ECG Normal - Erwan

8/7/2019 ECG Normal - Erwan

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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 : ?

ECG Normal - Erwan

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