HOW TO READ ELECTROCARDIOGRAPHY

Department of Internal MedicineFaculty of Medicine Chrisitan University of Indonesia

Kurniyanto, MD

ECG INTERPRETATION

1. RATE 2. RHYTHM 3. AXIS 4. HIPERTROPHIC SIGNS5. MYOCARDIAL INFARCTION6. ARRHYTHMIA

Pola Membaca EKG Irama Rate QRS Aksis QRS Morfologi Gelombang P Interval PR Durasi QRS Morfologi QRS Deviasi Segmen ST Morfologi Gelombang T Morfologi Gelombang U Lain-lain (LVH,LV

Strain,BBB, QT interval) Kesimpulan EKG

Nilai Normal :

Interval PR 0,12’’ s/d 0,20’’

Durasi QRS 0,04’’ s/d 0,12’’

Aksis Normal - 300 s/d + 1100

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

3. AXIS

4. HYPERTROPHIC SIGNS

5. MYOCARDIAL INFARCTION

Ischemia Injury Necrosis

ANTERIOR INFARCTION

INFERIOR INFARCTION

POSTEROLATERAL INFARCTION

ARRHYTHMIA

AV BLOCK

WHAT’S WRONG??Lead Error: V1 and V3 are Transposed!In this normal 12-lead ECG the V1 and V3 chest electrodes are interchanged. Experienced ECG interpreters should be able to spot this lead placement error.

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