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8/14/2019 00401 ECG Basic.pptx
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Dr. David D Ariwibowo, Sp.JP
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Standard 12 leads ECG
Limb Lead Precordial Lead
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Right Arm (white)
Left Arm (black)
Standard Configuration
Exercise Configuration
The right & left arm
electrodes are transferred to
the upper torso while the leg
electrodes are transferred to
the lower torsoRight Leg (green - ground)
Left Leg (red)
Standard Configuration
V1 red
V2 yellow
V3 green V5 orange
V4 blue V6 violet
PrecordialLeads
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Electrode Anatomical Location
Right Arm (RA) The base of the right shoulder against the deltoid border about 2cm below the clavicle but above the border of pectoralis (in deltoidfossa).
Left Arm (LA) The base of the left shoulder against the deltoid border about 2 cm
below the clavicle but above border of pectoralis (in deltoid fossa).
Right Leg (RL) Right anterior axillary line a few centimeters above the umbilicus
Left Leg (LL) Left anterior axillary line a few centimeters above the umbilicus
V1 Fourth intercostal space at right sternal border.
V2 Fourth intercostal space at left sternal border.
V3 Midway between positions for V2 and V4. V4 Fifth intercostal space at left midclavicular line.
V5 Horizontal level of V4 at left anterior axillary line. V6 Horizontal level of V4 at left midaxillary line.
Anatomical Placement of Electrodes
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The Concept of a "Lead"
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LEAD II
LEAD I
LEAD III
Remember, the RLis always the ground
Limb Leads
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Precordial Leads
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V9
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Standard 12 leads ECG
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The ECG waves P wave : atrial
depolarisation
QRS complex :ventriculardepolarisation
T wave : ventricular
repolarisation
Atrial repolarisationhidden by QRS
P
Q
R
S
T
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Local action potential
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• The depolarization
traveling acros the
heart continue
traveling through the
body• By examining the
different leads, shape,
time intervals,
contour, frequency,
and type of the ECGcomplexes, we can
diagnose cardiac
illnesses.
The ECG Complex
R
S
Q
T
UP
PRinterval
0.12 - 0.20
sec
< 0.10
sec
QRS
duration
ST
segment
QTinterval
0.35 - 0.45
sec
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ECG Paper
Standard recording:
- Speed: 25 mm/s
- Voltage: 1 mV
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Standard 12 leads ECG
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++++ ++++ ++++------
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++++
----++++
----++++
----
++++
----++++
----++++
----
----++++
--++
--++
--++
--++
----++++
++++
----++++
----++++
----
++++
----++++
----++++
----
----++++
--++
--++
--++
--++
----++++
++++
----++++ ++++
---- ----
++++
----++++----
++++
----
----++++
--++
--++
--++
--++
----++++
++++++++
--------++++ ++++
---- ----
++++
----++++
----++++++++
--------
----++++
----++++
Generation of the
ECG complexes A wave of depolarization
moving toward an electrode
will cause an upward
deflection on the ECG.
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.
60 o
Depolarization of the atria in Lead II Atrial depolarization proceeds
from the top down in all
directions.
Summing these vectors of
depolarization the main
atrial depolarization vector
(large green arrow).
It is moving towards the lead II
resulting in an upward
deflection of the ECG.
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60o
Depolarization of the LV in Lead II. Septum depolarizes from inside out resulting depolarization wavemoves away from Lead II.
The rest ventricle depolarizes
counter-clockwise from inside out main cardiac vector (large arrow)which is sum of all of the smalldepolarization vectors.
This vector in normal heart, almost
always moving directly toward LeadII a mostly positive QRS complex.
The RV is much smaller andcontributes little to the overall mainvector of depolarization
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Repolarization of the LV in Lead II Repolarization is the beginning of
depolarization left off .
Proceeding clockwise from thelateral wall back to the septum.
The vector is moving away from theLead II T-wave is always positive.
The process much slower thandepolarization T-wave is wide &rounded.
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Rules of pacemaker & Conduction1. Setiap sel jantung dapat berperan sebagaipacemaker.
2. Pacemaker dengan frekuensi pulsustertinggi yang menentukan frekuensidenyut jantung.
3. Pulsus secara normal di konduksikan dariatrium ke ventrikel hanya melalui AVnode.
4. Pulsus dari atrium mengalamiperlambatan di AV node sebelumdikonduksikan ke ventrikel.
5. AV node memiliki masa refrakter
tertentu(masa tidak dapat dirangsang).6. Pulsus yang berasal dari supra ventrikelakan mengeksitasi ventrikel dengan cepat gambaran QRS sempit.
7. Pulsus yang berasal dari ventrikel akanmengeksitasi ventrikel dengan lambat gambaran QRS lebar.
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Heart Excitation Related to ECG
Figure 18.17
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Thank You
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