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ECG interpretation
Quality of ECG?
Rate
Rhythm
Axis
P wave
PR interval
QRS duration
QRS morphology
Abnormal Q waves
ST segment
T wave
QT interval
Patient name
Date of the ECG
Is there any interference?
Is there electrical activity from all 12
leads?
Calibration:
- speed = 25mm/second
- height = 1cm/mV (10mm/mV)
Horizontally
Vertically
3 sec
Calibration
Calibration
ECG interpretation
Quality of ECG?
Rate
Rhythm
Axis
P wave
PR interval
QRS duration
QRS morphology
Abnormal Q waves
ST segment
T wave
QT interval
Rhythm Analysis
Step
Step
Step
Step
Step
1:Calculate rate.
2:Determine regularity.
3:Assess the P waves.
4:Determine PR interval.
5:Determine QRS duration.
3 sec
Option 1
Interpretation? 9 x 10 = 90 bpm
Option 2
Option 2 (cont)
Rate
Differential Diagnosis of
Tachycardia
Tachycardi Narrow
a
Complex
ST
Regular
SVT
Atrial flutter
Wide Complex
ST w/
aberrancy
SVT w/
aberrancy
VT
Irregular
A-fib
A-flutter w/
variable
conduction
A-fib w/
aberrancy
A-fib w/ WPW
Rate
Step 2: Determine
regularity
R
Interpretation?
Regular
P-Wave:
SA Node
AV
Node
LA/RA
Depol
1/QRS?
Step 4: Determine PR
interval
Interpretation?
0.12 seconds
Interpretation?
0.08 seconds
Sinus Rythm
Mattu, 2003
Rhythm Summary
Rate
Regularity
P waves
PR interval
QRS duration
Interpretation?
90-95 bpm
regular
normal
0.12 s
0.08 s
Gelombang P
Tidak Ada
Ada / Normal
Komplek QRS
Diikuti QRS
PR Interval
Normal
Irama
Teratur
Frekwensi
Memanjang
AV Blok
Tidak Teratur
Atrial Flutter
Sinus Aritmia
< 60 x/mnt
60-100 x/mnt
Sinus
Bradikardi
Sinus Rhythm
Sinus Takikardi
Sempit
Lebar
Atrial Takikardi/
Supra ventricular
takikardi
Irama
Teratur
Tidak teratur
Ventrikel
takikardi
Ventrikel fibrilasi
Atrial Fibrilasi
N
o
Jenis
Irama
3.
Ciri Utama
Contoh
Irama
sinus
Nodus
sinoatrial
(NSA)
Adanya P diikuti
QRS
Irama
atrial
Sel-sel atrial
Irama
juncti
onal
Nodus
P
atrioventrikul hilang/inversi
er
/mundur
Takikardi (>60),
ekstrasistol, junctional
Irama
ventri
Sel-sel
ventrikuler
Takikardi, ventrikular,
ekstrasistol, flutter,
1.
2.
Pemacu
dominan
P menghilang,
jika ada biasanya
Types of Arryhthmias:
Sinus Problems: Formed in the
sinus node, but irregular
Ectopic Problems: Formed outside
of the sinus node
Conduction Problems: Formed in
the sinus node, but conduction in
error
Pre-Excitation Problems: Short
circuits in normal conduction
Causes of
Hypoxia: Lung disease
Arrhytmias:
Sinus bradikardi
Sinus takikardi
VT
Ventrikel flutter
Ventrikel fibrilasi
SVT
VT
Axis
Axis
Axis
Positive in I and
aVF = NORMAL
Positive in I and
negative in aVF =
LAD
Negative in I and
positive in aVF =
RAD
Kondisi-kondisi yang
ditandai perubahan axis
ECG interpretation
Quality of ECG?
Rate
Rhythm
Axis
P wave
PR interval
QRS duration
QRS morphology
Abnormal Q waves
ST segment
T wave
QT interval
Gelombang P
Mewakili
depolarisasi otot
atrium
Normal: Kecil,
melengkung
Tinggi < 2,5 mm,
lebar < 0.11 dtk
P wave
P mitrale
P pulmonale
PR interval
ECG interpretation
Quality of ECG?
Rate
Rhythm
Axis
P wave
PR interval
QRS duration
QRS morphology
Abnormal Q waves
ST segment
T wave
QT interval
Mewakili depolarisasi
otot ventrikel
Gel Q: defleksi I,
<0,03 dtk, <25 %
tinggi R
Gel R: defleksi + I
Gel S: defleksi
mengikuti R
Lebar Kompleks QRS:
0,04 0,10 dtk
QRS complex
QRS complex
W I LL ia m = LBBB
Monophasic R wave in I and V6, QRS
> 0.12 sec
Loss of R wave in precordial leads
QRS T wave discordance I, V1, V6
Consider cardiac ischemia if a new
finding
M a RR o w = RBBB
V1: RSR prime pattern with
inverted T wave
V6: Wide deep slurred S wave
QRS complex
Is there LVH?
Q waves
Lebar >1kk
Dalam >2kk
(>1/3 R)
ECG interpretation
Quality of ECG?
Rate
Rhythm
Axis
P wave
PR interval
QRS duration
QRS morphology
Abnormal Q waves
ST segment
T wave
QT interval
ST segment
ST depression
- downsloping or horizontal =
ABNORMAL
ST elevation
- infarction
- pericarditis (widespread)
ST segment
ST segment
ST segment
EKG Distributions
Lateral MI
Reciprocal changes
Inferolateral MI
Anterolateral / Inferior
Ischemia
Mewakili repolarirasi
otot ventrikel
Tinggi: < 5 mm pd
lead di ekstremitas
< 10 mm pd lead di
precordial
Bentuk: melengkung
& sedikit Asismetris
T wave
Small = hypokalaemia
Tall = hyperkalaemia
Inverted/biphasic =
ischaemia/previous infarct
T wave
T wave
T wave
Gelombang kecil
melengkung, kadang2
mengikuti gel T
Sering dijumpai pd lead
V2-V3
Tinggi: 10 % tinggi gel T
Merupakan bagian dr
repolarisasi ventrikel dan
menunjukkan repolarisasi
serat purkinje
QT interval
QT interval
Normal Intervals
PR
QRS
QT
Torsades de Pointes
Wolff-Parkinson-White
Syndrome
Hyperkalemia
Hypokalemia
U waves
Can also see PVCs, ST depression, small T waves
Digitalis