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Interpretation
DR. FIRMAN B. LEKSMONO, SPJP
Decision
Cardiovascular disease are the number 1
cause of death globally
WHO September 2016
Anatomy
Conduction System
Sinoatrial Node (SA Node)
Rhythmic rate : 60 100 bpm
Internodal Pathway
Anterior, middle, posterior pathways
Atrioventricular Node (AV Node)
Regions: atrionodal (AN), nodal (N),
nodal-His (NH)
Delays the impulse
F_11
Conduction System
Bundle of His
Rate : 40 60 bpm
Bundle Branches
LBB & RBB
LBB : anterior, posterior, septal fascicles
Purkinje Fibers
Rate : 20 40 bpm
F_11
Cardiac Cells Properties
Automaticity
Excitability
Conductivity
Contractility
F_11
Action Potential
Conduction System
F_11
ECG
Electrocardiography is a fundamental
part of cardiovascular assessment.
The contraction and relaxation of
cardiac muscle results from the
depolarisation and repolarisation of
myocardial cells. These electrical
changes are recorded via electrodes
placed on the limbs and chest wall
and are transcribed on to graph
paper to produce an
electrocardiogram
ECG
For What?
LEADS
Standard Limb Leads
Lead I, II, III
Augmented Limb Leads
aVL, aVR, aVF
Precordial Leads
V1, V2, V3, V4, V5, V6
V1R, V2R, V3R, V4R, V5R, V6R
V7, V8, V9
F_11
LEADS
F_11
LEADS
PRECORDIAL LEADS
LEADS
ADDITIONAL LEADS
F_11
Why we need 12 leads ECG??
Leads
Rhytme? Ischemia/Infarctio
Rate? n?
Axis? Chamber
P wave? Hipertrophy?
PR interval? Arrhytmia?
QRS complex?
ST segment?
T wave?
Boxes
Standarization :
Speed Paper : 25 m/s
Amplitudo : 10 mm/1 mv
Heart Rate
Normal Isoelektrik
T wave
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