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ECG interpretation
Quality of ECG?
Rate
Rhythm
Axis
P wave
PR interval
QRS duration
QRS morphology
Abnormal Q waves
ST segment
T wave
QT interval
Quality of the ECG
Patient name
Date of the ECG
Is there any interference?
Is there electrical activity from all 12
leads?
Calibration:
- speed = 25mm/second
- height = 1cm/mV (10mm/mV)
The ECG Paper
Horizontally
One small box - 0.04 s
One large box - 0.20 s
Vertically
One large box - 0.5 mV
The ECG Paper (cont)
3 sec 3 sec
rate.
NOTE: the following strips are not
marked but all are 6 seconds long.
Calibration
Calibration
ECG interpretation
Quality of ECG?
Rate
Rhythm
Axis
P wave
PR interval
QRS duration
QRS morphology
Abnormal Q waves
ST segment
T wave
QT interval
Rhythm Analysis
Option 1
Count the # of R waves in a 6 second
rhythm strip, then multiply by 10.
Reminder: all rhythm strips in the Modules
are 6 seconds in length.
Interpretation? 9 x 10 = 90 bpm
Step 1: Calculate Rate
R wave
Option 2
Find a R wave that lands on a bold line.
Count the number of large boxes to the next R
wave. If the second R wave is 1 large box
away the rate is 300, 2 boxes - 150, 3 boxes -
100, 4 boxes - 75, etc. (cont)
Step 1: Calculate Rate
3 1 1
0 5 0 7 6 5
0 0 0 5 0 0
Option 2 (cont)
Memorize the sequence:
300 - 150 - 100 - 75 - 60 - 50
(30 – 10 – 5 – 3 – 2)
Rate is either:
- normal: 60-100/mnt
- bradycardic: <60/mnt
- tachycardic: >100/mnt
Differential Diagnosis of Tachycardia
1.SA Node “fires”
2. Right and Left
Atria Depolarize
AV
SA Node 3. AV Node
Node
“pauses”
Questions:
P waves
present?
LA/RA Regular
Depol rhythm?
1/QRS?
Step 4: Determine PR interval
0.12 seconds
Interpretation?
Step 5: QRS duration
0.08 seconds
Interpretation?
Sinus Rythm
HR: 60 – 100 bpm
Irama: Reguler
Gel P: mendahului setiap kompleks QRS & bentuknya
konsisten
Interval PR: 0,12 – 0,20 dtk
Kompleks QRS: 0,04 – 0,10 dtk
Normal Sinus Rhythm
Mattu, 2003
Rhythm Summary
Komplek QRS
Diikuti QRS
Sempit Lebar
PR Interval
Atrial Takikardi/
Normal Memanjang Tidak dapat dihitung Supra ventricular
takikardi Irama
Sinus takikardi
VT
The QRS Axis
Represents the overall direction of the heart’s activity
Axis of –30 to +90 degrees is normal
Axis
Axis
The Quadrant Approach
QRS up in I and up in aVF = Normal
What is the axis?
Normal- QRS up in I and aVF
Axis
Positive in I and
aVF = NORMAL
Positive in I and
negative in aVF =
LAD
Negative in I and
positive in aVF =
RAD
Kondisi-kondisi yang ditandai
perubahan axis
Gangguan konduksi, mis. Left anterior
hemiblock
Pembesaran ventrikel, mis. RVH
Penyakit jantung kongenital, mis. Atrial
septal defect
Konduksi pre eksitasi
Embolus pulmoner
ECG interpretation
Quality of ECG?
Rate
Rhythm
Axis
P wave
PR interval
QRS duration
QRS morphology
Abnormal Q waves
ST segment
T wave
QT interval
Gelombang P
Mewakili depolarisasi
otot atrium
Normal: Kecil,
melengkung
Tinggi < 2,5 mm,
lebar < 0.11 dtk
P wave
Are there P waves present?
Rate
Rhythm
Axis
P wave
PR interval
QRS duration
QRS morphology
Abnormal Q waves
ST segment
T wave
QT interval
Gelombang, Kompleks &
Interval, Cont…
Kompleks QRS
Mewakili depolarisasi
otot ventrikel
Gel Q: defleksi Θ I,
<0,03 dtk, <25 %
tinggi R
Gel R: defleksi + I
Gel S: defleksi Θ
mengikuti R
Lebar Kompleks QRS:
0,04 – 0,10 dtk
QRS complex
Normal = <0.12 seconds
M a RR o w = RBBB
V1: RSR prime pattern with inverted T
wave
V6: Wide deep slurred S wave
QRS complex
Is there LVH?
Rate
Rhythm
Axis
P wave
PR interval
QRS duration
QRS morphology
Abnormal Q waves
ST segment
T wave
QT interval
Gelombang, Kompleks &
Interval, Cont…
Segmen ST
Mewakili waktu yang
diperlukan oleh
ventrikel untuk
depolarisasi
Mulai dr akhir kompleks
QRS – permulaan gel T
Segmen ST harus pada
garis isoelektrik
ST segment
ST depression
- downsloping or horizontal =
ABNORMAL
ST elevation
- infarction
- pericarditis (widespread)
ST segment
ST segment
ST segment
EKG Distributions
Anteroseptal: V1, V2, V3, V4
Anterior: V1–V4
Anterolateral: V4–V6, I, aVL
Lateral: I and aVL
Inferior: II, III, and aVF
Inferolateral: II, III, aVF,
and V5 and V6
What is the diagnosis?
Acute inferior MI with ST elevation
in leads II, III, aVF
What do you see in this EKG?
ST depression II, III, aVF, V3-V6 = ischemia
Lateral MI
Reciprocal changes
Inferolateral MI
Tall = hyperkalaemia
Inverted/biphasic = ischaemia/previous
infarct
T wave
T wave
T wave
Gelombang, Kompleks &
Interval, Cont…
Gelombang U
Gelombang kecil
melengkung, kadang2
mengikuti gel T
Sering dijumpai pd lead V2-
V3
Tinggi: 10 % tinggi gel T
Merupakan bagian dr
repolarisasi ventrikel dan
menunjukkan repolarisasi
serat purkinje
Gelombang, Kompleks &
Interval, Cont…
Interval QT
Menunjukkan durasi
aktivasi dan
recovery ventrikel
Diukur mulai awal
Kompleks QRS –
akhir gel T
QT interval
Start of QRS to end of T wave
U waves
Can also see PVCs, ST depression, small T waves
Digitalis