HOW TO READ

ELECTROCARDIOGRAPHY
Department of Cardiology and Vascular Medicine
Faculty of Medicine University of Indonesia
National Cardiovascular Center Harapan Kita
Aryo Soeryo Kuncoro, MD, FIHA
How to read ECG
Anatomy and electrophysiology of the
heart
The purpose of ECG recording
ABC of ECG recording
Interpretation of normal ECG
Normal variant

Anatomy and electrophysiology of
the heart
Anatomy of THE HEART
V
6
V
5


V
4


V
3
V
2
V
1


V
6R
V
5R


V
4R


V
3R
Midclavicular line

Anterior axillary line

Midaxillary line

Unipolar Precodial (Chest) Leads
Mervin J. Goldman, MD. 11
th
edition Principles of clinical Electrocardiography. Clinical Professor of Medicine University of
California School of Medicine San Francisco @1995-1982
V
7
V
8
V
9
V
9R
V
8R
V
7R
Horizontal plane of V
4-6
Unipolar Precodial (Chest) Leads
Mervin J. Goldman, MD. 11
th
edition Principles of clinical Electrocardiography. Clinical Professor of Medicine University of
California School of Medicine San Francisco @1995-1982
ATTACHMENT OF THE LEADS
EINTHOVENS TRIANGLE
The purpose of ECG recording
Morphology of ECG tracing
Is any abnormality of P wave, QRS complex, ST, T wave
Hypertrophy?
Ischemia/infarction
Electrolyte imbalance
Disturbance of AVN, specific disease (Brugada, Long QT,WPW
syndrome)
To look whether any rhythm disturbance (arrhythmias)
Normal
Abnormal
Irregular
Bradycardia
Tachycardia
P wave
Absent (really absent or buried within QRS complex)
Present
Axis
Normal (its vector, from upper right to lower left)
Abnormal
Its vector goes up (it is retrograde from the ventricle or abnormal site of
its origin)
Morphology
Normal morphology
Abnormal morphology (LAH, RAH)
Rate
Regular (normal, brady or tachy)
Irregular (atrial extra systole oratrial fibrillation)

CARA MENGHITUNG HEART RATE
2. RHYTHM
Karakteristik Sinus Ritme:
Rate : 60-100x/menit
Ritme : Interval P-P regular, interval R-R reguler
Gelombang P : Positif (upright) di lead II, selalu diikuti kompleks QRS
PR interval : 0.12-0.20 detik dan konstan dari beat to beat
Durasi QRS : kurang dari 0.10 detik kecuali ada gangguan konduksi
intraventrikel
3. AXIS
4. HYPERTROPHIC SIGNS
5. MYOCARDIAL ISCHEMIA OR
INFARCTION
Ischemia
Injury
Necrosis
6. ARRHYTHMIA
WHATS WRONG??
Lead Error: V1 and V3 are Transposed!
In this normal 12-lead ECG the V1 and V3 chest electrodes are
interchanged. Experienced ECG interpreters should be able to spot this
lead placement error.

DISCUSSION
Sinus arrhythmia
Limb lead reversal
Early repolarization
Subendocardial ischemia.
Anterolateral ST-segment depression
Unstable angina
acute anterolateral myocardial infarction
High lateral infarction
Lateral myocardial infarction
Right ventricular infarction
Acute inferoposterior myocardial infarction
left ventricular aneurysm
Mobitz I
High-grade atrioventricular block
Wolff-Parkinson-White syndrome
Wolff-Parkinson-White syndrome
Atrial fibrillation
Atrial flutter
premature ventricular contraction
Supraventricular tachycardia
Wide complex tachycardia
Ventricular flutter
Idioventricular rhythm