ECG

Heri Fadjari
Ventri-
cular
depola-
rization

Heri Fadjari
Ventri-
cular
depola-
rization
(contd)

Heri Fadjari
Ventri-
cular
depola-
rization
(contd)

Heri Fadjari
Ventri-
cular
repola-
rization
- +
- +
+
- + - -
- + - -+
- + - +
-
- +- +
-
- + - +
- + - -
+
- + - - +
+ +
-+
-
+

Heri Fadjari
Lead I

Heri Fadjari
Lead II

Heri Fadjari
Lead III

Heri Fadjari
Limb
Leads Lead I

(bipolar)

Lead II

Lead III

Heri Fadjari
aVR

Heri Fadjari
aVL

Heri Fadjari
aVF

Heri Fadjari
Uni- aVR
polar
Lead

aVL

aVF

Heri Fadjari
Normal Intrinsicoid
deflection
values < 0.05
QT segment
Men < 0.39
Wo < 0.40

ST segment
Std: > 1mm
Pre : > 2mm
PR interval
0.12-0.20 U wave

P wave QRS duration T wave

0.8-0.11 0.06-0.10
Heri Fadjari
Pre-
cordial
leads

V6
V5
V1 V4
V2 V3

Heri Fadjari
Hori-
zontal
vs
Verti-
cal
heart

Heri Fadjari
Hori-
zontal
vs
Verti-
cal
heart

Heri Fadjari
Clock-
wise
vs
Counter
clock-
4
24
4
4
wise 3 1
1
2
2
11
2

rotation 3 3
3

Viewed from below the heart looking towards the ape

Heri Fadjari
P wave

V1

Heri Fadjari
Atrial
Enlarge
ment

Left atrial
enlargement
P mitral
Wide and notch

Biphasic with
(-) terminal
component
V1

Heri Fadjari
Atrial
Enlarge
ment
(contd)

Right atrial
enlargement
Tall and peaked
P wave

Tall and peaked

P wave

V1

Heri Fadjari
Elec-
trical
qRS = +3
axis

Lead I

qRS = +1

aVF
Heri Fadjari
Myo- Electrical forces are directed away from a injured area

cardi A B C D
al
injur
y

Normal Minimal Subendocard Transmural S

Heri Fadjari
Myo- ST segment deviated towards the surface of injure

cardi A B C D
al
injur
y

Normal Minimal Subendocard Transmural S

Heri Fadjari
Myo- Zones of myocardial infarction:
Necrosis
cardial Injury
infarction
Ischaemia

4 3

2 1 4
2
1 2
1
3 3

Heri Fadjari
Myo- ECG parameters of myocardial infarction
Necrosis
cardial Injury
infarction
Ischaemia
(contd)

4
2
1 V6
3

V1

Heri Fadjari
Myo- Phases of myocardial infarction:
cardial Hyperacute phase
infarction
- Slope elevation of the ST sement
(contd)
- Tall widened T wave
- Increased ventr. activation time

Fully evolved phase

- Pathological Q wave
- Coved, elevated ST segment
- Inverted symetrical T wave

Old infarction
- Pathological Q wave
- ST segment and T wave return to normal

Heri Fadjari
Myo- Localization of infarcted areas
cardial
infarction
(contd)

2 I
1 aVL
3 V4
V1
V5
V2
V6
V3

II, III, aVF

Heri Fadjari
Right
ventri
cular
hyper
trophy
4
2
V6
1
3

V1

Heri Fadjari
 Diatolic overload
Left
ventri
cular
hyper
trophy
4
2
V6
1
3

V1

Heri Fadjari
 Systolic overload
Left
ventri
cular
hyper
trophy
4
2
V6
1
3

V1

Heri Fadjari
LBBB

4
3
2 1a V6

V1
1b

Heri Fadjari
QT Prolonged QTc
interval Hypocalcemia
Acute rheumatic carditis

Shortened QTc
Hypercalcemia
Digitalis effect
Hyperthermia
Vagal stimulation

Normal QT does not exclude the diagn

Acute myocardial infarction
QT Acute myocarditis of any causes
QTc= Sympathetic stimulation
R-R Procain effect

Heri Fadjari
 Disturbances of impulse formation
Atrial
Septal Sinus rhythms
Ectopic atrial rythms
Atrial extrasystole
Activa- Sinus arrythmia
Sinus tachycardia
PAT
Atrial fibrilation
tion Sinus bradycardia Atrial flutter

AV nodal rythms
AVn extrasystole
Paroxysmal AVn tachycardia
Idionodal tachycardia
Ventricular rhytms
V-extrasystole
V-tachycardia
V-flutter
V-fibrilation
Heri Fadjari
Idioventricular tachyc
 Disturbances of impulse conduction
Arrhyth
mias
A-V block
S-A block

Reciprocal rythms
WPW syndrome
(Wolf-Parkinson-White)
LGL syndrome
(Lawn-Ganong-Levin)

Heri Fadjari
 2nd disorders of rythms
Arrhyth
mias
A-V dissociation
AVn escape
Atrial escape

Aberrant ventricular Ventricular

conduction escape

Heri Fadjari
 Diagnostic approach
Arrhyth
mias

To be
continued
next week
Insyaa
Allah

Heri Fadjari
Arrhyth
mias

4
2
V6
1
3

V1

Heri Fadjari
Arrhyth
mias

4
2
V6
1
3

V1

Heri Fadjari
Arrhyth
mias

4
2
V6
1
3

V1

Heri Fadjari
Arrhyth
mias

4
2
V6
1
3

V1

Heri Fadjari
Arrhyth
mias

4
2
V6
1
3

V1

Heri Fadjari