FACULTY OF MEDICINE

ISLAMIC UNIVERSITY OF MALANG

ELECTROCARDIOGRAPHY
BASIC ECG INTERPRETATION

Timothy G. Janz, MD
Department of Emergency Medicine
Pulmonary/Critical Care Division
Department of Internal Medicine

(Dubin, 6th Ed: Pages 1 – 96; 203 – 242)

12-Lead ECG
Standard Leads
12-Lead ECG
Augmented Leads
12-Lead ECG
Lead Placement

Standard Leads Augmented Leads

12-Lead ECG
Hexaxial System
12-Lead ECG
Precordial Leads (V1-V6)

V1

V6
12-Lead ECG
Precordial Leads

 V1
 4th RICS (Right InterCostal Space)
 V2
 4th LICS (Left InterCostal Space)
 V3
 ½ distance between V2 & V4
 V4
 5th ICS – MCL (MidCavicular Line)
 V5
 5th ICS – AAL (Anterior Axillary Line)
 V6
 5th ICS – MAL (Mid Axillary Line)
12-Lead ECG
Lead Placement
ECG Amplitude - vertical
axis
 ECG
Time - horizontal
axis
ECG - Components
ECG
P-wave
ECG
P-wave
 What does the P-wave represent?
 Atrial depolarization

 What is a normal P-wave?

 Amplitude
 < 2.5 mm
 Duration
 < 0.12 sec
 Upright
 I, II, aVL, aVF, & V4-6
 Biphasic in V1
ECG
P-wave

Monophasic

V1
Biphasic
ECG
PR Interval
ECG
PR Interval
ECG
PR Interval

 What defines a normal PR interval?

 0.12 – 0.21 sec

 What is defined by a  PR interval?

 10 AV block

 What is the significance of  PR interval?

 Accessory pathway
ECG
PR Segment

Normal: lies
on
isoelectric
line
ECG
QRS Complex
ECG
QRS Complex

 What does the QRS represent?

 Ventricular depolarization

 What defines a normal QRS complex?

 Duration
 0.08 – 0.10 sec
ECG
QRS Complex
ECG
QRS Complex

 What defines an abnormal Q-wave?

 Duration > 0.04 sec (1 mm box)

 Amplitude > 1/3 of the R-wave
 Amplitude > ¼ of the QRS complex
ECG
Vectors
ECG
QRS Complex
1) Normal R-wave
progression
V1  V6

2) Transition zone:
V3-4
ECG
ST Segment

Normal: lies on isoelectric line

ECG
ST Segment
ECG
T-wave
ECG
T-wave

 What does the T-wave represent?

 Ventricular repolarization

 What defines a normal T-wave?

 Upright
 I, II, V3-6
 Polarity of P-wave = polarity of T-wave
 Amplitude
 Limb leads < 5 mm
 Precordial leads < 10 mm
ECG
T-wave

Abnormal
ECG
QT Interval
ECG
QT Interval

 What does the QT interval represent?

 Total ventricular depolarization & repolarization

 What is a corrected QT (QTc) interval?

 QT corrected for the heart rate
 QTc = QT + 1.75(ventricular rate – 60)
 Normal: 0.42 + 0.02 sec
ECG
U-wave

-Normal finding
-Follows T-wave
-Same polarity of T-wave
-Abnormally large U-
wave = hypokalemia
Normal T-wave compared to U-wave

T
U
ECG
Rate Determination
ECG
Normal Sinus Rhythm
ECG
QRS Axis
ECG
P-wave Vector
ECG
P-wave Vector
ECG
P-wave Vector
 P-wave usually best seen in:

Lead II
ECG Vector 1 – intraventricular septal depolarization
Vector 2 – depolarization of RV and beginning of LV
QRS Vector Vector 3 – depolarization of remainder of LV
ECG
QRS Axis
QRS axis
determined by 6
limb leads
ECG
QRS Axis (For this course, Normal = 00 – 900)

00
ECG
QRS Axis

I
ECG
QRS Axis

QRS polarity
ECG - Summary
 Rhythm (regular or irregular)
 Rate
 P-wave
  I, II, aVF, aVL, V4-6
 Amplitude < 2.5 mm
 Check V1
 PR Interval
 0.12 – 0.21 sec
 QRS Complex
 Duration < 0.10 sec
 Axis = 00 – 900
 ST Segment
 T-wave
  I, II, aVF, aVL, V4-6
 Amplitude: limb leads < 5 mm; precordial leads < 10 mm)
 QTc Interval
 0.41 + 0.02 sec
 Interpretation
12-Lead ECG - Summary
Hexaxial System