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Text Book Reading: Interpretation of The Electrocardiogram
Text Book Reading: Interpretation of The Electrocardiogram
Text Book Reading: Interpretation of The Electrocardiogram
Interpretation of the
Electrocardiogram
Delivered By :
M. Dzikrul Haq Karimullah, MD
Supervised :
Cholid Tri Tjahjono, MD, Cardiologist
Consultant of Preventive and Rehabilitative Medicine
Introduction
1928 1953
Einthoven reported the first
attempt to evaluate the
Fiel and Masters Simonson
reported the
response of the Siegel first step test electrocardiogra
electrocardiogram (ECG) to noted ST introduced phic response to
exercise. depression treadmill
with testing of a wide
age range of
1908 exercise.
1930 normal subjects.
Timelines
S-Wave Changes
Contd
U-Wave Changes
ST-T Changes
The most common ECG
abnormality seen in the
exercise laboratory is
ST-segment depression,
whereas ST elevation is
relatively rare
Is ST Elevation Caused by Ischemia or Wall Motion Abnormality?
ST-Segment Depression
ST Depression in Recovery
R-Wave Amplitude Adjustment
Resting ST-Segment Displacement
Exercise-Induced ST-Segment Depression Not Caused by
Coronary Artery Disease
Atrial
Repolarization
Atrial Repolarization
Contd
Hyperventilation
Abnormalities
ST Shift Location
and Ischemia
Chest Pain
Do Diabetics Have a Higher Prevalence of Silent Ischemia during
Treadmill Testing Than Non diabetics?
Interpretation of Exercise TestInduced
Arrhythmias
Pathophysiology :
Activation of the sympathetic nervous system and an increase in the
availability of circulating catecholamines
These changes interact with the three major mechanisms involved in
the generation of arrhythmias: enhanced automaticity, triggered
automaticity, and reentry.
Potential proarrhythmic mechanisms include electrolyte shifts,
baroreceptor activation, myocardial stretch, and ischemia.
Atrial arrhythmias may reflect underlying left atrial enlargement and
ventricular dysfunction.
Reproducibility