DASAR-DASAR

INTERPRETASI EKG
Radityo Prakoso, Hary S Muliawan
Department of Cardiology and Vascular Medicine
Faculty of Medicine University of Indonesia
National Cardiovascular Center Harapan Kita

Unipolar Precodial (Chest) Leads

Midclavicular line
Anterior axillary line
Midaxillary line

V6

V6R
V5R
V4R

V5
V4

V3R

V3

V2

V1

Mervin J. Goldman, MD. 11th edition Principles of clinical Electrocardiography. Clinical Professor of Medicine University of
California School of Medicine San Francisco @1995-1982

Unipolar Precodial (Chest) Leads

Horizontal plane of V4-6

V7 V8 V9 V9RV8RV7R

Mervin J. Goldman, MD. 11th edition Principles of clinical Electrocardiography. Clinical Professor of Medicine University of
California School of Medicine San Francisco @1995-1982

ECG INTERPRETATION
1.
2.
3.
4.
5.
6.

RATE
RHYTHM
AXIS
HIPERTROPHIC SIGNS
MYOCARDIAL INFARCTION
ARRHYTHMIA

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

Gelombang P

12

3. AXIS

Determining Axis: An Example

4. HYPERTROPHIC SIGNS

Atrial Hypertrophy

Atrial Hypertrophy

P Pulmonale: Right (RAH)

P Mitrale: Left (LAH)

5. MYOCARDIAL INFARCTION
Ischemia
Injury
Necrosis

ANTERIOR INFARCTION

INFERIOR INFARCTION

POSTEROLATERAL INFARCTION

ARRHYTHMIA

Causes of Cardiac Arrhythmias

Disturbed automaticity : this may involved a speeding up or
slowing down of areas of automaticity such as the sinus
node, the atrioventricular (AV) node, or the myocardium.
Abnormal beats (depolarizations) may arise through this
mechanism from the atria, the AV junction, or the ventricles.
Disturbed conduction : conduction may be either too rapid (as
in Wolff- Parkinson-White syndrome) or too slow (as in AV
block)

Combinations of disturbed automaticity and disturbed

conduction

Sinus Rhythm

First Degree Heart Block

Second Degree Block Type I

Second Degree Block Type II

Third Degree Heart Block

Premature Atrial Contraction

Premature Ventricular
Contraction

Atrial Fibrillation

Atrial Flutter

Supraventricular Tachycardia

Ventricular Fibrillation

Ventricular Tachycardia

Torsade de Pointes

Bundle Branch Blocks

Characteristic QRS
pattern in lead I, V1,
and V6

Left Bundle Branch Block

Right Bundle Branch Block

*

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