Ecg Presentation 2013
Ecg Presentation 2013
Ecg Presentation 2013
Definition
ECG lead
+/-
II
III
Precordial lead
ECG Terminology
Normal ECG
P wave
Width < 0.12 s
Height < 0.3 milliVolt
Always positive in lead II, negative in
aVR
PR interval
From the start of P wave to the start of
QRS
Normal duration 0.12 0.20 s
QRS complex
Width 0.06 0.12 s (~ 0.10 s)
Length varies among leads
Q first negative deflection
R first positive deflection
S negative deflection after R
ST segment
From the end of S to the start of T
Normal : iso-electrical
T wave
Positive in lead I, II, V3 V6 and
negative in aVR
Normal ECG
Basic interpretation
Rate
Rhythm
Axis
P wave morphology
PR interval
QRS complex morphology
ST segment morphology
T wave morphology
U wave morphology
QTc interval
Rule of 300
Source of depolarization
Normal ECG
Axis
Defleksi positif
Defleksi negatif
ECG abnormalities
Hypertrophy
Ischemia/infarct
Arrhythmia
Hypertrophy
peaked p wave
Ventricular Hypertrophy
di V1 + R di V5 atau V6 > 35 mm
R di V5 atau V6 > 26 mm
R + S di lead precordial > 45 mm
RVH
R/S
R in V5 > 26 mm
Infarct / Ischemia
Evolution of MI
I, aVL, V5
V2-V4
Arrhythmia
Classification
Supraventrivular
Ventricular
arrythmia
AV
arrythmia
conduction abnormalities
Rhythm
Rhythm Guidelines:
Check
the bottom rhythm strip for regularity, i.e. regular, regularly irregular, and irregularly irregular.
Check for a P wave before each QRS, QRS after
each P.
Check PR interval (for AV blocks) and QRS (for
bundle branch blocks). Check for prolonged QT.
Recognize "patterns" such as atrial fibrillation, PVC's,
PAC's, escape beats, ventricular tachycardia,
paroxysmal atrial tachycardia, AV blocks and bundle
branch blocks
Blocks
SA node block
Failure
AV node block
Block
Blocks
Blocks
Blocks
RBBB
Complete
Incomplete
rSR complex in lead V1
QRS duration of 0.12 s or less
R or S waves are not broad or
slurred
Normal QRS axis
LBBB
Complete
LAFB
Criteria
LPFB
Criteria
QRS
Supraventricular Arrythmia
Atrial fibrillation
Supraventricular
Atrial flutter
Ventricular Arrythmia
Ventricular tachycardia
Sustained (lasting >30 sec) vs. nonsustained
Ventricular
Ventricular fibrillation
Chaotic,