00401 ecg basic.pptx

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Dr. David D Ariwibowo, Sp.JP

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Standard 12 leads ECG

Limb Lead Precordial Lead

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Right Arm (white)

Left Arm (black)

Standard Configuration

Exercise Configuration

The right & left arm

electrodes are transferred to

the upper torso while the leg

electrodes are transferred to

the lower torsoRight Leg (green - ground)

Left Leg (red)

Standard Configuration

V1 red

V2 yellow

V3 green V5 orange

V4 blue V6 violet

PrecordialLeads

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Electrode  Anatomical Location 

Right Arm (RA)  The base of the right shoulder against the deltoid border about 2cm below the clavicle but above the border of pectoralis (in deltoidfossa). 

Left Arm (LA)  The base of the left shoulder against the deltoid border about 2 cm

below the clavicle but above border of pectoralis (in deltoid fossa). 

Right Leg (RL)  Right anterior axillary line a few centimeters above the umbilicus

Left Leg (LL)  Left anterior axillary line a few centimeters above the umbilicus 

V1  Fourth intercostal space at right sternal border. 

V2  Fourth intercostal space at left sternal border. 

V3  Midway between positions for V2 and V4. V4  Fifth intercostal space at left midclavicular line. 

V5  Horizontal level of V4 at left anterior axillary line. V6  Horizontal level of V4 at left midaxillary line. 

Anatomical Placement of Electrodes 

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The Concept of a "Lead" 

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LEAD II

LEAD I

LEAD III

Remember, the RLis always the ground

Limb Leads

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Precordial Leads

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V9

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Standard 12 leads ECG

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The ECG waves P wave : atrial

depolarisation

QRS complex :ventriculardepolarisation

T wave : ventricular

repolarisation

 Atrial repolarisationhidden by QRS 

P

Q

R

S

T

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Local action potential

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• The depolarization

traveling acros the

heart continue

traveling through the

body• By examining the

different leads, shape,

time intervals,

contour, frequency,

and type of the ECGcomplexes, we can

diagnose cardiac

illnesses.

The ECG Complex 

R 

S 

Q 

T 

UP 

PRinterval 

0.12 - 0.20

sec 

< 0.10

sec 

QRS

duration 

ST

segment 

QTinterval 

0.35 - 0.45

sec 

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ECG Paper

Standard recording:

- Speed: 25 mm/s

- Voltage: 1 mV

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Standard 12 leads ECG

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++++ ++++ ++++------

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++++

----++++

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Generation of the

ECG complexes A wave of depolarization

moving toward an electrode

will cause an upward

deflection on the ECG.

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.

60 o 

Depolarization of the atria in Lead II Atrial depolarization proceeds

from the top down in all

directions.

Summing these vectors of

depolarization the main

atrial depolarization vector

(large green arrow).

It is moving towards the lead II

 resulting in an upward

deflection of the ECG.

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60o

Depolarization of the LV in Lead II. Septum depolarizes from inside out resulting depolarization wavemoves away from Lead II.

The rest ventricle depolarizes

counter-clockwise from inside out main cardiac vector (large arrow)which is sum of all of the smalldepolarization vectors.

This vector in normal heart, almost

always moving directly toward LeadII a mostly positive QRS complex.

The RV is much smaller andcontributes little to the overall mainvector of depolarization

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Repolarization of the LV in Lead II Repolarization is the beginning of

depolarization left off .

Proceeding clockwise from thelateral wall back to the septum.

The vector is moving away from theLead II T-wave is always positive.

The process much slower thandepolarization T-wave is wide &rounded.

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Rules of pacemaker & Conduction1. Setiap sel jantung dapat berperan sebagaipacemaker.

2. Pacemaker dengan frekuensi pulsustertinggi yang menentukan frekuensidenyut jantung.

3. Pulsus secara normal di konduksikan dariatrium ke ventrikel hanya melalui AVnode.

4. Pulsus dari atrium mengalamiperlambatan di AV node sebelumdikonduksikan ke ventrikel.

5. AV node memiliki masa refrakter

tertentu(masa tidak dapat dirangsang).6. Pulsus yang berasal dari supra ventrikelakan mengeksitasi ventrikel dengan cepat gambaran QRS sempit.

7. Pulsus yang berasal dari ventrikel akanmengeksitasi ventrikel dengan lambat gambaran QRS lebar.

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Heart Excitation Related to ECG

Figure 18.17

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Thank You

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