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Electrocardiography
P. Pujowaskito
Medical School of General Ahmad Yani
University
Electrocardiography
Electrical phenomena, science
Simple, cheap, usefull but limited
Almost all arrhythmias
Infarction or ischaemia
LVH
Electrolyte imbalance
Bipolar standard leads I, II and III
The unipolar
limb leads and
their axes
Locations of unipolar
precordial leads
The precordial leads and their axes
ECG Information
The 12 leads allow
tracing of electric
vector in all three
planes of interest
Not all the leads are
independent, but are
recorded for
redundant
information
Electrocardiographic views of the heart
Regions of the Myocardium
Lateral
I, AVL,
V5-V6
Anterior /
Inferior Septal
II, III, aVF V1-V4
PED 596
ECG recording
Electrical phenomena
Electrical phenomena
Recording
R
Waves
T
P
U?
Q
S Katrina Kardos, MD
PGY-3
Albany Medical Center
Nomenclature
Cardiac Cycle
Upward/
Positive deflection
Garis Isoelektris/ baseline
Downward/
Negative deflection
Example:
sinus rhythm 80 x/minute, normal axis (normal sinus
rhythm)
sinus rhythm 80 x/minute, LAD, LVH
sinus rhythm 75 x/minute, RAD, RA abnormality, RVH
sinus bradycardia 50x/minute, normal axis, Inferior LV wall
ischaemic
sinus tachycardia 110 x/minute, normal axis, acute
myocardial infarction on anterior LV wall
ECG paper
Start Start
75 38
300 150 100 300 150 100 75 60 50 43
R R R R
Mnemonic
Rhythm
Pace maker Sinus Rhythm
Amplitudo: voltase
ISO ELECTRICE
Durasi
Rhythm
Amplitudo: voltase
ISO ELECTRICE
Durasi
Normal Sinus Rhythm
Rate: 60-100 b/min
Rhythm: regular
P waves: upright in
leads I, II, aVF
PR interval: < .20 s
QRS: < .10 s
P wave
Contour :
-normal : smooth, monophasic (except V1)
-abnormal: monophasic > 0.25mV or P biphasic (notched)
Configuration :
-normal : positive at I,II, aVF, V3-V6, negative at aVR
-abnormal: negative at II,III or aVF,
may be an inversal leads or junctional rhytm
Duration (horisontal axis): 0.08-010 second (2-2.5 small box)
Amplitudo (vertikal axis): 0.25 mV or 2.5mm or 2.5 small box
PR interval: 0.12-0.20 second (3-5 small box),
-short PR interval: may be preexitacion syndrome
-long PR interval: may be AV blokade
Direction of the
normal frontal and
horizontal plane P
vectors with
resulting P wave in
the 12-lead ECG
P wave
Q wave
Configuration :
-normal : small q
-abnormal : patologic Q, wide ( 0.04s)
and deep ( 4mm or 25% R)
Lead of abnormal Q: old infarction area
-lead V1-V4 : anteroseptal
-lead V1-V6, I and aVL : anterior extensive
-lead V4-V6, I and aVL : anterolateral
-lead V3-V5 atau V1-V6: anterior
-lead II,III and aVF : inferior
-lead I and aVL : high lateral
-Mirror image of V1-V3 to horisontal line: true posterior
Normal: Isoelektris
Abnormal:
Depol. Repol. Restoration of - Elevation: > 1mm
ionic balance - Depression: horizontal,
downsloping,
upsloping
> 1mm was significant;
deeper: more specific
ST Segment depression : Ischaemic area
Normal adult: positive T wave in all lead except aVR and V1.
Abnormal: - Tall T/ hyperacute T: Injury/ Acute Infarction
- Negative T (vector of T was on opposite direction
than QRS vector/ T inversi): myocardial ischaemia,
more specific if arrow head T inversion.
Area of injury or ischaemic
Nomogram for
rate correction of
Q-T interval
Bazetts formula
QTc = QT
R-R
U Wave