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

V6R V6
V5
V5R
V4
V4R V3
V3R 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. RATE
2. RHYTHM
3. AXIS
4. HIPERTROPHIC SIGNS
5. MYOCARDIAL INFARCTION
6. 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