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Yandi Ariffudin, dr
Overview ecg
-       +/-




    +
Menggunakan terminal sentral sebagai titik nol
Overview ecg
Overview ecg
Overview ecg
Overview ecg
 Kertas grafik garis horizontal
    dan vertical dengan jarak 1 mm.
   Garis lebih tebal terdapat pada
    setiap 5 mm.
   Garis horizontal
    menggambarkan waktu
    1 mm = 0,04
    5mm = 0,20.
   Garis vertikal menggambarkan
    voltase
    1 mm = 0,1 milivolt
    10 mm = 1 milivolt.
   Kecepatan perekaman 25
    mm/detik.
   Kalibrasi 1 milivolt yang
    menghasilkan defleksi setinggi
    10 mm.
Overview ecg
Overview ecg
   P wave : activation of the atria
   PR interval: duration of AV
    conduction
   QRS complex:activation of right and
    left ventricular
   QRS duration: duration of ventricular
    muscle depolarization
   PP interval: duration of atrial cycle
    (an indicator or atrial rate)
   RR interval: duration of ventricular
    cardiac cycle (an indicator of
    ventricular rate
   QT interval: duration of ventricular
    depolarization and repolarization
Overview ecg
ECG REPORTING


1. Rhythm
2. QRS rate
3. Axis
4. P wave
5. PR interval
6. QRS complex
7. QRS duration
8. ST segment
9. T wave
10. Extra systoles
   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
ECG REPORTING


1. Rhythm
2. QRS rate
3. Axis
4. P wave
5. PR interval
6. QRS complex
7. QRS duration
8. ST segment
9. T wave
10. Extra systoles
Overview ecg
KELAINAN
Overview ecg
Overview ecg
Overview ecg
Overview ecg
Overview ecg
Overview ecg
Overview ecg
Overview ecg
ECG REPORTING


1. Rhythm
2. QRS rate
3. Axis
4. P wave
5. PR interval
6. QRS complex
7. QRS duration
8. ST segment
9. T wave
10. Extra systoles
 Rule of 300
   300/[number of large boxes between two R waves].
   only works for regular rhythms !!




                                                  300/7.5 large boxes = rate 40




   Six second methods
       Count the number of R-R intervals in six seconds and multiply by
        10
       Useful for irregular rhythm  average rate

                                                         There are 8 R-R intervals
                                                         within 30 boxes. Multiply 8 x
                                                         10 = Rate 80
ECG REPORTING


1. Rhythm
2. QRS rate
3. Axis
4. P wave
5. PR interval
6. QRS complex
7. QRS duration
8. ST segment
9. T wave
10. Extra systoles
Overview ecg
Defleksi positif   Defleksi negatif
Overview ecg


             3600




                    I

                        +
 -
1800                    00




       aVF

              +
              900
Overview ecg
Overview ecg
Overview ecg
Overview ecg
ECG REPORTING


1. Rhythm
2. QRS rate
3. Axis
4. P wave
5. PR interval
6. QRS complex
7. QRS duration
8. ST segment
9. T wave
10. Extra systoles
 Indicate wave of atrial depolarization
 Normal characteristic:
  1. Smooth and rounded
  2. Upright in leads I, II, aVF, aVL
  3. Upright or downward in lead III
  4. Biphasic in right precordial lead (V1,V2)
  5. P wave duration: 120 milliseconds (measured in
     the widest P wave)
  6. Amplitude in limb lead: < 0.25 mV and terminal
     negative deflection in V1 or V2 < 0.1 mV in depth
Overview ecg
Overview ecg
ECG REPORTING


1. Rhythm
2. QRS rate
3. Axis
4. P wave
5. PR interval
6. QRS complex
7. QRS duration
8. ST segment
9. T wave
10. Extra systoles
 Mulai dari awal gelombang P sampai dengan
  permulaan kompleks QRS
 Durassi normal 0.12-0.2 detik
Overview ecg
Overview ecg
Overview ecg
Overview ecg
Overview ecg
ECG REPORTING


1. Rhythm
2. QRS rate
3. Axis
4. P wave
5. PR interval
6. QRS complex
7. QRS duration
8. ST segment
9. T wave
10. Extra systoles
 Wave of ventricular depolarization
 5-20 mm tall
 Duration 0.06-0.10/0.12 seconds
Overview ecg
QRS morphology
  qRs      Rs       R   rS




 QR     Q/QS            rSr
                 RsR
 Any pathological Q wave or not
     >1/3 of QRS complex




      QR        Q/QS
Overview ecg
Overview ecg
Overview ecg
Overview ecg
Overview ecg
ECG REPORTING


1. Rhythm
2. QRS rate
3. Axis
4. P wave
5. PR interval
6. QRS complex
7. QRS duration
8. ST segment
9. T wave
10. Extra systoles
 Begins at J point
 Between ventricular depolarization and
  ventricular repolarization
 Generally isoelectric
J Poin
Overview ecg
Overview ecg
Overview ecg
Overview ecg
Overview ecg
Overview ecg
NON-STEMI / UAP
ECG REPORTING


