Overview ecg

OverviewECG

Yandi Ariffudin, dr

Limb lead (bipolar)

+/-

+

-

Extremity lead (unipolar)

Menggunakan terminal sentral sebagai titik nol

Precordial lead (unipolar)

Kertas EKG

Kertas grafik garis horizontal dan vertical dengan jarak 1 mm.

Garis lebih tebal terdapat pada setiap 5 mm.

Garis horizontal menggambarkan waktu 1 mm = 0,04“ 5mm = 0,20“.

Garis vertikal menggambarkan voltase 1 mm = 0,1 milivolt10 mm = 1 milivolt.

Kecepatan perekaman 25 mm/detik.

Kalibrasi 1 milivolt yang menghasilkan defleksi setinggi 10 mm.

ECG Terminology

P wave : activation of the atria PR interval: duration of AV

conduction QRS complex:activation of right and

left ventricular QRS duration: duration of

ventricular muscle depolarization PP interval: duration of atrial cycle

(an indicator or atrial rate) RR interval: duration of ventricular

cardiac cycle (an indicator of ventricular rate

QT interval: duration of ventricular depolarization and repolarization

ECG REPORTING

1. Rhythm

2. QRS rate

3. Axis

4. P wave

5. PR interval

6. QRS complex

7. QRS duration

8. ST segment

9. T wave

10.Extra systoles

Normal ECG

P wave Width < 0.12 s Height < 0.3 milliVolt Always positive in lead II, negative in

aVR PR interval

From the start of P wave to the start of QRS

Normal duration 0.12 – 0.20 s QRS complex

Width 0.06 – 0.12 s (~ 0.10 s) Length varies among leads Q first negative deflection R first positive deflection S negative deflection after R

ST segment From the end of S to the start of T Normal : iso-electrical

T wave Positive in lead I, II, V3 – V6 and

negative in aVR

ECG REPORTING

1. Rhythm

2. QRS rate

3. Axis

4. P wave

5. PR interval

6. QRS complex

7. QRS duration

8. ST segment

9. T wave

10.Extra systoles

Rhytme

KELA

INA

N

ECG REPORTING

1. Rhythm

2. QRS rate

3. Axis

4. P wave

5. PR interval

6. QRS complex

7. QRS duration

8. ST segment

9. T wave

10.Extra systoles

Determining the Heart Rate

Rule of 300 300/[number of large boxes between two R waves]. only works for regular rhythms !!

300/7.5 large boxes = rate 40

Six second methods Count the number of R-R intervals in six seconds and multiply by 10 Useful for irregular rhythm average rate

There are 8 R-R intervals within 30 boxes. Multiply 8 x 10 = Rate 80

ECG REPORTING

1. Rhythm

2. QRS rate

3. Axis

4. P wave

5. PR interval

6. QRS complex

7. QRS duration

8. ST segment

9. T wave

10.Extra systoles

Axis

Defleksi positif Defleksi negatif

aVF

—

3600

-1800

I

+900

+

00

R A D

L A D

ECG REPORTING

1. Rhythm

2. QRS rate

3. Axis

4. P wave

5. PR interval

6. QRS complex

7. QRS duration

8. ST segment

9. T wave

10.Extra systoles

P morphology

Indicate wave of atrial depolarization Normal characteristic:

1. Smooth and rounded2. Upright in leads I, II, aVF, aVL3. Upright or downward in lead III4. Biphasic in right precordial lead (V1,V2)5. P wave duration: 120 milliseconds

(measured in the widest P wave)6. Amplitude in limb lead: < 0.25 mV and

terminal negative deflection in V1 or V2 < 0.1 mV in depth

P morphology

ECG REPORTING

1. Rhythm

2. QRS rate

3. Axis

4. P wave

5. PR interval

6. QRS complex

7. QRS duration

8. ST segment

9. T wave

10.Extra systoles

PR interval

Mulai dari awal gelombang P sampai dengan permulaan kompleks QRS

Durassi normal 0.12-0.2 detik

PR interval

ECG REPORTING

1. Rhythm

2. QRS rate

3. Axis

4. P wave

5. PR interval

6. QRS complex

7. QRS duration

8. ST segment

9. T wave

10.Extra systoles

QRS duration

Wave of ventricular depolarization 5-20 mm tall Duration 0.06-0.10/0.12 seconds

QRS morphology

qRs Rs R rS

QR Q/QS RsR’ rSr’

Q wave

Any pathological Q wave or not• >1/3 of QRS complex

QR Q/QS

R wave progression

ECG REPORTING

1. Rhythm

2. QRS rate

3. Axis

4. P wave

5. PR interval

6. QRS complex

7. QRS duration

8. ST segment

9. T wave

10.Extra systoles

ST segment

Begins at J point Between ventricular depolarization

and ventricular repolarization Generally isoelectric

J Poin

NON-STEMI / UAP

ECG REPORTING

1. Rhythm

2. QRS rate

3. Axis

4. P wave

5. PR interval

6. QRS complex

7. QRS duration

8. ST segment

9. T wave

10.Extra systoles

T wave

Ventricular repolarization, followed by ventricular relaxation

Positive in lead : I, II, V3-V6 Negative in lead avR

ECG REPORTING

1. Rhythm

2. QRS rate

3. Axis

4. P wave

5. PR interval

6. QRS complex

7. QRS duration

8. ST segment

9. T wave

10.Extra systoles

Sekian

Terima Kasih