Basic ECG Interpretation for Coass

8/16/2019 Basic ECG Interpretation for Coass

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Basic ECG Interpretation for Co ass

Firman B. Leksmono

Cardiology and Vascular DepartmentMedical Faculty of Hasanuddin University


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For What?


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Anatomy


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Action Potential


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Leads


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LEADSLEADS VIEW OF HEARTVIEW OF HEART

I, aVLI, aVL LateralLateral

II, III, aVFII, III, aVF Inferior Inferior

Leads

V1, V2V1, V2 Antero Antero--SeptalSeptal

V3, V4V3, V4 Antero Antero--Apical Apical

V5, V6V5, V6 Antero Antero--LateralLateral

I, aVL, V5, V6I, aVL, V5, V6 High LateralHigh Lateral

V1V1--V6V6 Whole Anterior Whole Anterior


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How to Interprate ECG?

• Rhytme?

• Rate?

• Axis?

•

• Ischemia/Infarction?

• Chamber Hipertrophy?

• Arrhytmia?

• PR interval?

• QRS complex?

• ST segment?

• T wave?


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Boxes

Standarization :

Speed Paper : 25 m/s

Amplitudo : 10 mm/1 mv


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Heart Rate

Large BoxesLarge Boxes 300/R300/R--R intervalR interval

Small BoxesSmall Boxes 1500/R1500/R--R intervalR interval


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Axis


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Waves, Segment, Complex and Interval


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Sinus Rhytme

• Rate 60-100 bpm

• Constant R – R interval

• Negative P wave in lead aVR and positive in lead II

•


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P wave

NoNo more than 2.5 mm inmore than 2.5 mm in heightheightNo more than 0.11 secNo more than 0.11 sec in durationin duration


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P-R Interval

DurationDuration 0.120.12 – – 0.20 sec in0.20 sec in adult, mayadult, may be beshorter inshorter in children andchildren and longer inlonger in elders.elders.


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PR segment


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QRS Complex

DurationDuration 0.060.06 – – 0.12 sec0.12 secQ : 1Q : 1stst negative deflection after Pnegative deflection after P

R : 1R : 1stst positive deflection after Ppositive deflection after P

S : negative deflection after RS : negative deflection after R


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R wave Progression


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QT interval

Qtc= Qt measured√RR interval

Normal


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ST segment

NormalNormal IsoelektrikIsoelektrik


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T wave

Limb lead : no more than 5Limb lead : no more than 5 mmmm

PrecordialPrecordial lead : no more than 10 mmlead : no more than 10 mm


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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


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Myocardial Infarctionyocardial Infarction


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Myocardial Infarction

• Ischemia

• Injury

• Necrosis


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STEMI evolution


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Infarct Location


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LOCALIZED S-T ELEVATION CORONARY ARTERY

Anterior MI V1-V6 LAD

Septal MI V1-V4 LAD

Coronary Oclution

Lateral MI I, aVL, V5, V6 RCX

Inferior MI II, III, aVF RCA (80%) RCX (20%)

Posterior MI V7, V8, V9 RCX or RCA

NB :

LAD Left Anterior Descending ArteryRCX Ramus Circumflexa

LM Left Main Artery

RCA Right Coronary Artery


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Acute Anterior Infarction


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Acute Inferior Infarction


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Chamber Hypertrophyhamber Hypertrophy


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Atrial Enlargement

P - Pulmonal

P - Mitral


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•• Left Ventricular HypertrophyLeft Ventricular Hypertrophy

– – S wave in V1/V2 + R wave inS wave in V1/V2 + R wave in

V5/V6V5/V6 ≥≥ 35 mm (mV)35 mm (mV)

Ventricular Hypertrophy

– – StrainStrain pattern in V5 and V6pattern in V5 and V6

– – May be accompanied by LADMay be accompanied by LAD


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•• Right Ventricular HypertrophyRight Ventricular Hypertrophy

– – RADRAD

Ventricular Hypertrophy

– – Reversed RReversed R--wave progression (tallerwave progression (tallerR waves and smaller S waves in VR waves and smaller S waves in V11 &&

VV22; deeper S waves & small R waves; deeper S waves & small R waves

in Vin V55 & V& V66


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Common Arrhytmiaommon Arrhytmia


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Atrial Fibrilation

No P wave,No P wave, IrregulerIrreguler RR--R IntervalR Interval


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Atrial Flutter

Saw teeth App.Saw teeth App. RegulerReguler//IrregulerIrreguler RR--R IntervalR Interval


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Supraventricular Tachycardia

Narrow QRS,Narrow QRS, RegullerReguller,, UssuallyUssually P waves is not seen,P waves is not seen,


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Extrasystole

Narrow QRS,Narrow QRS, RegullerReguller,, UssuallyUssually P waves is not seen,P waves is not seen,


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Ventricular Tachycardia

Wide QRS,Wide QRS, RegullerReguller


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Ventricular Fibrilation


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AV blocks1st Degree1st Degree

2nd Degree, Type 1 (2nd Degree, Type 1 (wenckebachwenckebach))

2nd Degree, Type 22nd Degree, Type 2

3rd Degree (Total AV block)3rd Degree (Total AV block)


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Basic ECG Interpretation for Coass

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