1. Rhythm
2. QRS rate
3. Axis
4. P wave
5. PR interval
6. QRS complex
7. QRS duration
8. ST segment
9. T wave
10. Extra systoles
 Ventricular repolarization, followed by
  ventricular relaxation
 Positive in lead : I, II, V3-V6
 Negative in lead avR
Overview ecg
ECG REPORTING


1. Rhythm
2. QRS rate
3. Axis
4. P wave
5. PR interval
6. QRS complex
7. QRS duration
8. ST segment
9. T wave
10. Extra systoles
Overview ecg
Overview ecg
Overview ecg
Overview ecg
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Overview ecg

  • 3. - +/- +
  • 4. Menggunakan terminal sentral sebagai titik nol
  • 9. Kertas grafik garis horizontal dan vertical dengan jarak 1 mm. Garis lebih tebal terdapat pada setiap 5 mm. Garis horizontal menggambarkan waktu 1 mm = 0,04 5mm = 0,20. Garis vertikal menggambarkan voltase 1 mm = 0,1 milivolt 10 mm = 1 milivolt. Kecepatan perekaman 25 mm/detik. Kalibrasi 1 milivolt yang menghasilkan defleksi setinggi 10 mm.
  • 12. P wave : activation of the atria PR interval: duration of AV conduction QRS complex:activation of right and left ventricular QRS duration: duration of ventricular muscle depolarization PP interval: duration of atrial cycle (an indicator or atrial rate) RR interval: duration of ventricular cardiac cycle (an indicator of ventricular rate QT interval: duration of ventricular depolarization and repolarization
  • 14. ECG REPORTING 1. Rhythm 2. QRS rate 3. Axis 4. P wave 5. PR interval 6. QRS complex 7. QRS duration 8. ST segment 9. T wave 10. Extra systoles
  • 15. 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
  • 16. ECG REPORTING 1. Rhythm 2. QRS rate 3. Axis 4. P wave 5. PR interval 6. QRS complex 7. QRS duration 8. ST segment 9. T wave 10. Extra systoles
  • 27. ECG REPORTING 1. Rhythm 2. QRS rate 3. Axis 4. P wave 5. PR interval 6. QRS complex 7. QRS duration 8. ST segment 9. T wave 10. Extra systoles
  • 28. Rule of 300 300/[number of large boxes between two R waves]. only works for regular rhythms !! 300/7.5 large boxes = rate 40 Six second methods Count the number of R-R intervals in six seconds and multiply by 10 Useful for irregular rhythm average rate There are 8 R-R intervals within 30 boxes. Multiply 8 x 10 = Rate 80
  • 29. ECG REPORTING 1. Rhythm 2. QRS rate 3. Axis 4. P wave 5. PR interval 6. QRS complex 7. QRS duration 8. ST segment 9. T wave 10. Extra systoles
  • 31. Defleksi positif Defleksi negatif
  • 33. 3600 I + - 1800 00 aVF + 900
  • 38. ECG REPORTING 1. Rhythm 2. QRS rate 3. Axis 4. P wave 5. PR interval 6. QRS complex 7. QRS duration 8. ST segment 9. T wave 10. Extra systoles
  • 39. Indicate wave of atrial depolarization Normal characteristic: 1. Smooth and rounded 2. Upright in leads I, II, aVF, aVL 3. Upright or downward in lead III 4. Biphasic in right precordial lead (V1,V2) 5. P wave duration: 120 milliseconds (measured in the widest P wave) 6. Amplitude in limb lead: < 0.25 mV and terminal negative deflection in V1 or V2 < 0.1 mV in depth
  • 42. ECG REPORTING 1. Rhythm 2. QRS rate 3. Axis 4. P wave 5. PR interval 6. QRS complex 7. QRS duration 8. ST segment 9. T wave 10. Extra systoles
  • 43. Mulai dari awal gelombang P sampai dengan permulaan kompleks QRS Durassi normal 0.12-0.2 detik
  • 49. ECG REPORTING 1. Rhythm 2. QRS rate 3. Axis 4. P wave 5. PR interval 6. QRS complex 7. QRS duration 8. ST segment 9. T wave 10. Extra systoles
  • 50. Wave of ventricular depolarization 5-20 mm tall Duration 0.06-0.10/0.12 seconds
  • 52. QRS morphology qRs Rs R rS QR Q/QS rSr RsR
  • 53. Any pathological Q wave or not >1/3 of QRS complex QR Q/QS
  • 59. ECG REPORTING 1. Rhythm 2. QRS rate 3. Axis 4. P wave 5. PR interval 6. QRS complex 7. QRS duration 8. ST segment 9. T wave 10. Extra systoles
  • 60. Begins at J point Between ventricular depolarization and ventricular repolarization Generally isoelectric
  • 69. ECG REPORTING 1. Rhythm 2. QRS rate 3. Axis 4. P wave 5. PR interval 6. QRS complex 7. QRS duration 8. ST segment 9. T wave 10. Extra systoles
  • 70. Ventricular repolarization, followed by ventricular relaxation Positive in lead : I, II, V3-V6 Negative in lead avR
  • 72. ECG REPORTING 1. Rhythm 2. QRS rate 3. Axis 4. P wave 5. PR interval 6. QRS complex 7. QRS duration 8. ST segment 9. T wave 10. Extra systoles