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Dr. David D Ariwibowo, Sp.

JP
ECG Interpretation
I. Calibration : Standard recording : speed 25 mm/sec & amplitude 1 mV.
II. Basic rhythm : (after no III-VI)
Sinus / Supraventricular (atrial/junctional)/
Ventricular rhytm.
III. QRS (R-R) Regularity : Regular Brady/Normal/Tachy.
& Rate Irregular Fibrilation .
IV. P wave : Presentation/ Regularity/ Rate/ Axis/ Width/
Height/ followed by QRS.
V. PR interval : Normal / Short / Long.
VI. QRS complex : Width/ Height/Morphology.
QRS axis : Normal / LAD / RAD / Superior
VII. ST segment : Normal / Depression / Elevation
(Morphology & Location).
VIII. T wave : Normal / Tall / Inverted (Morphology & location)
IX. QT Interval : Normal / Short / Long.
X. U wave : Normal / Prominent/ Inverted
Conclusion Diagnosis
IV.
III.
I. Enlargement
QRS axis &
Basic Rhythm &
voltage
hypertrophy

VI. Ischemia,
injury &
infarction

II.
Activation
Sequence
disorders

V.
VII. VIII.
Repolarization
Clinical disorders Pacemaker
abnormalities
I. Basic Rhythms: Conduction system
I. Basic Rhythms (1)
A. Sino-atrial node Arrhytmia.
1. Sinus rhythm (normal).
2. Sinus tachycardia.
3. Sinus bradycardia.
4. Sinus arrhytmia.
5. Sinus arrest / Pause.
6. Sino-atrial exit block.

Journal of the American College of Cardiology Vol. 38, No. 7, 2001


I. Basic Rhythms (2)
B. Supraventricular Arrhytmia.
1. Atrial
a. Atrial premature complex.
b. Ectopic atrial rhythm.
c. Ectopic atrial tachycardia.
a. Unifocal.
b. Multifocal.
d. Atrial flutter.
e. Atrial Fibrillation.
2. Junctional
a. Junctional premature complex.
b. Junctional escape complex or rhythm.
c. Accelerated junctional rhythm.
d. AVNRT
e. AVRT

Journal of the American College of Cardiology Vol. 38, No. 7, 2001


I. Basic Rhythms(3)
C. Ventricular Arrhythmia
1. Ventricular premature complex.
2. Ventricular escape complex or rhythm.
3. Accelerated idioventricular rhythm.
4. Ventricular tachycardia.
a. Monomorphic.
b. Polymorphyc (Torsade de pointes).
5. Ventricular Fibrillation.
a. Fine.
b. Coarse.

Journal of the American College of Cardiology Vol. 38, No. 7, 2001


II. Activation Sequence disorders (1)
A. Atrio-ventricular conduction block.
1. First degree AV block.
2. Second degree AV block.
a. Mobitz type 1 (Wenckebach)
b. Mobitz type 2
3. AV block with conduction ratio
a. 2:1
b. 3:1 or more.
4. AV block with varying conduction ratio.
5. Advance AV block / High grade AV block.
6. Third degree AV block / complete AV block.
7. AV dissociation.

Journal of the American College of Cardiology Vol. 38, No. 7, 2001


II. Activation Sequence disorders (2)
B. Intraventricular conduction block.
1. Left bundle branch block.
a. Complete.
b. Incomplete.
2. Right bundle branch block.
a. Complete.
b. Incomplete.
3. Left anterior fascicular block.
4. Left posterior fascicular block.
5. Nonspecific intraventricular conduction delay.
6. Aberrant conduction of supraventricular beats.

C. Bifascicular block & Trifascicular block.


D. Pre-excitation Syndrome.

Journal of the American College of Cardiology Vol. 38, No. 7, 2001


III. QRS axis & Voltage
1. Left axis deviation.
2. Right axis deviation.
3. Indeterminan axis
4. Electrical alternans
5. Low voltage (total QRS amplitude <0.5 mV in limb
lead or < 1 mV in each precordial lead)

Journal of the American College of Cardiology Vol. 38, No. 7, 2001


IV. Chamber hypertrophy / enlargement
1. Left atrial enlargement.
2. Right atrial enlargement.
3. Left ventricular Hypertrophy.
a. QRS abnormality only
b. With ST-T abnormality
4. Right ventricular Hypertrophy.
a. QRS abnormality only
b. With ST-T abnormality

Journal of the American College of Cardiology Vol. 38, No. 7, 2001


V. Repolarization abnormalities (ST-T, U)
1. ST and /or T abnormalities suggest injury.
2. ST and /or T abnormalities suggest ischemia.
3. ST and /or T abnormalities non specific .
4. Early repolrization.
5. Persistent juvenile T waves.
6. QT interval prolonged.
7. Prominent U wave.

Journal of the American College of Cardiology Vol. 38, No. 7, 2001


VI. Myocardial ischemia, injury & infarction.
1. Location.
a. Septal
b. Anterior
c. Lateral
d. Posterior
e. Inferior
f. Right ventricular
2. Onset
a. Acute.
b. Recent.
c. Old.

Journal of the American College of Cardiology Vol. 38, No. 7, 2001


VII. Clinical disorders.
1. Cardiac
a. Myocarditis
b. Pericarditis
2. Noncardiac
a. Electrolyte imbalance
a. Hypo/hyperkalemia.
b. Hypo/hypercalcemia.
b. Acute pulmonary embolism.
c. Chronic pulmonary disease.
d. Suggest CNS disesase
3. Drugs effects
a. Digitalis
b. Others

Journal of the American College of Cardiology Vol. 38, No. 7, 2001


VII. Pacemaker
1. Atrial-paced rhythm.
2. Ventricular-paced rhythm.
3. Atrial-sensed ventricular paced rhythm.
4. AV dual-paced rhythm.
5. Failure of capture atrial.
6. Failure of capture ventricular.
7. Failure of inhibition atrial.
8. Failure of inhibition ventricular.
9. Failure of pacemaker firing.
10. Retrograde atrial activation.
11. Pacemaker mediated tachycardia.

Journal of the American College of Cardiology Vol. 38, No. 7, 2001


IX. Technical problems
1. Artifact
2. Lead Misplaced

Journal of the American College of Cardiology Vol. 38, No. 7, 2001


Thank You