Electrocardiography

OVERVIEW

Cardiac Physiology

Electrocardiography

Diagnosing Heart Conditions

Cardiac Physiology Electrocardiography Diagnosis

ARTERIES VEINS
distributes brings blood
blood from back to heart
heart
Cardiac Physiology Electrocardiography Diagnosis

Atria

Ventricles
Cardiac Physiology Electrocardiography Diagnosis

Sinoatrial
Node

Atrioventricular
Node
Electrocardiography (EKG)

• Prinsip Dasar EKG

• EKG Leads
• Interpretasi Basic EKG
 Directions of Ventricular Depolarization
and Repolarization Waves
Depolarization Wave
Repolarization Wave

Base
-
Repolarization
EKG Depolarization
+
Apex
Major Electrical Axis of the Heart

(-) Base

Major Electrical Axis

Apex
(+)
 EKG Leads

• The 12 EKG leads measure the electrical

activity of the heart from 12 different
directions
• Bipolar Leads: Lead I, Lead II, Lead III
• Unipolar Leads: aVR, aVL, aVF
• Precordial Leads: V1, V2, V3, V4, V5, V6
Leads
Precordial leads
Bipolar Leads
- Lead I +
VII = VI + VIII

Right Arm Left Arm

-
Major Electrical Axis -
+
Lead III
+
Right Leg Left Leg
- (Ground)

Lead II +
 Unipolar Lead (aVR)
-
aVR
+
Right Arm Left Arm

Left Leg
 Unipolar Lead (aVL)
+
aVL
-
Right Arm Left Arm

Left Leg
 Unipolar Lead (aVF)

Right Arm Left Arm

-
aVF + Left Leg
 Precordial Leads (V1 to V6)

Right Arm Left Arm

+ V1
+ V2
V3
+
V4
- +
V5
+
V6
+
Left Leg
 Directionality of Bipolar and
Unipolar Leads

aVR aVL

Lead I

Lead II
Lead III
aVF
Directionality of Precordial Leads

Body Cross-section
at Heart Level
Heart
V6

V5
V4
V3
V2
V1
 Basic EKG Interpretation

• EKG Waves (P, QRS, and T waves)

• EKG Intervals (P-R, Q-T intervals)
Cardiac Physiology Electrocardiography Diagnosis
Timing of ECG
 EKG Waves
QRS Complex
(Ventricular Depolarization)

P wave T wave
(Atrial (Ventricular
Depolarization) Repolarization) P wave

One Cardiac Cycle

EKG Intervals P-R Interval = A-V Conduction Time
Q-T Interval = Ventricular Contraction
Time
R-R Interval = Cardiac Cycle Time
Heart Rate = 1/R-R Interval

QRS Complex

P wave T wave P wave

P-R Q-T
Interval Interval
Cardiac Physiology Electrocardiography Diagnosis

P T

Q
S
Cardiac Physiology Electrocardiography Diagnosis

P T

Q
S
Cardiac Physiology Electrocardiography Diagnosis

R 1 sec

P T

Q
S
0.5 Sec
Graphic ECG
ECG Graphic
 Menghitung Heart Rate

• Kecepatan standard =25 mm/sec

• 1 menit : 25x60 =1500/menit
• Kotak besar = 5mm
• 1500/5 =300
• Kotak kecil = 1mm
• 1500/1 =1500
Menghitung Heart Rate

300/6 =50 bpm

Menghitung Heart Rate

300/? =……..bpm
 Mean Electricle Axis
• Cari lead yang paling ‘nol’
• Axisnya adalah yg tegak lurus terhadap
‘nol’
• Garis tegak ini ada + dan -
• Lihat kembali lead ‘nol’
– Bila benar-benar nol = axis
– Bila lebih positif axis 15 derjat dekat ‘nol’
– Bila lebih negatif axis 15 derhat jauh dari ‘nol’
Cardiac Physiology Electrocardiography Diagnosis

P T

Q
S
Cardiac Physiology Electrocardiography Diagnosis

P T

Q
S
Cardiac Physiology Electrocardiography Diagnosis

R 1 sec

P T

Q
S
0.5 Sec
ECG Normal
Rhythm (Irama)

