INTERPRETATION OF NORMAL ECG

No Procedure Interpretation
1. Patient identity MR.Broto, 35 y.O male
name, age, gender , read clinical history of 4 nov 2008 09:47
patient if ade No clinical history of patient found
2. Placement of precordial leads Look for Lead II and aVR (for P wave)
Lead II : +ve
aVR : -ve
Concl: OK and correct placement!!!
3. Placement of standard calibration 1o mm/mv = 10 small box/mv
Concl: 1 small box =0.1 mv

4. Read standard paper speed 25 mm/sec25 boxes/sec

Concl: 1 small box = o.o4 sec

5. Measure HR Atrial rate = 1500 /17 =88 bpm

A.rate=1500/small box btwn PP interval Ventricle rate =1500/17 = 88bpm
=@@ 300/big box “ “ Concl: HR normal (range : 80-100bpm)
V.rate =1500/small box btwn RR interval
=@@ 300/big box

6. Assess Regularity Atrial rate = ventricle rate (amik kertas dan tanda jarak antara PP or RR interval)
Concl: regular

7. Assess Rhythm  every P is followed by QRS

 P +ve (upright) in Lead I,II,III
 PR interval more than o.12 sec (3 small box)
 every QRS is preceded by P wave
concl: Sinus rhythm

8. Assess P wave
i. contour Smooth and monophasic in all lead Except in V1, V2 (biphasic)
NO notch foundconcl: Normal and no Left atrial enlargement

ii. morphology/configuration Upward in all lead, except aVR concl: Normal

 iii. duration 3 small boxconcl: Normal (range : ≤3 small box)

iv. amplitude 2 small box concl: Normal (range : ≤2 small box)

Assessment of atrial enlargement assess P wave in lead II and V1

Concl: NO atrial enlargement!!

13. Measure PR interval 5 small boxconcl: Normal and no block (range: 3-5 small box)

14. Assess morphology Q wave  Present at V5 and V6 (Lead II and aVR: any size) and no Q wave in V1, V2,
V3concl: No pathologic Q wave
 duration : 1 small box concl: Normal (range :≤ 1 small box)
 amplitude : less than 25 % of R waveConcl: Normal

15. Assess morphology R wave Amplitude getting larger from V1- V6

Concl: Normal

16. Assess morphology S wave Amplitude getting smaller from V1- V6

Concl: Normal

17. Measure R/S amplitude in V1 or V2 R/S amplitude in V1 less than 1 (smaller value divide larger value)
Concl:Normal and no RV enlargement

Assessment of ventricle enlargement by using R/S ratio

tgk kt precordial V1, V2,V5,V6)
RV enlargement LV enlargement
1. R/S ratio at 1. sokolow Lyon criteria
V1 OR V2 > 1 RV5 OR V6 > 2.6 MV (26 small box)
V5 OR V6 < 1 RV5 OR V6 + SV1 > 3.5 MV (35 small
2. sokolow Lyon criteria box)
R v1 + S V5 OR V6 ≥ 1.1 MV(11 s.b)

Concl:

19. Measure QRS

i. duration 1 small boxconcl: Normal (range : 2-3 small box)

ii. maximal amplitude Limb lead : >5 small boxconcl: Normal (range > 5 small box)
Precordial : >10 small boxconcl: normal (range >15 small box)
 iii. QRS axis Lead I : +ve
aVF : -ve
concl: Left axis deviation

23. Assess morphology ST segment No ST segment elevation or depression

Isoelectric=parallel to PR segment (tandakan kt ECG paper)
Concl: Isoelectric and normal

24. Assess morphology T wave T wave amplitude

Limb lead <5 small boxconcl: Normal
Precordial < 15 small boxconcl : Normal

25. Assess morphology U wave No U waveno hypokalemia concl : Normal

(can see at V1 and V2)

26.
Measure QTc interval QTc = QT (in sec) / √ RR (in sec)
=
Concl : Normal (range male less than o.46, female less than 0.48)

FINAL CONCLUSION
 SINUS RHYTHM
 NO atrial enlargement
 normal axis
 left ventricle hyperthrophy
 others: within normal limit

Systematic approach to the

evaluation of Ventricular
Enlargement

1. Examine the contour of the QRS complex

2. Measure the duration of the QRS complex

3. Measure the maximal amplitudo of the QRS

complex

4. Estimate the axes of the QRS complex

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