamental
part of cardiovascular assessment.
The contraction and relaxation of
cardiac muscle results from the
depolarisation and repolarisation of
myocardial cells. These electrical
changes are recorded via electrodes
placed on the limbs and chest wall
and are transcribed on to graph
paper to produce an
electrocardiogram
ECG
For What?
 LEADS
Standard Limb Leads
Lead I, II, III
Augmented Limb Leads
aVL, aVR, aVF
Precordial Leads
V1, V2, V3, V4, V5, V6
V1R, V2R, V3R, V4R, V5R, V6R
V7, V8, V9

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 LEADS

The extremity leads are:

I from the right to the left arm
II from the right arm to the left leg
III from the left arm to the left leg

Augmented Limb leads are:

AVL points to the left arm
AVR points to the right arm
AVF points to the feet

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 LEADS
PRECORDIAL LEADS
 LEADS
ADDITIONAL LEADS

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Why we need 12 leads ECG??
Leads

LEADS VIEW OF HEART

I, aVL Lateral
II, III, aVF Inferior
V1, V2 Antero-Septal
V3, V4 Antero-Apical
V5, V6 Antero-Lateral
I, aVL, V5, V6 High Lateral
V1-V6 Whole Anterior
 How to Interprate ECG?

Rhytme? Ischemia/Infarctio
Rate? n?
Axis? Chamber
P wave? Hipertrophy?
PR interval? Arrhytmia?
QRS complex?
ST segment?
T wave?
Boxes

Standarization :
Speed Paper : 25 m/s
Amplitudo : 10 mm/1 mv
Heart Rate

Large Boxes 300/R-R

interval
Small Boxes 1500/R-R
interval
Axis
Waves, Segment, Complex
and Interval
Sinus Rhytme
P wave

No more than 2.5 mm in

height
No more than 0.11 sec in
duration
P-R Interval

Duration 0.12 0.20 sec in adult,

may be shorter in children and
longer in elders.
QRS Complex

Duration 0.06 0.12 sec

Q : 1st negative deflection
after P
R : 1st positive deflection
after P
S : negative deflection
after R
R wave Progression
ST segment

Normal Isoelektrik
T wave

Limb lead : no more than 5

mm
Precordial lead : no more
than 10 mm
Normal ECG

Sinus Rhytme, HR : 80 bpm, Normoaxis, P wave : 0,06 s, PR interval :

0,12 s, QRS complex : 0,08 s, ST segment : isoelectric, T wave :
normal.
Conclussion : Normal ECG
Myocardial Infarction
Myocardial Infarction
Ischemia
Injury
Necrosis
STEMI evolution
Infarct Location
Coronary Oclussion
Acute Anterior
Infarction
Acute Inferior
Infarction
Chamber Hypertrophy
Atrial Enlargement

P - Pulmonal

P - Mitral
 Ventricular Hypertrophy

Left Ventricular
Hypertrophy
S wave in V1/V2 + R
wave in V5/V6 35 mm
(mV)
Strain pattern in V5 and
V6
May be accompanied
by LAD
 Ventricular Hypertrophy

Right Ventricular Hypertrophy

RAD
Reversed R-wave
progression (taller R waves
and smaller S waves in V1 &
V2; deeper S waves & small
R waves in V5 & V6
Common Arrhytmia
Atrial Fibrilation

No P wave, Irreguler R-R Interval

 Atrial Flutter

Saw teeth App. Reguler/Irreguler R-R

Interval
Supraventricular Tachycardia

Narrow QRS, Reguller, Ussually P waves is

not seen,
Ventricular Tachycardia

Wide QRS, Reguller

Ventricular Fibrilation
1st Degree
AV blocks

2nd Degree, Type 1 (wenckebach)

2nd Degree, Type 2

3rd Degree (Total AV block)