Dr. Bagus Ari Pradnyana D.S.

, SpJ P
Konsep dasar
EKG
Sistem sandapan
pada EKG
Konsep vektor
Interpretasi EKG
EKG normal
KONSEP DASAR
ELEKTROKARDIOGRAFI
Ketut Susila
SMF Penyakit J antung RSUD Kabupaten
Buleleng
August D. Waller
An early electrocardiogram
Sel-sel otot jantung:
susunan ion yang
berbeda intra dan
ekstra sel: Na+/K+
Sel-sel otot jantung:
susunan ion yang
berbeda intra dan
ekstra sel: Na+/K+
K+ Na
+ + + + + + + + + + + + + + +
+ + + + + + + + + + + + + + +
- - - - - - - - - - - - - - - - - - - - -
- - - - - - - - - - - - - - - - - - - - -
K+ Na+
-
+
- 90 mV
K+ Na
+ + + + + + + + + + + + + + +
+ + + + + + + + + + + + + + +
- - - - - - - - - - - - - - - - - - - - -
- - - - - - - - - - - - - - - - - - - - -
K+ Na+
0
0
0 mV
+ + + + +
+ + + + +
- - - - - - -
- - - - - - -
+ + + + +
+ + + + +
+ + +
+ + +
- - - - -
- - - - -
- - - - - - -
- - - - - - -
Istirahat
(polarisasi)
Repolarisasi)
Aktivasi
(depolarisasi)
The summation of myocyte potentials
POTENSIAL AKSI
Perbedaan potensial listrik antara intra dgn ekstra sel
saat mendapat stimulus , maka perubahan potensial yg
terjadi sbg fungsi waktu > potensial aksi
Kurva potensial aksi mempunyai karakteristk yg khas tdri
4 fase
- Fase 0 lonjakan potensial mencapai
+ 20mv karena masuknya ion Na
- Fase 1 masa repolarisasi awal potensial
kembali dari + 20 mv ke 0 mv.
- Fase 2 fase ini masuk ion Ca menghimbangi gerak
keluar ion K.
- Fase 3 fase repolarisasi cepat dmn potensial kembali
secara tajam ke tingkat awal yaitu fase 4
Sistim konduksi J antung
Sistim Sandapan pada EKG
Electrocardiographic leads
Bipolar limb leads ( I,II,III)
Unipolar limb leads( aVR,aVL,aVF )
Unipolar precordial leads ( V1,V2,V3,V4,V5,V6 )
Bipolar limb leads
Unipolar limb leads
Unipolar precordial leads
Konsep Vektor
pada
Elektrokardiografi
Relationship of vectors to deflections
Relation of vectors to deflections
Impulse origination and atrial depolarization
Relationship of vectors to deflections
Septal depolarization
Apical and early ventricular
depolarization
Late ventricular depolarization
Sumbu bidang frontal
Einthovens triangle
Limb Lead Axis (vertical axis)
Frontal plane axis (mean QRS vector)
Frontal plane axis (mean QRS vector)
Frontal plane axis (mean QRS vector)
Frontal plane axis (mean QRS vector)
Hexaxial reference system
Frontal plane axis (mean QRS vector)
Activity related to Precordial Leads
(Horizontal Axis)
Sumbu bidang horizontal
Interpretasi EKG normal
Terminologi.
- Kalibrasi sblm lakukan rekaman EKG
kecepatan standar kertas 25 mm/dt depleksi yg
sesuai 10 mm sesuai dgn 1 mV.
- Garis mendatar tanpa potensial listrik = grs
isoelktrik.
- Depleksi mengarah keatas = depleksi positif,
depleksi kebawah = depleksi negatif.
Basic Principles of ECG Interpretation
Be Systematic
Rate: Fast-Normal-Slow
Rhythm: Sinus, Blocks, Atrial, Ventricular
Axis: Normal, Right, Left
Intervals and Durations
Waveforms and Segments (Morphology)
Basic Principles of ECG Interpretation
Be Systematic
Rate: Fast-Normal-Slow
Rate always the 1
st
Step!
Extra slides
Name of patient
1. Calculate Heart Rate
2 Basic Methods
Big-Box Method
3
0
0
1
5
0
6
0
1
0
0
7
5
Pengukuran waktu
Penentuan frekuensi .
Kecepatan atrium atau ventrikel dihitung
berdasarkan kecepatan kertas. Kecepatan kertas
25 mm/dt, kertas menempuh 60 x 25 mm =
1500 mm/mnt frekuensi jantung = 1500 : jarak
siklus dlm mm ( jarak R-R)
Penetuan interval
Kecepatan 25 mm/dt : 1 mm = 1/25 dt = 0,04
dt atau 5 mm = 0,20 dt
Basic Principles of ECG Interpretation
Be Systematic
Rate: Fast-Normal-Slow
Rhythm: Sinus, Blocks, Atrial, Ventricular
Rhythm Sinus? Fast or Slow?
Regular or Irregular ?
Basic Principles of ECG Interpretation
Be Systematic
Rate: Fast-Normal-Slow
Rhythm: Sinus, Blocks, Atrial, Ventricular
Axis: Normal, Right, Left
Axis Normal ? Right ? Left ?
-I
RA
LA
+I
+AVF
-AVF
RA&LA
+I/+AVF
+I/-AVF
-I/+AVF
Left Axis
Right Axis
Extreme
Axis
Normal
Axis
Horizontal & Transverse Axis
http://www.UpToDate.com
Basic Principles of ECG Interpretation
Be Systematic
Rate: Fast-Normal-Slow
Rhythm: Sinus, Blocks, Atrial, Ventricular
Axis: Normal, Right, Left
Intervals and Durations
Intervals and Durations:
Short ? Long ?
Intervals, segments, and durations
Intervals
QRS duration
PR interval QT Interval
Normal: .12-.20 sec
(3-5 small boxes)
Normal: .07-.10 sec Normal (corrected for rate
or QTc): .440-.470 sec
QT Interval
PR Interval
QRS Duration
Basic Principles of ECG Interpretation
Be Systematic
Rate: Fast-Normal-Slow
Rhythm: Sinus, Blocks, Atrial, Ventricular
Axis: Normal, Right, Left
Intervals and Durations
Waveforms and Segments (Morphology)
Waveforms and Segments
(Morphology)
Inferior Myocardial Infarction
I
II
aVF
aVR
aVL
III
Waves & Segments
Waves: P-QRS-T
Segments: PR, ST, TP
http://medstat.med.utah.edu
The electrocardiogram normal
Nilai normal untuk interval-interval
Interval P : < 0,12 dt
Interval PR : 0,12 0,20 dt
Interval QRS : 0,07 0,10 dt
Interval QT
- HR 60 x / mnt : 0,33 0,43 dt.
- HR 80 x/mn : 0,29 0,33 dt.
- HR 100x/mnt : 0,27 0,35 dt
QT sebagai fungsi frekuensi jantung
rumus Bazett QT
QT-c =
R-R
QT-c : QT terkoreksi ( corected QT )
QT : QT yg terukur
R-R : interval R-R yang terukur
Normal QT-c = 0,33 0,43 dt.
The electrocardiogram
TERIMAKASIH
SELAMAT SIANG
Om Shanti Shanti Shanti Om