HOW TO READ

ELECTROCARDIOGRAPHY

Department of Cardiology and Vascular Medicine

Faculty of Medicine University of Indonesia
National Cardiovascular Center Harapan Kita
Unipolar Precodial (Chest)
Midclavicula
Leads
r line
Anterior
axillary line
Midaxillary
line

V6
V6
R V5 V5
R V4 V4
V3 V3
R V2
R
V1

Mervin J. Goldman, MD. 11th edition Principles of clinical Electrocardiography. Clinical Professor of Medicine University of
California School of Medicine San Francisco @1995-1982
Unipolar Precodial (Chest) Leads

Horizontal plane of V4-6

V7 V8 V9 V9RV8RV7R

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) illustrates
conduction of electrical
impulses in the heart.
The depolarization of the
ventricles occurs from
the endocardium
(inside) to the
epicardium (outside)
[e]
The repolarization of the
ventricles occurs in the
opposite direction. [g]
ECG INTERPRETATION
1. RATE
2. RHYTHM
3. AXIS
4. HIPERTROPHIC SIGNS
5. MYOCARDIAL INFARCTION
6. 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
WHATS 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