Introduction to ECG

Yoga Waranugraha, MD, FIHA

Cardiology and Vascular Medicine Department
Faculty of Medicine – Universitas Brawijaya
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Basic Electrophysiology

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 Cells of The Heart

PACEMAKER CONDUCTING MYOCARDIAL

CELLS CELLS CELLS

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Thaler MS, The Only EKG Book You'll Ever Need 7th Ed, 2012
 60-100 bpm

60-80 bpm

40-60 bpm

Cardiac
Conduction
System

20-40 bpm
Baltazar RF, Basic and Bedside Electrocardiography, 2009 4
Barrett KE, Ganong's Review of Medical Physiology 25th Ed, 2015
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Thaler MS, The Only EKG Book You'll Ever Need 7th Ed, 2012
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Barrett KE, Ganong's Review of Medical Physiology 25th Ed, 2015
 Cardiac Action Potential
NON PACEMAKER CELL PACEMAKER CELL

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Lilly LS, Pathophysiology of Heart Disease: A Collaborative Project of Medical Students and Faculty, 6 th Ed, 2016
 Refractory Period

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Lilly LS, Pathophysiology of Heart Disease: A Collaborative Project of Medical Students and Faculty, 6 th Ed, 2016
The Lead System

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 Extremity Lead

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Wagner GS and Strauss DG, Marriot’s Practical Electrocardiography 12 th Ed, 2014
 Extremity Lead

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Baltazar RF, Basic and Bedside Electrocardiography, 2009
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Wagner GS and Strauss DG, Marriot’s Practical Electrocardiography 12 th Ed, 2014
 Precordial Lead

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Wagner GS and Strauss DG, Marriot’s Practical Electrocardiography 12 th Ed, 2014
Precordial Lead – Special Condition

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Vector

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 Time and Voltage
• Duration, measured in fractions of a second
• Amplitude, measured in millivolts (mV)
• Configuration, a more subjective criterion referring to the shape and
appearance of a wave.

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Thaler MS, The Only EKG Book You'll Ever Need 7th Ed, 2012
 Standard ECG Recording

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Baltazar RF, Basic and Bedside Electrocardiography, 2009
 Depolarization

Repolarization

Baltazar RF, Basic and Bedside Electrocardiography, 2009

Goldberger AL, Goldberger’s Clinical Electrocardiography A
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Simplified Approach 8th Ed, 2013
Waves, Intervals, and Segments

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 Summary of the Electrocardiogram:
Waves, Intervals, and Segments

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Baltazar RF, Basic and Bedside Electrocardiography, 2009
 P Wave
• The P wave represents
atrial depolarization

• Small positive (or

negative) deflection
before the QRS complex

Baltazar RF, Basic and Bedside Electrocardiography, 2009

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Goldberger AL, Goldberger’s Clinical Electrocardiography A Simplified Approach 8 th Ed, 2013
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Baltazar RF, Basic and Bedside Electrocardiography, 2009
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Baltazar RF, Basic and Bedside Electrocardiography, 2009
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 PR Interval
• The time for the stimulus
to spread through the atria
and pass through the AV
junction.

• In adults the normal PR

interval is between 0.12
and 0.2 sec
Baltazar RF, Basic and Bedside Electrocardiography, 2009
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Goldberger AL, Goldberger’s Clinical Electrocardiography A Simplified Approach 8 th Ed, 2013
 QRS Complex
• The QRS width, or interval,
represents the time required
for a stimulus to spread
through the ventricles
(ventricular depolarization)

• Normally about 0.10 or less

Baltazar RF, Basic and Bedside Electrocardiography, 2009

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Goldberger AL, Goldberger’s Clinical Electrocardiography A Simplified Approach 8 th Ed, 2013
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Baltazar RF, Basic and Bedside Electrocardiography, 2009
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Goldberger AL, Goldberger’s Clinical Electrocardiography A Simplified Approach 8 th Ed, 2013
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Lilly LS, Pathophysiology of Heart Disease: A Collaborative Project of Medical Students and Faculty, 6 th Ed, 2016
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Lilly LS, Pathophysiology of Heart Disease: A Collaborative Project of Medical Students and Faculty, 6 th Ed, 2016
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 ST Segment
• The ST segment is that
portion of the ECG cycle
from the end of the QRS
complex to the beginning of
the T wave.
• It represents the beginning
of ventricular repolarization.
• The normal ST segment is
usually isoelectric.

Baltazar RF, Basic and Bedside Electrocardiography, 2009

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Goldberger AL, Goldberger’s Clinical Electrocardiography A Simplified Approach 8 th Ed, 2013
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Baltazar RF, Basic and Bedside Electrocardiography, 2009
 T Wave
• The T wave represents part
of ventricular repolarization.

• A normal T wave has an

asymmetrical shape; that is,
its peak is closer to the end
of the wave than to the
beginning.

Baltazar RF, Basic and Bedside Electrocardiography, 2009

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Goldberger AL, Goldberger’s Clinical Electrocardiography A Simplified Approach 8 th Ed, 2013
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 QT Interval
• The QT interval is measured from
the beginning of the QRS
complex to the end of the T
wave.

• It primarily represents the return

of stimulated ventricles to their
resting state (ventricular
repolarization).

Baltazar RF, Basic and Bedside Electrocardiography, 2009

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Goldberger AL, Goldberger’s Clinical Electrocardiography A Simplified Approach 8 th Ed, 2013
 Rate-Corrected QT Interval (QTc)
• Bazzet formula:

• Hodges formula:

• Normally the QTc is between about 330 msec and about 440 msec

Baltazar RF, Basic and Bedside Electrocardiography, 2009

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Goldberger AL, Goldberger’s Clinical Electrocardiography A Simplified Approach 8 th Ed, 2013
 U Wave

• Functionally, U waves
represent the last
phase of ventricular
repolarization.

Baltazar RF, Basic and Bedside Electrocardiography, 2009

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Goldberger AL, Goldberger’s Clinical Electrocardiography A Simplified Approach 8 th Ed, 2013
Electrical Axis

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Baltazar RF, Basic and Bedside Electrocardiography, 2009
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Baltazar RF, Basic and Bedside Electrocardiography, 2009
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Baltazar RF, Basic and Bedside Electrocardiography, 2009
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Baltazar RF, Basic and Bedside Electrocardiography, 2009
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Baltazar RF, Basic and Bedside Electrocardiography, 2009
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Baltazar RF, Basic and Bedside Electrocardiography, 2009
Rhythm and Rate

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 Sinus Rhythm as The Normal Rhythm
• The normal cardiac rhythm, initiated by depolarization of the
sinus node, is known as sinus rhythm and is present if:
• Every P wave is followed by a QRS
• Every QRS is preceded by a P wave
• The P wave is upright in leads I, II, and III
• The P wave is downward in lead aVR
• The PR interval is greater than 0.12 sec

Baltazar RF, Basic and Bedside Electrocardiography, 2009

Goldberger AL, Goldberger’s Clinical Electrocardiography A Simplified Approach 8 th Ed, 2013
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Lilly LS, Pathophysiology of Heart Disease: A Collaborative Project of Medical Students and Faculty, 6 th Ed, 2016
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Baltazar RF, Basic and Bedside Electrocardiography, 2009
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Baltazar RF, Basic and Bedside Electrocardiography, 2009
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Baltazar RF, Basic and Bedside Electrocardiography, 2009
?

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MATUR SEMBAH NUWUN

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