ELECTROCARDIOGRAM

Agus Harsoyo, MDClinical Cardiac Electrophysiologist and Device Implantable

Cardiology Intervensionist

Unit Clinical Cardiac Electrophysiology and Device Implantable and Cardiology Intervensional

Faculty of Medicine University Pembangunan Nasional JakartaDepartment of Cardiology

Gatot Soebroto Army Center Hospital Jakarta Indonesia

201304/19/23 1

Anatomy of the heart

04/19/23 2

Conducting system : atrial and ventricle

04/19/23 3

04/19/23 4

Conducting system : atrial and ventricle

04/19/23 5

Depolarization and Repolarization

Depolarization and Repolarization

04/19/23 6

04/19/23 7

Atrial and Ventricular Depolarization and Repolarization

04/19/23 8

04/19/23 9

Electromechanical coupling

04/19/23 10

Ventricle : Contraction and relaxation

04/19/23 11

Plane view

04/19/23 12

Einthoven’s Triangel Unipolar Lead I, II, III

04/19/23 13

04/19/23 14

Einthoven’s Triangel Unipolar Lead I, II, III

Electrode site : limb Bipolar lead( Einthoven )

04/19/23 15

Electrode site : limb Unipolar lead( Goldberger )

04/19/23 16

Hexaxial system from limb lead Bipolar ( Einthoven ) and Unipolar ( Goldberger )

04/19/23 17

04/19/23 18

Hexaxial system from limb lead Bipolar ( Einthoven ) and Unipolar ( Goldberger )

Limb Bipolar and Unipolar lead( Einthoven and Goldberger )

Extremity LEAD : RED : RIGHT HAND YELLOW : LEFT HAND GREEN : LEFT FOOT BLACK : RIGHT FOOT

I, II, III, aVR, aVL, aVF

04/19/23 19

Precardiac Unipolar Lead( Wilson )

v1 : ICS IV RIHGT para sternal v2 : ICS IV LEFT para sternal v4 : ICS V LEFT mid klavikuler v3: ½ v2 & v4 v6: ~ v4 LEFT mid axillaris v5: ½ v4 & v6

04/19/23 20

04/19/23 21

Precardiac Unipolar Lead( Wilson )

Placement chest electrodeSuperior view

04/19/23 22

Placement chest electrode Anterior view

04/19/23 24

Lead perspective

04/19/23 25

Lead perspective

Normal standarization

04/19/23 26

Calibration signal

1 mm/ 25 mm/ s = 0,04 s

MB = 5 SB

SB

LB = 5 MB

J point and ST Segment

04/19/23 28

Interval and Duration

04/19/23 29

Interval and Segment

04/19/23 30

04/19/23 31

Interval and Segment

04/19/23 32

Interval and Amplitude

Transitional zone

04/19/23 33

04/19/23 34

Transitional zone

Configuration QRS

04/19/23 35

Configuration QRS

04/19/23 36

qRSrS

RS

QS

qRsRs

QRr’ rs

rSR’

Configuration QRS

04/19/23 37

Intrinsicoid deflection

04/19/23 38

HR Determination

04/19/23 39

HR Determination

04/19/23 40

Determination QT Interval

04/19/23 41

Direction of Depolarization

04/19/23 42

Direction of Vector

04/19/23 43

Sequence of Ventricle Depolarization

04/19/23 44

Two Quadrant

04/19/23 45

Vector Determination

04/19/23 46

Vector Direction

04/19/23 47

Mean QRS axis determination

04/19/23 48

QRS axis Deviation

04/19/23 49

QRS axis Deviation

04/19/23 50

Mean QRS Determination

04/19/23 51

Mean qrs determination

04/19/23 52

Normal Axis

04/19/23 53

Left Axis Deviation

04/19/23 54

Right Axis Deviation

04/19/23 55

Superior/ extrem Axis

04/19/23 56

INTERPRETASI EKG1. Monitor : Sinus : ( >< Aritmia ) 1 gel P + 1 QRS kompl PR Interval N (<5 kotak kecil, <20 det) angka / rate : > 100 ST 60 – 100 SR 60 SB interaksi keseluruhan n2. Rekaman 12 lead EKG, contigous lead II-III-avF ; I-AvI-

V5-V6; V1V2V3V4; V7V8V9;V1RV2RV3RV4R;3. Irama dasar, HR, Aksis, Pwave, PRint, QRS dur, QT int,

ST segmen, T wave, irama tambahan --> Kesimpulan 04/19/23

57

read EKGKalibrasi, Irama, Hr, gel p, pr int, aksis, qrs kompl,

st seg, gel t, block, irama tambahan kesimpulan

Contoh : af, hr 110 – 140, p mitral, aksis lad, qrs n,

st – t changes ( - ), lafb af v r r, lae, hhd

04/19/23 58

Normal 12 lead ekg

04/19/23 59

The end

04/19/23 60

04/19/23 61

Arrhythmia

04/19/23 62

Agus Harsoyo, MDClinical Cardiac Electrophysiologist and Device Implantable

Cardiology Intervensionist

Unit Clinical Cardiac Electrophysiology and Device Implantable and Cardiology Intervensional

Faculty of Medicine University Pembangunan Nasional JakartaDepartment of Cardiology