• Sinus
• Arrythmia
Frequency

• Normal
• Tachycardia
• Bradycardia
 Arrythmia

SK
 Arrhytmia

Tachyarrhythmia Bradyarrhytmia
(rate >100 x/min) (rate < 60 X/min)

• QRS sempit (<0.12 ms) • AV blok derajat 1, 2 & 3

• QRS lebar (>0.12 ms) • RBBB & LBBB
 Approach to
electrocardiographic diagnosis

• Duration of QRS

• Regularity of QRS

P wave ??
 QRS complex
Regular / irregular ?

QRS complex
Normal-looking QRS complex?
Wide / narrow ?

P wave ?

Relationship between P and QRS ?

Atrial Flutter :
-The result of a re-entry circuit within
the atria
-Irregular / regular QRS rate
-Narrow QRS complex
-Rapid P waves (300x/min), “sawtooth”
Atrial Flutter
PSVT :
-due to re-entry mechanism
-narrow QRS complex
-regular
-retrograde atrial depolarization
-P wave ?
PSVT (Paroxysmal SupraVentricular Tachyradia)
SVT
SVT
Atrial Fibrillation :

-from multiple area of re-entry within atria

-or from multiple ectopic foci
-irregular, narrow QRS complex
-very rapid atrial electrical activity
(400-700 x/min).
-no uniform atrial depolarization
Atrial Fibrillation :

-from multiple area of re-entry within atria

-or from multiple ectopic foci
-irregular, narrow QRS complex
-very rapid atrial electrical activity
(400-700 x/min).
-no uniform atrial depolarization
Rapid AF
Junctional rhythm:
-AV junction can function as a pace maker
(40-60 x/min).
-due to the failure of sinus node to initiate time
impulse or conduction problem.
-normal-looking QRS.
-retrograde P wave.
-P wave may preceede, coincide with, or
follow the QRS
 Cardiac Physiology Electrocardiography Diagnosis

Preventricular Contractions

• Coffee
• Cigarettes
• Sleep deprivation
• Pathology
Cardiac Physiology Electrocardiography Diagnosis

Normal ECG

ECG with Preventricular Contractions

 VENTRIKEL EXTRA SYSTOLE

SR

VES
 Sinus rhythm
with
Multifocal VES

VES VES

SR SR
SR SR SR SR
Ventricular Tachycardia
VT
Ventricular Fibrillation
Cardiac Physiology Electrocardiography Diagnosis

Normal ECG

ECG during Ventricular Fibrillation

 Cardiac Physiology Electrocardiography Diagnosis

Ventricular Fibrilation
• Ischemia
• Electric Shock
 Bradyarrhytmia
(rate < 60 x/min)

Failure of impulse AV conduction

formation abnormalities
• Sinus Bradycardia • 1st and 2nd AV Block
• Sick Sinus Syndrome • Total AV Block
• BBB (Bundle Branch
Block)
Sick Sinus Syndrome
LBBB
 The
Deadly
Rhythms

PEA
(Pulse less
VT VF A systole
Electrical
Activity)
Cardiac Physiology Electrocardiography Diagnosis

Normal ECG

ECG with Atrioventricular Block

 SUMMARY
• Atria
• Ventricles
Cardiac Physiology
• Nodes
Electrocardiography • Electrical
Propagation

Diagnosing Heart Conditions

 SUMMARY
• ECG
Measurement
Cardiac Physiology • P-Wave
• QRS-Complex
Electrocardiography • T-Wave

Diagnosing Heart Conditions

 SUMMARY

• AV Block
Cardiac Physiology • PVCs
• V-Fib
Electrocardiography

Diagnosing Heart Conditions

 Summary
Cardiac Arrthythmias
• Tachycardia: abnormally fast heart rate
• Bradycardia: Abnormally slow heart rate
• Incomplete Atrioventricular Block:
Prolonged P-R interval
• Complete Atrioventricular Block: P waves
and QRS complexes become dissociated
• Fibrillation: Complete lack of coordination
Dr.MARNA SURYA ISMY, Sp.PD