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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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