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Basic EKG
Electrical Physiology
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รูปแสดง เปรียบเทียบ ความสั มพันธ์ ของ EKG, Nerve conduction,BP&Aortic pressure

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AO = aortic valve opening;

AC = aortic valve closing;
LV = left ventricle;
LA = left atrium;
RV = right ventricle;
RA = right atrium; MO = mitral valve
opening.
The phases of the cardiac cycle are
atrial systole (a), isometric contraction
(b), maximal ejection (c), reduced
ejection (d), protodiastolic phase (e),
isometric relaxation (f), rapid inflow
(g), and diastasis, or slow LV filling
(h). For illustrative purposes, time
intervals between valvular events
have been modified, and the z point
has been prolonged.

ส่ วนประกอบต่างๆ ของ EKG เด้อ

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Remark……………………………………………………………………………………………
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PR interval

Normal QRS complex=……………………………………………………………………

QT interval

RR interval

Basic EKG interpretation

1.Rate
Regular rate 
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If Irregular rate 

2.Rhythm Regular or Irregular

Arrhythmia
Theory of Tachyarrhythmia
-Abnormal impulse formation
-Enhance normal automaticity: auto phase 4 depolarization
SA,AV node,His –Purkinje
** resting membrane potential,threshold potential,slope of phase 4 depol
-Abnormal automaticity
Myocardial [Atrial &Ventricle] irritability  generate impulse
-Trigger activity
-Early after depolarization
ex. Torsade de point[Polymorphic ventricular tachycardia]
Prolong QT syndrome,brady or phase dependent antiarrhythemic drug
-Delay after depolarization
ex. digitalis toxicity
-Abnormal impulse conduction
Reentry
-Classical reentry
slow conduction zone[unidirectional block]

-Random reentry:AF

Bradyarrhythmia
- SA block ,Sinus pause ,sinus arrest and Sickness Sinus Syndrome
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-AV block
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-Bundle branch block

3.Axis
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Note………………………………………………………………………………………………
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4.Chamber enlagement
Atrium

Note………………………………………………………………………………………………
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Ventricle
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Rt Ventricular :
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Lt Ventricular :
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Strain pattern
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5.Ischemic pattern
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-Injury
ST segment change

ST depressed & ST elevated

Note………………………………………………………………………………………………
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Schema of the shape of ST-segment elevation. (A),

Concave type. (B), Straight type. (C), Convex type.
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1. Upsloping ST segment depression.

2. ST segment convex depression.
3. ST segment horizontal depression.
It should be measured at the Y point,
at 80 ms from the J point (J80).
4.ST segment downward depression..
5. ST segment elevation. It should be
measured at the Y point, at 40 ms from
the J point (J40).

Reciprocal change=……………………………………………………………………….

Region of ST Elevation Region of ST Depression

Anterior (leads V1-V4) Inferior (true posterior)
Inferior (leads II, III, aVF) Anterior (leads V1-V3 or lateral lead 1. aVL)
Lateral ( leads I, aVF, V5, V6) Inferior ( leads II, III, aVF)
True Posterior Anterior (leads V1-V3)
-Ischemia
Inverted T
Ischemia is suggested by symmetric T wave inversion, especially when seen in
two or more leads of a group

-Infarction
Q wave pathological Q wave
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Vascular supply of The Heart

Blood supply to Cardiac wall

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Anatomical relationship of leads

 Inferior wall—Leads II, III, and aVF
 Anteroseptal wall—Leads V1 to V4 [Septal wall V1-V2,Anterior wall V3-V4]
 Lateral wall—Leads I, aVL, V5, and V6

Non-standard leads
Right ventricle—Right sided chest leads V1R to V6R
Posterior wall—Leads V7 to V9

. Posterior wall infarction Isolated posterior infarction

with no associated inferior changes (note ST segment
depression in leads V1 to V3)
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The ECG does not have a lead that faces directly to the posterior wall of the heart. However, abnormalities of
depolarisation will cause reciprocal or mirror changes in the anterior leads. The important leads are V1,2,3 of which
V2 is the most important. The 3 classical changes to be sought are:

1.A tall and slightly wide R wave.

2.There should be, in theory, elevation of the ST segment but in
practice it is usually very slight if at all.
3.There must be a high T wave in V2. This is essential and without it the diagnosis is unsafe.
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Abnormal EKG ที่ควร

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