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ELECTROCARDIOGRAPHY

Department of Cardiology and Vascular Medicine


Faculty of Medicine University of Indonesia
National Cardiovascular Center Harapan Kita

Unipolar Precodial (Chest) Leads


Midclavicular line
Anterior axillary line
Midaxillary line

V6

V6R
V5R
V4R

V3R

V5

V4

V3

V2
V1

Mervin J. Goldman, MD. 11th edition Principles of clinical Electrocardiography. Clinical Professor of Medicine University of
California School of Medicine San Francisco @1995-1982

Unipolar Precodial (Chest) Leads

Horizontal plane of
V4-6

V7 V8 V9

V9RV8RV7R

Mervin J. Goldman, MD. 11th edition Principles of clinical Electrocardiography. Clinical Professor of Medicine University of
California School of Medicine San Francisco @1995-1982

The electrocardiogram
(ECG) illustrates
conduction of electrical
impulses in the heart.
The depolarization of the
ventricles occurs from
the endocardium
(inside) to the
epicardium (outside)
[e]
The repolarization of the
ventricles occurs in the
opposite direction. [g]

ECG INTERPRETATION
1.
2.
3.
4.
5.
6.

RATE
RHYTHM
AXIS
HIPERTROPHIC SIGNS
MYOCARDIAL INFARCTION
ARRHYTHMIA

1. RATE
Normal heart rate : 60 100 x/minutes
> 100 x/minutes : Sinus Tachycardia
< 60 x/minutes
: Sinus Bradicardia

Determination heart rate (normal paper speed 25 mm/s):

300
Count number of large square (bold boxes in one R R interval)

1500
Count number of small square in one R R intervals

Number of QRS complex in 6 seconds, multiply by 10

2. RHYTHM
Normal cardiac rhythm : SINUS rhythm
Sinus rhythm characteristics :
Rate 60-100 bpm
Constant R R interval
Negative P wave in aVR and positive di II
P wave is always followed by QRS complex

3. AXIS

4. HYPERTROPHIC SIGNS

5. MYOCARDIAL INFARCTION
Ischemia
Injury
Necrosis

ANTERIOR INFARCTION

INFERIOR INFARCTION

POSTEROLATERAL INFARCTION

ECG changes in ACS

ARRHYTHMIA

AV BLOCK

WHATS WRONG??
Lead Error: V1 and V3 are Transposed!
In this normal 12-lead ECG the V1 and V3 chest electrodes are
interchanged. Experienced ECG interpreters should be able to spot this
lead placement error.

DISCUSSION

Sinus arrhythmia

Limb lead reversal

Early repolarization

Subendocardial ischemia.
Anterolateral ST-segment depression

Unstable angina

acute anterolateral myocardial infarction

High lateral infarction

Lateral myocardial infarction

Right ventricular infarction

Acute inferoposterior myocardial infarction

left ventricular aneurysm

Mobitz I

High-grade atrioventricular block

Wolff-Parkinson-White syndrome

Wolff-Parkinson-White syndrome

Atrial fibrillation

Atrial flutter

premature ventricular contraction

Supraventricular tachycardia

Wide complex tachycardia

Ventricular flutter

Idioventricular rhythm