The document provides an overview of electrocardiography (ECG). It discusses how ECG provides information about the heart's electrical activity through electrodes on the body surface. It describes the cardiac conduction system and normal impulse transmission through the heart. It explains how to interpret various components of a normal ECG, including rate, rhythm, intervals, amplitudes, and morphology. It also discusses some examples of abnormal ECG patterns that can indicate conditions like myocardial infarction, arrhythmias, and conduction blocks.
The document provides an overview of electrocardiography (ECG). It discusses how ECG provides information about the heart's electrical activity through electrodes on the body surface. It describes the cardiac conduction system and normal impulse transmission through the heart. It explains how to interpret various components of a normal ECG, including rate, rhythm, intervals, amplitudes, and morphology. It also discusses some examples of abnormal ECG patterns that can indicate conditions like myocardial infarction, arrhythmias, and conduction blocks.
The document provides an overview of electrocardiography (ECG). It discusses how ECG provides information about the heart's electrical activity through electrodes on the body surface. It describes the cardiac conduction system and normal impulse transmission through the heart. It explains how to interpret various components of a normal ECG, including rate, rhythm, intervals, amplitudes, and morphology. It also discusses some examples of abnormal ECG patterns that can indicate conditions like myocardial infarction, arrhythmias, and conduction blocks.
The document provides an overview of electrocardiography (ECG). It discusses how ECG provides information about the heart's electrical activity through electrodes on the body surface. It describes the cardiac conduction system and normal impulse transmission through the heart. It explains how to interpret various components of a normal ECG, including rate, rhythm, intervals, amplitudes, and morphology. It also discusses some examples of abnormal ECG patterns that can indicate conditions like myocardial infarction, arrhythmias, and conduction blocks.
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ELECTROCARDIOGRAPHY
Irwan M. Loebis, dr., SpJP
UNSWAGATI, CIREBON Lecture outline
Part one Information provided by ECG
Cardiac conduction system: anatomy
and physiology (Normal) ECG interpretation
Part two Abnormal ECG ECG is…?
Printout as a result of a particular electrical
function of the heart
The standard 12-lead electrocardiogram is a
representation of the heart's electrical activity recorded from electrodes on the body surface Information provided by ECG: what do you think? Cardiac conduction system
SA node AV node Bundle His Impulse Transmission
SA Node Internodal branch AV Node Hiss Bundle Purkinje Fiber Contraction One ‘complex’ of ECG waveform
right and left ventricular depolarization (normally the
ventricles are activated simultaneously)
the sequentialactivation (depolarization) of the right and left atria
ventricular repolarization Leads position Limb leads Einthoven Triangle Chest lead Chest lead Chest lead ECG interpretation…? 1. Calibration 2. Rate and rhythm 3. QRS axis 4. P morphology 5. PR interval 6. QRS duration 7. QRS morphology 8. ST segment morphology 9. T morphology 10. U morphology 11. Others: LVH, LV strain, BBB, QT interval 12. Conclusion: normal/abnormal Calibration 1 mV = 1 cm Important in assessing tall waves in hypertrophic state Paper speed and normal value
One small box: 0.04 s
One large box: 0.2 s PR Interval: 0,12’’ - 0,20’’ QRS duration: 0,04’’ - 0,12’’ Rate calculation
Method: – 300 divided by number of large boxes between R-R – 1500 divided by number of small boxes between R-R, – Number of QRS complexes in 6 seconds times 10. Rate calculation paper 25 mm/s Sinus Rhythm Sinus Rhythm –Rhythm: Regular –Rate: 60 – 100 –P wave: Normal in configuration; precede each QRS –PR: Normal (0. 12 – 0.20 s) –QRS: Normal (<0.12 s) QRS Axis (N:- 30 s/d + 110) P wave
Wave of atrial depolarization
Normal characteristic: 1. Smooth and rounded 2. ≤ 3 mm tall 3. Upright in leads I, II avF PR interval
Including P wave until the beginning
of QRS complex Normal duration is 0.12-0.2 seconds QRS complex
Wave of ventricular depolarization
5-20 mm tall Duration 0.06-0.10 seconds QRS morphology R qRs Rs rS
QR Q/QS RsR’ rSr’
ST segment
Begins at J point Between ventricular depolarization and ventricular repolarization Generally isoelectric T wave
Ventricular repolarization, followed by
ventricular relaxation Positive in lead : I, II, V3-V6 Negative in lead avR Interpret this ECG.. And this.. Abnormal ECG
Unstable Angina Acute myocardial infarction STEMI Non STEMI Mid LAD occlusion after the first septal ECG : large anterior MI perforator (arrow) Occlusion of diagonal branch ( arrow )
ST elevation in I and aVL
ECG demonstrates large anterior infarction Proximal large RCA occlusion
ST elevation in leads II, III, aVF, V5, and V6
with precordial ST depression Small inferior distal RCA occlusion
ECG changes in leads II, III, and aVF
Acute inferoposterior MI Questions…?? HIPERKALEMIA
• Peaking T • Shortening QT interval
• Widening P wave, QRS complex • Prolongation PR interval PPM How to identify arrhythmias ? QRS complex Regular / irregular ?
-or from multiple ectopic foci -irregular, narrow QRS complex -very rapid atrial electrical activity (400-700 x/min). -no uniform atrial depolarization Atrial Flutter : -The result of a re-entry circuit within the atria -Irregular / regular QRS rate -Narrow QRS complex -Rapid P waves (300x/min), “sawtooth” Junctional rhythm: -AV junction can function as a pace maker (40-60 x/min). -due to the failure of sinus node to initiate time impulse or conduction problem. -normal-looking QRS. -retrograde P wave. -P wave may preceede, coincide with, or follow the QRS SR
VES Sinus rhythm with Multifocal VES
VES VES
SR SR SR SR SR SR Sinus rhythm with VES couplet Sinus Rhythm with VES, R on T Ventricular Tachycardia Torsade de Pointes Ventricular Fibrillation 1st degree AV block
