HOW TO READ ELECTROCARDIOGRAPHY

Department of Internal Medicine Faculty of Medicine Chrisitan University of Indonesia Kurniyanto, MD

ECG INTERPRETATION
1. 2. 3. 4. 5. 6. RATE RHYTHM AXIS HIPERTROPHIC SIGNS MYOCARDIAL INFARCTION 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 Durasi QRS Aksis Normal 0,12 s/d 0,20 0,04 s/d 0,12 - 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

WHATS 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