PRINSIP DASAR EKG

Normal Impulse Conduction

Sinoatrial node

AV node

Bundle of His

Bundle Branches

Purkinje fibers
PHYSIOLOGIC BASIS OF
PACEMAKER CELLS
1. Irama : Sinus (60 -100 x/m) normal
Bukan Sinus Atrial Fibrilasi/flutter
SVT
Irama JUNCTION
VT
2. Laju QRS : HR?
Regularitas
3. Aksis : Normal
RAD/LAD
Superior Aksis
4. Interval PR : < 0.20 Detik (Normal)
5. Morfologi
a. Gelombang P : Normal P.Pulmonal P.Mitral
b. Kompleks QRS : Q patologis
RSR pattern di V1&V2
Interval-QRS (0.08 detik)
c. Segmen ST : ST-elevasi, ST-depresi
d. Gel.T : Flat-T, Inverted-T, tall-T
Gambar 3.2. Perhitungan aksis
A. Aksis Normal : Lead I: I= +4.5; lead aVF : +12.5; aksis = 72°
B. Deviasi aksis ke kanan : Lead I = -10; lead aVF : +8; aksis = +140°
C. Deviasi aksis ke kiri : Lead I = +5; lead aVF : -10; aksis = - 60°
ECG & dipole movement
Lead II, normal ECG
Limb leads Chest Leads
Unipolar Precodial (Chest) Leads
Midclavicular line
Anterior axillary line
Midaxillary line

V6R V6
V5
V5R
V4
V4R V3
V3R 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
 LEADS VIEW OF HEART
I, aVL Lateral
II, III, aVF Inferior
V1, V2 Septal
V3, V4 Anterior
V5, V6 Lateral
V1-V6 Whole Anterior
V1-V6, I, aVL Ekstensif Anterior
V7, V8, V9 Posterior
V3R, V4R Right
I aVR
V1 V4

ANT
LATERAL SEPTAL
ANT
II aVL V2 APICAL
V5

ANT
V3 V6 LAT
III aVF
INFERIOR
The 10 rules for a normal ECG

I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

.2
 Rule 1
1.0 R

PR
interval
0.5
PR interval should
T
Millivolts

be 120 to 200
P
milliseconds or 3 to
Q
0 5 little squares

S
-0.5
Interval PR harus 0,12-
0,20 dt (3-5 kotak)

0 200 400 600

Milliseconds
 Rule 2

1.0 R

0.5 The width of the

T
Millivolts

QRS complex
P
should not exceed
Q
0 110 ms, less than 3
little squares

S Kompleks QRS tdk boleh

-0.5
lebih dari 0,11 dtk (hrs < 3
QRS kotak)
0 200 400 600

Milliseconds
Rule 3

I II III aVR aVL aVF

The QRS
complex should
be dominantly
upright in leads I
and II

Kompleks QRS harus

dominan ke atas (positif)
di lead I dan II)
Rule 4

I II III aVR aVL aVF

QRS and T waves

tend to have the
same general
direction in the limb
leads

QRS dan T cenderung

memiliki arah yang secara
umum sama di lead
ekstremitas (I, II, III, aVL,
aVF)
Rule 5

All waves are negative

in lead aVR

T
Semua gelombang
negatif di lead aVR
Q S
 Rule 6
V6
V5
V4
V3
V1 V2

The R wave in the precordial leads must grow from V1 to at

least V4
Rule 7

I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

The ST segment should start isoelectric except in V1

and V2 where it may be elevated
Rule 8

I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

The P waves should be upright in I, II, and V2 to V6

Rule 9

I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

There should be no Q wave or only a small q less

than 0.04 seconds in width in I, II, V2 to V6
Rule 10

I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

The T wave must be upright in I, II, V2 to V6

INTERPRETASI EKG
 1. “Arus Listrik” yang dihasilkan selain dari 4
pacemaker utama  IRREGULER
2. “Arus Listrik” yang dihasilkan dari
supraventrikel  QRS SEMPIT

1. “Arus Listrik” yang dihasilkan

dari 4 pacemaker utama 
REGULER
2. “Arus Listrik” yang dihasilkan
dari ventrikel  QRS LEBAR
ECG INTERPRETATION
1. RHYTHM
2. RATE
3. P WAVE
4. PR INTERVAL
5. AXIS
6. QRS CONFIGURATION
7. ST SEGMENT
8. T WAVE
Lead II, normal ECG
REMEMBER

• Identity
• Name
• Age
• Date and Time
• Calibration
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
6 Seconds Method
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. P WAVE

– No more than 2.5 mm in

height
– No more than 0.12 sec in
duration
– Positive : I,II,aVF,V2-6
– May be positive, negative, or
biphasic : III,aVL,V1

ABNORMAL
4. PR Interval

– 0.12 – 0.20 sec in adult,

may be shorter in children
and longer in elders

Abnormal :
PR interval : prolonged, shortened
5. AXIS
6. QRS Complex

– 0.06 – 0.10 sec

– Q : 1st negative deflection after P
– R : 1st positive deflection after P
– S : negative deflection after R
Abnormal :
• Q : pathologic Q (>0.04 sec, 25% of
the R wave)
• QRS complex : widened (>0.10 sec)
• Right Ventricular Hypertrophy

• Left Ventricular Hypertrophy

• Bundle branch block

 QRS waveform nomenclature

R r qR qRs Qrs QS

Qr Rs rS qs rSr’ rSR’
 7. ST Segment
– Isoelectric (flat)

Abnormal
ST segment : depression (>1 mm), elevation (>1 mm in limb leads or
>2mm in precordial leads)
 8. T wave
– Limb lead : no more than 5 mm (height)
Precordial lead : no more than 10 mm (height)

Abnormal :
T : peaked/tall, inverted, flattened