Gatot Soebroto Army Center Hospital Jakarta Indonesia

2013

Rhythm determination : RRCR

04/19/23 63

Pacemaker sites

04/19/23 64

Supraventricular and ventricular beats

04/19/23 65

Wide QRS supraventricle rhythm

04/19/23 66

SB, SR, ST

04/19/23 67

Sinus arrhytmia

04/19/23 68

Atrial Premature Contraction

04/19/23 69

Junctional premature beat

04/19/23 70

Wandering atrial pacemaker

04/19/23 71

Multifocal atrial tachycardia

04/19/23 72

Accelerated junctional rhythm

04/19/23 73

Paroxismal Atrial Tachycardia

04/19/23 74

Atrial Flutter

04/19/23 75

Atrial Fibrilation

04/19/23 76

AF and Ashman beat

04/19/23 77

Ventricle Premature Contraction

04/19/23 78

Ves multifocal

04/19/23 79

VES Bi / Tri geminy

04/19/23 80

N N

NNNN

N

Ves couplet / salvo

04/19/23 81

Ventricular Parasystole

04/19/23 82

Ves R on T

04/19/23 83

Accelerated idioventricular rhythm

04/19/23 84

Ventricle Tachycardi

04/19/23 85

Ventricle fibrilation

04/19/23 86

VT Torsade de pointes

04/19/23 87

The end

04/19/23 88

04/19/23 89

Heart block

04/19/23 90

Agus Harsoyo, MDClinical Cardiac Electrophysiologist and Device Implantable

Cardiology Intervensionist

Unit Clinical Cardiac Electrophysiology and Device Implantable and Cardiology Intervensional

Faculty of Medicine University Pembangunan Nasional JakartaDepartment of Cardiology

Gatot Soebroto Army Center Hospital Jakarta Indonesia

2013

Anatomy of Heart block

04/19/23 91

1st AV Block

04/19/23 92

Pr int 0,20 sec

2nd AV Block tipe 1

04/19/23 93

Pr int gradually lengthen

2nd AV Block tipe 2

04/19/23 94

Pr int constans

3rd AV Block

04/19/23 95

Atrial beat independently of ventricle

Intraventricular Block

04/19/23 96

Complete Right Bundle Block

04/19/23 97

Incomplete Right Bundle Block

04/19/23 98

Complete Left Bundle Block

04/19/23 99

inComplete left bundle block

04/19/23 100

Left Post / Ant Fascicular Block

04/19/23 101

The end

04/19/23 102

04/19/23 103

04/19/23 104

Agus Harsoyo, MDClinical Cardiac Electrophysiologist and Device Implantable

Cardiology Intervensionist

Unit Clinical Cardiac Electrophysiology and Device Implantable and Cardiology Intervensional

Faculty of Medicine University Pembangunan Nasional JakartaDepartment of Cardiology

Gatot Soebroto Army Center Hospital Jakarta Indonesia

2013

Acute Coronary Syndrome

04/19/23 105

Normal t wave and ischemia

04/19/23 106

J point and ST segment normal injury

04/19/23 107

Q infarction

04/19/23 108

Location of AMI

04/19/23 109

Evolution AMI

04/19/23 110

Non Q Q AMI

04/19/23 111

Atrial ami

04/19/23 112

The end

04/19/23 113

04/19/23 114

Atrial and Ventriclehypertrophy

04/19/23 115

Agus Harsoyo, MDClinical Cardiac Electrophysiology and Device Implantable

Cardiology Intervensionist

Unit Clinical Cardiac Electrophysiology and Device Implantable and Cardiology Intervension

Department of Cardiology Army Center Hospital Gatot Soebroto

Jakarta

2013

Normal and hypertrophy

04/19/23 116

LAE

04/19/23 117

RAE

04/19/23 118

LVH

04/19/23 119

Estes criteria LVH

04/19/23 120

RVH

04/19/23 121

The end

04/19/23 122

04/19/23 123

Drug electrolyte others

04/19/23 124

Agus Harsoyo, MDClinical Cardiac Electrophysiology and Device Implantable

Cardiology Intervensionist

Unit Clinical Cardiac Electrophysiology and Device Implantable and Cardiology Intervension

Department of Cardiology Army Center Hospital Gatot Soebroto

Jakarta

2013

Digoxin effect

04/19/23 125

anti arhythmia effect

04/19/23 126

Electrolyte imbalancehyperkalemia

04/19/23 127

Electrolyte imbalancehypokalemia

04/19/23 128

Hyper/ hypo calcemia

04/19/23 129

hypotermia

04/19/23 130

Cerebro vascular accident

04/19/23 131

Non spesific st-t changes and ventricle strain

04/19/23 132

pericarditis

04/19/23 133

Early repolarization

04/19/23 134

Lv aneurisms

04/19/23 135

Pulmonary embolism

04/19/23 136

ST, RAE, C/ IRBBB, ST-T, RAD

copd

04/19/23 137

Reentry mechanism

04/19/23 138

antegrade, retrograde

Preexcitation WPW syndrome

04/19/23 139

Preexcitation LGL syndrome

04/19/23 140

Aberrant ventricle conduction

04/19/23 141

DD Wide QRS Tachycardia

04/19/23 142

Lown’s grading for VES

04/19/23 143

Sick sinus syndrome

04/19/23 144

Pacemaker pattern

04/19/23 145

Exercise stress test

04/19/23 146

The end

04/19/23 147

04/19/23 148