Basic ECG Interpretation for Co-ass

Firman B. Leksmono

Cardiology and Vascular Department

Medical Faculty of Hasanuddin University
For What?
Anatomy
Action Potential
Leads
Leads

LEADS VIEW OF HEART

I, aVL Lateral
II, III, aVF Inferior
V1, V2 Antero-Septal
V3, V4 Antero-Apical
V5, V6 Antero-Lateral
I, aVL, V5, V6 High Lateral
V1-V6 Whole Anterior
 How to Interprate ECG?
• Rhytme? • Ischemia/Infarction?
• Rate? • Chamber Hipertrophy?
• Axis? • Arrhytmia?
• P wave?
• PR interval?
• QRS complex?
• ST segment?
• T wave?
Boxes

Standarization :
Speed Paper : 25 m/s
Amplitudo : 10 mm/1 mv
Heart Rate

Large Boxes  300/R-R interval

Small Boxes  1500/R-R interval
Axis
Waves, Segment, Complex and Interval
 Sinus Rhytme
• Rate 60-100 bpm
• Constant R – R interval
• Negative P wave in lead aVR and positive in lead II
• P wave is always followed by QRS complex
 P wave

No more than 2.5 mm in height

No more than 0.11 sec in duration
 P-R Interval

Duration  0.12 – 0.20 sec in adult, may be

shorter in children and longer in elders.
PR segment
 QRS Complex

Duration  0.06 – 0.12 sec

Q : 1st negative deflection after P
R : 1st positive deflection after P
S : negative deflection after R
R wave Progression
QT interval

Normal <0,40 s

Qtc= Qt measured
√RR interval
 ST segment

Normal  Isoelektrik
 T wave

Limb lead : no more than 5 mm

Precordial lead : no more than 10 mm
 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
Myocardial Infarction
 Myocardial Infarction
• Ischemia
• Injury
• Necrosis
STEMI evolution
Infarct Location
 Coronary Oclution

LOCALIZED S-T ELEVATION CORONARY ARTERY

Anterior MI V1-V6 LAD

Septal MI V1-V4 LAD

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 Artery
RCX  Ramus Circumflexa
LM  Left Main Artery
RCA  Right Coronary Artery
Acute Anterior Infarction
Acute Inferior Infarction
Chamber Hypertrophy
Atrial Enlargement

P - Pulmonal

P - Mitral
 Ventricular Hypertrophy

• Left Ventricular Hypertrophy

– S wave in V1/V2 + R wave in
V5/V6 ≥ 35 mm (mV)
– Strain pattern in V5 and V6
– May be accompanied by LAD
 Ventricular Hypertrophy

• Right Ventricular Hypertrophy

– RAD
– Reversed R-wave progression (taller
R waves and smaller S waves in V1 &
V2; deeper S waves & small R waves
in V5 & V6
Common Arrhytmia
Atrial Fibrilation

No P wave, Irreguler R-R Interval

 Atrial Flutter

Saw teeth App. Reguler/Irreguler R-R Interval

Supraventricular Tachycardia

Narrow QRS, Reguller, Ussually P waves is not seen,

 Extrasystole

Narrow QRS, Reguller, Ussually P waves is not seen,

Ventricular Tachycardia

Wide QRS, Reguller

Ventricular Fibrilation
1st Degree
AV blocks

2nd Degree, Type 1 (wenckebach)

2nd Degree, Type 2

3rd Degree (Total AV block)