Abnormal ECG

Yogi PR, MD, FIHA

Sinus Bradycardia
Rate : Less than 60 beats per minute
Rhythm : Regular
P waves : normal
PR interval : normal
Sinus Tachycardia
Rate : More than 100 beats per minute
Rhythm : Regular
P waves : normal
PR interval : normal
Atriovenrticular (AV) block 1st degree
Rhythm : Atrial and ventricular regular
P waves : Normal in size and shape
PR interval : Prolonged (greater than 0.20 second) but constant
 AV block nd
2 degree
• Type I (Wenckebach) / Mobitz I
Rhythm : Atrial regular (P’s plot through), Ventricular irregular.
P waves : Normal in size and shape. Some P waves are not followed by a
QRS complex (more P’s than QRS’s).
PR interval : Lengthens with each cycle (although lengthening may be very
slight), until a P wave appears without a QRS complex
 AV block nd
2 degree
• Type II / Mobitz II
Rate : Atrial rate is greater than the ventricular rate. Ventricular rate is
often slow.
Rhythm : Atrial regular (P’s plot through) Ventricular irregular.
P waves : Normal in size and shape. Some P waves are not followed by a QRS
complex (more P’s than QRS’s).
PR interval : Within normal limits or prolonged but always constant for the
conducted beats.
 AV block 3rd degree / Total AV block
Rate : Atrial rate is greater than the ventricular rate.
Rhythm : Atrial regular (P’s plot through). Ventricular regular. There is no
relationship between the atrial and ventricular rhythm.
P wave : Normal in size and shape.
PR inteval : None – the atria and ventricles beat independently of each other,
thus there is no true PR interval.
Right Bundle Branch Block (RBBB)
• Characteristics : rSR’ di V1/V2 dan qRS di V5/V6
• QRS : > 0,12 s (complete) ; 0.10-0.12 (incomplete)
 Left Bundle Branch Block (LBBB)
• Characteristics : Deep and broad S wave di V1/V2 , Broad & clumsy di V5/V6
• QRS : > 0,12 s (complete) ; 0.10-0.12 (incomplete)
 Supraventricular tachycardia (SVT)
• Rhythm : Regular
• Rate : 150-220 bpm
• P wave : Difficult to determine,
maybe hidden
• PR interval : Normal or shortened
• QRS complex : Normal
 Atrial Fibrilation
• Rhythm : Irregular
• Rate : Rapid ventricular response,
Normal ventricular response,
Slow ventricular response
• P wave : Fibrillatory (fine to course)
• PR interval : not available
 Atrial Flutter
• Rhythm : Regular or variable
• Rate : atrial rate 220 – 430 bpm
• P wave : sawtoothed appearance
• PR interval : not available
 Left Ventricular hypertrophy
• Sokolow-Lyon
 S di V1 + R di V5 atau V6 > 35 mm
• Cornell voltage
 S di V3 + R di aVL > 28 mm (pria) ,
20 mm (wanita)
 R di lead I + S di lead III > 25 mm
 R di aVL > 11 mm
• Romhilt-Estes ?
 Right Ventricular hypertrophy
• R wave > S wave di V1 atau
R di V1 > 7 mm
• Right axis deviation
• Deep S di V5 dan V6
Left atrial enlargement (LAE)
• P mitrale
• QRS durasi > 0.08 s
• P negative terminale
force di V1
Right atrial enlargement (RAE)
• P pulmonale
• Tinggi P > 2.5 mm
 ECG pada acute coronary syndrome
• ST elevasi
 ECG pada acute coronary syndrome

• ST depresi
Supra Ventricular extra systole (SVES) / Premature atrial complex (PAC)
• P waves : premature and abnormal
• QRS : narrow ( <0.12s)
Ventricular extra systole (VES) / Premature ventricular complex (PVC)
• P waves : no P waves preceding the PVC
• QRS : wide and bizarre
Ventricular tachycardia (VT)
• Rate : 120-250 bpm
• P waves : No p waves kecuali pada AV disosiasi
• QRS : ≥ 0.12 s
 Ventricular fibrilation (VF)
Rate : Cannot be determined since there are no discernible waves or
complexes to measure
Rhythm : Rapid and chaotic with no pattern or regularity
ECG in hyperkalemia
Wolf-Parkinson-White (WPW)
• Short PR interval ( < 0.12 s)
• Delta wave
• QRS duration > 0.12 s
 Torsade de pointes
• Cause :
• Long QT syndrome
• Hypomagnesemia
• Drug : quinidine,
erhytromycine
• Myocardial
infarction