INTERPRETASI

ELEKTROKARDIOGRAFI

PENDRIK TANDEAN
CARDIAC CENTRE
RS. WAHIDIN SUDIROHUSODO MAKASSAR
 Chest Leads
6 Unipolar leads
Also known as precordial leads
V1, V2, V3, V4, V5 and V6 - all positive
Atrial depolarization, P-wave
Ventricular depolarization, Q
Ventricular depolarization, R
Ventricular depolarization, S
Ventricular repolarization, T
ECG & dipole movement
 Right sided chest leads are much more sensitive to the presence of right
ventricular infarction. The most useful lead is lead V4R (an electrode is place

over the right fifth intercostal space in the mid-clavicular line).

ECG diagnosis
 Aims

10 ECG rules

ECG signs of M.I.

Evolution of changes in M.I.

Classical Appearences
 QRS waveform nomenclature

R r qR qRs Qrs QS

Qr Rs rS qs rSr rSR
 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

0 200 400 600

Milliseconds
 Rule 1
1.0 R

PR
interval
0.5
T PR interval
Millivolts

P should be
Q 120 to 200
0 milliseconds or
3 to 5 little
squares
S
-0.5

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
-0.5
QRS

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
 Rule 4

I II III aVR aVL aVF

QRS and T waves

tend to have the
same general
direction in the limb
leads
 Rule 5

All waves are negative

in lead aVR
T

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