ECG Basics

Dr. David D. Ariwibowo SpJP, FIHA

 12 leads ECG

Limb Lead Precordial Lead

 ECG Electrode Placement
Exercise Configuration
The right & left arm
electrodes are transferred
Standard Configuration to the upper torso while Standard Configuration
Right Arm (white) the leg electrodes are Right Leg (green - ground)
transferred to the lower
Left Arm (black) torso Left Leg (red)

Precordial
Leads

V1 red V3 green V5 orange

V2 yellow V4 blue V6 violet
 Anatomical Placement of Electrodes

Electrode Anatomical Location

Right Arm (RA) The base of the right shoulder against the deltoid border about 2 cm below
the clavicle but above the border of pectoralis (in deltoid fossa).

Left Arm (LA) The base of the left shoulder against the deltoid border about 2 cm below
the clavicle but above border of pectoralis (in deltoid fossa).

Right Leg (RL) Right anterior axillary line a few centimeters above the umbilicus

Left Leg (LL) Left anterior axillary line a few centimeters above the umbilicus

V1 Fourth intercostal space at right sternal border.

V2 Fourth intercostal space at left sternal border.

V3 Midway between positions for V2 and V4.

V4 Fifth intercostal space at left midclavicular line.

V5 Horizontal level of V4 at left anterior axillary line.

V6 Horizontal level of V4 at left midaxillary line.

 The Concept of a "Lead"

LEAD I

LEAD III LEAD II

Remember, the RL
is always the ground
 Right precordial lead: V3R, V4R

Posterior leads: V7, V8, V9

v9
Pola potensial aksi lokal
Pacemaking & conduction System
 Rules of pacemaker & Conduction
1. Setiap sel jantung dapat berperan
sebagai pacemaker.
2. Pacemaker dengan frekuensi pulsus
tertinggi yang menentukan frekuensi
denyut jantung.
3. Pulsus secara normal di konduksikan
dari atrium ke ventrikel hanya melalui
AV node.
4. Pulsus dari atrium mengalami
perlambatan di AV node sebelum
dikonduksikan ke ventrikel.
5. AV node memiliki masa refrakter
tertentu(masa tidak dapat dirangsang).
6. Pulsus yang berasal dari supra His
akan mengeksitasi ventrikel dengan
cepat (memberikan gambaran QRS
sempit).
Heart Excitation Related to ECG

Figure 18.17
 ECG Basics - the ECG Complex

By examining the R
different leads, and the
shape, time intervals,
contour, frequency, and PR ST
segment segment T
type of the ECG
complexes, we can,
among other things,
diagnose cardiac
P
U
illnesses, suggest
whether or not the heart
is receiving enough
oxygen, determine if the Q
person has suffered a
heart attack, and get an S
idea as to the size and .12 - .20 <.10
performance of the main
.35 - .45
sec sec sec
pumping chamber (left
ventricle) PR QRS QT
interval width interval
 ---- -- ++++ ++++
---- ----
++++
----
++++ ++ ++
--
--
Generation of the ++++ ++
---- -- ++ ----
++++
----
++++
----
++++
ECG complexes
-- ++ ++++ ++++
---- ---- ++
++++
-- ---- ----
++++
++++ --
++++ ---- ++ ++ ----
A wave of depolarization moving
-- ----
toward an electrode will cause an ---- ++++ ++++

upward deflection on the ECG

needle.
---- --
---- ++
++++
----
++++ ---- ++
++++ ++++
++++
++++ --
--
++++ ---- ---- ++ ++ ----
---- -- ++++

---- ---- ---- ----

++++ ---- ++++
++++
++++ ++++
++++ ++++ ++++
++++
++++ ---- ---- ---- ----
----
 Visualization of the generation of
the Atrial (P-wave) portion of
the ECG complex in Lead II

1. Atrial depolarization proceeds o

60
from the top down in all directions

2. Summing these vectors of depolarization

results in the main atrial depolarization
vector oriented as shown (large green arrow).
It is moving towards the positive electrode Lead
of the lead, resulting in an upward deflection o II electrode
of the ECG stylus.
60 downward
rotation angle
from the horizontal 0
Visualization of the generation of
the Left Ventricular portion of
the ECG complex in Lead II Note: compared to
the left ventricle, the
(DEPOLARIATION) right ventricle is much
smaller and contributes
little to the overall main
vector of depolarization
1. Septum depolarizes from the
o
inside out and the resulting 60
depolarization wave moves Lead
o
II electrode
away from the electrode 60 downward
recording Lead II rotation angle o
from the horizontal 0

2. The rest of the ventricle

depolarizes counter-clockwise
from the inside out and creates
the main cardac vector (large arrow)
which is essentially, the algebraic
sum of all of the small depolarization
vectors. This vector is, in a normal
heart, almost always moving directly
toward Lead II, generating a mostly
positive QRS complex
Visualization of the generation of
the Left Ventricular portion of
the ECG complex in Lead II
(REPOLARIATION)

3. Repolarization can be thought of as

beginning where depolarization left off
and proceeding clockwise from the lateral
wall back to the septum..

4. The repolarization process proceeds at

a much slower rate than depolarization
so the wave inscribed (T-wave) is wide
and rounded. The repolarization vector is
moving away from the Lead II electrode
so the inscribed T-wave is always positive
 Standard recording:

ECG paper - Speed: 25 mm/s

- Voltage: 1 mV
Thank You