ECG

Precordial Leads:
 V1: 4th intercostal space of right sternal border
 V2: 4th intercostal space of left sternal border
 V3: halfway between V2 and V4
 V4: 5th intercostal space left midclavicular line.
Subsequent lead at the same plane of V4
 V5: anterior axillary line
 V6: mid axillary line
 V7: posterior axillary line
 V8: posterior scapular line
 V9: left border of the spine
 V3R-V9R: Taken on the right of the chest on the
same location of the left-sided leads.
 INTERPRETASI ECG
Irama
Rate / Frekuensi
QRS / P – AXIS
Gel. P
PR Interval
QRS Complex
VAT
ST Segmen
Gel. T
QT Interval
Gel. U
Voltage Criteria
A normal adult 12-lead ECG
Normal sinus rhythm
each P wave is followed by a QRS
P waves normal for the subject
P wave rate 60 - 100 bpm with <10% variation
rate <60 = sinus bradycardia
rate >100 = sinus tachycardia
variation >10% = sinus arrhythmia
Normal QRS axis
Using leads I and aVF the axis can be calculated to within one of
the four quadrants at a glance.

If the axis is in the "left" quadrant take your second glance at lead II.

both I and aVF +ve = normal axis

both I and aVF -ve = axis in the Northwest Territory
lead I -ve and aVF +ve = right axis deviation
lead I +ve and aVF -ve
lead II +ve = normal axis
lead II -ve = left axis deviation
Normal P waves
 height < 2.5 mm in lead II
 width < 0.11 s in lead II
 for abnormal P waves see right atrial
hypertrophy, left atrial hypertrophy, atrial
premature beat, hyperkalaemia
Normal PR interval
 0.12 to 0.20 s (3 - 5 small squares)
 for short PR segment consider Wolff-
Parkinson-White syndrome or Lown-
Ganong-Levine syndrome (other causes -
Duchenne muscular dystrophy, type II
glycogen storage disease (Pompe's),
HOCM)
 for long PR interval see first degree heart
block and 'trifasicular' block
Normal QRS complex
 < 0.12 s duration (3 small squares)
 for abnormally wide QRS consider right or
left bundle branch block, ventricular rhythm,
hyperkalaemia, etc.
 no pathological Q waves
 no evidence of left or right ventricular
hypertrophy
Normal QT interval
 Calculate the corrected QT interval (QTc) by dividing the
QT interval by the square root of the preceeding R - R
interval. Normal = 0.42 s.
 Causes of long QT interval
myocardial infarction, myocarditis, diffuse myocardial disease
hypocalcaemia, hypothyrodism
subarachnoid haemorrhage, intracerebral haemorrhage
drugs (e.g. sotalol, amiodarone)
hereditary
 Romano Ward syndrome (autosomal dominant)
 Jervill + Lange Nielson syndrome (autosomal recessive) associated
with sensorineural deafness
Normal ST segment
 no elevation or depression
 causes of elevation include acute MI (e.g.
anterior, inferior), left bundle branch block,
normal variants (e.g. athletic heart, Edeiken
pattern, high-take off), acute pericarditis
 causes of depression include myocardial
ischaemia, digoxin effect, ventricular
hypertrophy, acute posterior MI, pulmonary
embolus, left bundle branch block
Normal T wave
 causes of tall T waves include hyperkalaemia,
hyperacute myocardial infarction and left bundle
branch block
 causes of small, flattened or inverted T waves are
numerous and include ischaemia, age, race,
hyperventilation, anxiety, drinking iced water,
LVH, drugs (e.g. digoxin), pericarditis, PE,
intraventricular conduction delay (e.g. RBBB)and
electrolyte disturbance.
P Pulmonale
P Mitrale
LVH
RVH
Unstable Angina Pectoris
(ST depresi di V2-V5)
Acute Anteroseptal Myocardial Infarction
Acute Anterolateral Myocardial Infarction
High Lateral Myocardial Infarction
Acute Inferoposterior Myocardial Infarction
Right Bundle Branch Block
RBBB + Anterior Infarction
SVT
Atrial Fibrillasi (AF)
Torsades de Pointes
Mobitz I
Atrial fibrillation
Atrial flutter
Premature ventricular contraction
Supraventricular tachycardia
Ventricular Flutter
Right Bundle Branch Block
Left Bundle Branch Block
Hipokalemia
A 64 year old lady on digoxin
Hiperkalemia