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Erwan Martanto
Division of Cardiology and Vaskular Disease
Sub Division of Cardiology Div of Internal Medicine
FK UNPAD - BANDUNG
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Usage of ECG
Twelve leads ECG shows:
1. ECG within normal limit
2. Rhytm distubances3. Conduction defects
4. Chamber enlargement
5. Inflamation, ischemia, infarct
6. Any abnormality/ pathologic conditionwhich affect the heart
Willem Einthoven, (1903)
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Measurement of electric current within the heart
0
+-
0
+-
0
+-
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Bipolar standard leads I, II, III
I
IIIII
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Bipolar standard leads I, II, III +
Augmented leads aVR, aVL, aVF
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Hexaxial system
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Horizontal plane electrocardiographic patterns
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EKG NORMAL Precordial leads V1- V6
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Genesis of leftventricular epicardial
complex
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Genesis of rightventricular epicardial
complex
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Genesis oftransitional zone
ventricular epicardialcomplex
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Genesis of right
ventricularcavity complex
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(SAN)
(AVN)
(BB)
(BB)
(HB)RA
LA
V
V
SAN
RA
LA
AVN
HB
BB
V
.Formation of the major deflection in the ECG
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Mesin EKG Kuno Mesin EKG Modern
ECG machine, ECG paper, Electrodes, Jelly
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Horizontal Axis : Time 1 mm : 0,04 sec 5 mm : 0,20 sec
Vertical Axis : Voltage (amplitudo), 1 cm: 1 mV
Standard speed 25 mm/second
ECG paper.
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Calibration.
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1. Identity, date, sex, technician2. Rhytm ( & Regularitas)
3. Axis
4. QRS rate / Heart rate
5. PR interval
6. Morfology of:
P wave
QRS complex
ST segment
T wave
U wave
7. QTc interval
ECG interpretation.
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Sinus rhytm : Each P wave followed by QRS complex
Normal ECG always has a regular R-R..
Rhytm, QRS rate & regularity .
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Heart Rate .
X mm
HEARTRATE = 1500/ X = bpm
Quick step:
R R = X large box
HR = 300 : X
art rate :1500 divided by sum of small boxesbetween 2 concecutive R
300 divided by sum of large boxesbetween 2 consecutive R
rmal : 60-100 bpm
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Normal Axis.
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Normal Axis.
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Normal Axis.
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Axis .
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Normal Axis.
Normal : - 30 to + 110
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Left Axis Deviation
LAD : - 30 to 90
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Right Axis Deviation.
RAD : > + 110 to + 180
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PR interval .
normal PR interval
0.12 to 0.20 s (3 - 5 small squares)
for short PR segment considerWolff-Parkinson-
White syndrome orLown-Ganong-Levine syndrome
(other causes - Duchenne muscular dystrophy, typeII glycogen storage disease (Pompe's), HOCM)
for long PR interval see first degree heart blockand
'trifasicular' block
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Abnormal PR interval .
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Smooth and monophasic
Should be Positive in 1,aVL,aVF, V5,V6
Widht : Less than 3 small boxes (0,12 sec)
Height : Less than 2.5 mm ( 0,25 mV)
P wave .
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Abnormal P wave .
Biphasic P wave
Tall P wave
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Has an important role in clinical practice
Occurred during ventricle depolarisation
Consist of 3 components Q wave
Negative deflection before R wave
R wave The first positive deflection
S wave Negative deflection after R wave
Shape and directions depends on the ventricle depolarisation
current Each lead may record various shape of QRS complex
Duration < 0,12 sec
QRS complex.
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Nomenclature of QRS .
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Abnormal : Q wave in V1,V2, & V3
normal (small) Q wave may be present in
other leads
Patologic Q wave
width >0,04 depth > 1/3 R
Q wave .
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Abnormal Q wave .
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Should be positive in all leads except in avR Precordial leads: R-wave progression R wave < S wave in V1-2
R wave in V6 < 25 mm R V6 + S V1 < 35 mm
Prominent S wave in V1 and diminish gradually
R & S wave .
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Abnormal R wave in V1 .
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Normal : isoelectric
Various in shape
Any depression or elevation = CAD ?
ST segment.
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ST Segment .
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Normal ST-segment deviation
ST Segment .
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ST segment .
elevation
depresion
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Appear after T wave particularly in V1-2 (not always)
- Hypokalemia, CVA
U wave .
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normal QT interval Calculate the corrected QT interval
(QTc) = QT interval : RR interval
Normal = 0.42 s.
QT interval .
Id tit ?
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Exercise .Identity : ?
Calibration : ?
Speed : ?
Date : ?
Technician : ?
Rhytm : ?
Axis :
Heart Rate : ?
QRS conf : ?
ST segment : ?
T wave : ?
Conclusion : ?