Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Circulation
system
Electrocardiography
P. Pujowaskito
Electrocardiography
Electrical phenomena, science
Simple, cheap, usefull but limited
Almost all arrhythmias
Infarction or ischaemia
LVH
Electrolyte imbalance
The unipolar
limb leads
and their
axes
Locations of unipolar
precordial leads
ECG Information
Lateral
I, AVL,
V5-V6
Inferior
II, III, aVF
Anterior /
Septal
V1-V4
PED 596
ECG recording
Electrical phenomena
Electrical phenomena
Recording
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
ELEKTROKARDIOGRAM
N a m a : .........
Kalibrasi : voltase...mV, speedmm/detik
Heart rate : .............../minute, teratur tidak teratur
rhythm
: ..............................
Gelombang P
Kontour : normal tidak normal, Alasan:.......................................................
Konfigurasi: normal tidak normal, Alasan: ..................................................
Durasi : detik normal tidak normal
Amplitudo: mV normal tidak normal
PR interval detik normal tidak normal
Konfigurasi gelombang Q: normal tidak normal, Alasan:.......................................
Kompleks QRS:
Durasi : normal tidak normal, Alasan:...........................................................
Axis : .....derajat Normal LAD RAD Superior
Konfigurasi: normal tidak normal, Alasan:.....................................................
Segmen ST : normal tidak normal, Alasan:....................................................
Gelombang T : normal tidak normal, Alasan:....................................................
Gelombang U : normal tidak normal, Alasan:...................................................
QTc
: ................................detik normal tidak normal
Index hipertrofi ventrikel:
LVH: Score Romhilt-estes: ............................................................
................................. normal tidak normal
RVH: R/S ratio di V1: ............................. normal tidak normal
Kesimpulan:
ECG paper
Small box
: 1 x 1 mm : 0.1 mV x 0.04 s
: 25 x 25 mm : 2.5 mV x 1 s
S1
Start
75
60
50
43
38
Amplitudo: voltase
Pace maker
Rhythm
Sinus Rhythm
ISO ELECTRICE
Durasi
Rhythm
Amplitudo: voltase
Pace maker
ISO ELECTRICE
Durasi
Junctional
Rhythm
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: infarction area
-lead V1-V4 : anteroseptal
-lead V1-V6, I and aVL : anterior extensive
-lead V4-V6, I and aVL : anterolateral
-lead V3-V5 : anterior
-lead II,III and aVF : inferior
-lead I and aVL : high lateral
-Mirror image of V1-V3 to horisontal line: true posterior
The significance of Q for old infarction if more than 1 lead
QRS
complex
Capital letter for deflection < 5mm
(Q,R,S),
Small letter for deflection < 5mm
(q,r,s).
QRS complex could be variable
Duration:
normal: < 0.12s (narrow QRS)
abnormal: < 0.12s (wide
QRS/bizare)
Genesis of left
ventricular epicardial
complex
Genesis of right
ventricular epicardial
complex
Genesis of
transitional zone
ventricular epicardial
complex
Genesis of right
ventricular
cavity complex
Determination of
axis deviation
ST Segment
Depol.
Repol.
Restoration of
ionic balance
Normal: Isoelektris
Abnormal:
- Elevation: < 1mm
- Depression: horizontal
downsloping,
upsloping
< 1mm was significant;
deeper: more specific
T Wave
Nomogram for
rate correction of
Q-T interval
Bazetts formula
QTc = QT
R-R
U Wave
Normal: unpresent U wave
(interferrence with T wave).
Abnormal: prominent U wave,
particularly in V2 and V3
(suspect hypokalemia)
LEFT
ATRIAL
HYPERTROPHY
Wide P Interval 0.12s at
lead II and notched (two
peak)
P wave with negative
terminal deflection at V1,
duration 0.04s and
deeper 1 mm
P wave of left atrial
abnormality was called P
Mitral
Score
3
3
3
2
1
Diagnosis
1Basic rhythm: sinus, junctional, Ventricular, Atrial
Fibrillation (AF),
Ventricular Fibrillation (VF), SupraVentricular Tachycardia (SVT), Ventricular Tachycardia (VT)
2. Heart rate
3. QRS complex axis
4. Abnormality
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
13th Block
Circulation
system
TQ, 4 your
attention
2009 General Ahmad Yani University
Refference
1Ferry DR. ECG In 10 Days. Second Edition. Singapore:
Mc Graw Hill; 2007. p. 37-93 and 151-193.
2Mirvis DM, Goldberger AL. Electrocardiography. In:
Braunwalds
Heart
Disease,
A
Textbook
of
Cardiovascular Medicine. Eighth Edition. Philadelphia:
Saunders Elsevier; 2008. p. 155-183.
3Pratanu S. Buku Pedoman Kursus Elektrokardiografi.
Surabaya; PT. Karya Pembina Swajaya; 2000. h. 19-36.
4The Alan E. Lindsay. ECG Learning Center in
Cyberspace.
http://library.med.utah.edu/kw/ecg/image_index