Download - Ecg interpretation
HOW TO READ ELECTROCARDIOGRAPHY
Department of Cardiology and Vascular MedicineFaculty of Medicine University of Indonesia
National Cardiovascular Center Harapan Kita
V6V5
V4 V3
V2
V1
V6R
V5R
V4R V3R
Midclavicular line
Anterior axillary line
Midaxillary line
Unipolar Precodial (Chest) Leads
Mervin J. Goldman, MD. 11th edition Principles of clinical Electrocardiography. Clinical Professor of Medicine University of California School of Medicine San Francisco @1995-1982
V7 V8 V9 V9RV8RV7R
Horizontal plane of V4-6
Unipolar Precodial (Chest) Leads
Mervin J. Goldman, MD. 11th edition Principles of clinical Electrocardiography. Clinical Professor of Medicine University of California School of Medicine San Francisco @1995-1982
The electrocardiogram(ECG) illustratesconduction of electricalimpulses in the heart.The depolarization of theventricles occurs fromthe endocardium(inside) to theepicardium (outside)[e]The repolarization of theventricles occurs in theopposite direction. [g]
ECG INTERPRETATION
1. RATE 2. RHYTHM 3. AXIS 4. HIPERTROPHIC SIGNS5. MYOCARDIAL INFARCTION6. ARRHYTHMIA
1. RATE
Normal heart rate : 60 – 100 x/minutes• > 100 x/minutes : Sinus Tachycardia• < 60 x/minutes : Sinus Bradicardia
Determination heart rate (normal paper speed 25 mm/s):
• 300
Count number of large square (bold boxes in one R – R’ interval)
• 1500
Count number of small square in one R – R’ intervals
• Number of QRS complex in 6 seconds, multiply by 10
2. RHYTHM
Normal cardiac rhythm : SINUS rhythm
Sinus rhythm characteristics :• Rate 60-100 bpm• Constant R – R interval• Negative P wave in aVR and positive di II• P wave is always followed by QRS complex
3. AXIS
4. HYPERTROPHIC SIGNS
5. MYOCARDIAL INFARCTION
Ischemia Injury Necrosis
ANTERIOR INFARCTION
INFERIOR INFARCTION
POSTEROLATERAL INFARCTION
ARRHYTHMIA
AV BLOCK
WHAT’S WRONG??Lead Error: V1 and V3 are Transposed!In this normal 12-lead ECG the V1 and V3 chest electrodes are interchanged. Experienced ECG interpreters should be able to spot this lead placement error.
DISCUSSION
Sinus arrhythmia
Limb lead reversal
Early repolarization
Subendocardial ischemia. Anterolateral ST-segment depression
Unstable angina
acute anterolateral myocardial infarction
High lateral infarction
Lateral myocardial infarction
Right ventricular infarction
Acute inferoposterior myocardial infarction
left ventricular aneurysm
Mobitz I
High-grade atrioventricular block
Wolff-Parkinson-White syndrome
Wolff-Parkinson-White syndrome
Atrial fibrillation
Atrial flutter
premature ventricular contraction
Supraventricular tachycardia
Wide complex tachycardia
Ventricular flutter
Idioventricular rhythm