Dasar Medik Utk Pengembangan

‘ekg’ Sederhana dan Manfaatnya

Bagi Dunia Kedokteran di Indonesia
Budhi Setianto
Dep. Kardiologi dan Ked. Vaskular FKUI/ PJNHK
Jakarta

JKT, 5 Feb 2005: 09.15-10.15: Sidang Ilmiah II Informatika Kedokteran

(08.30 – 12.30). Pusat Studi Informatika Kedokteran Universitas
Gunadarma, Jl Ps Minggu No. 99G di Jakarta Selatan
Elektrokardiograph (ekg) Dipakai di
Dunia Medik dlm Bentuk:

ƒ ekg: Utk merekam EKG (elektrokardio-

gram)/ EG (elektrogram); 1-12 kanal.
ƒ t-ekg: transtelephonic-ekg
ƒ ekg-Monitor: Utk merekam EKG
sederhana di ICU/ CVCU; sinkronisasi
pencitraan pd: Echo, MSCT.
ƒ ekg-Holter: Utk merekam EKG-2 kanal/
(+) T.D.
 Circumflex and Diagonal Branches

Klinikum Grosshadern, Munich

SOMATOM Volume Zoom, ECG-Gated Spiral, 1mm Slices , 190ms
 Coronary Thrombosis in LAD

Volume Rendering
Jikei University, Tokyo

SOMATOM Volume Zoom, ECG-Gated Spiral, 1mm Slices, 250ms

90% coronary stenosis in LAD distal to LAD-CX bifurcation most likely caused by
a thrombotic lesion after rupture of a non-calcified plaque. Combination of high
spatial and high low-contrast resolution allows for non-invasive CT angiographic
evaluation of non-calcified coronary stenosis.
Approve and certificated by FDA (Food & Drugs Association) USA in 1998 and
ISO 9002 in 1999 number FDA 51OK # 983717
D/ Myocardial Ischemia and AMI with 12 leads ECG. In USA National Heart
Attack Alert Program Coordinating Committee recommend to using the tool in
emergency service and increasing survival rate in heart attack patient. Able to
recorded 12 leads ECG, Simple, need 52 second to transmit all recorded
ECG to Central HRS.
 Nomenclature of Acute Coronary
Syndrome
ƒ No ST Elevation
Unstable Angina
Non Q Myocardial Infarction
Q-wave Myocardial Infarction
ƒ ST Elevation
Q-wave Myocardial Infarction
Non Q Myocardial Infarction
Braunwald E, et al. ACC/AHA guidelines J Am Coll Cardiol. 2000;36:974.
 Electrocardiogram (1)
ƒ within 10 minutes of arrival.
ƒ Should be repeated as necessary,
During any recurrences of
remitting chest pain.
ƒ Should be compared with prior
recordings.
ƒ ST-segment changes, especially
if they resolve with resolution of
chest pain, strongly suggest acute
ischemia.
Right ventricular infarction
 Electrocardiogram (2)

ƒ ST-segment deviations of 0.05 mV =

0.5 mm: identify ischemic changes.

ƒ A normal ECG does not rule out ACS:

1% to 6% of patients with acute
ischemia.
Permanent Pace Maker
pada Pasca
Infark Miokard Akut

Gugun Iskandar
Rawat Dewasa

15 Mei 2001
Right Coronary System Left Coronary System

LAO LAO Morton J. Kern : The Cardiac

Catheterization Handbook, Mosby : 277-
277-
280,1995.
Kelainan Konduksi Pada Inferior dan Anterior MI

Inferior MI Anterior MI
Dysrhythmia Atrial Uncommon Uncommon
Ventricular Common Common
Intraventicular block Uncommon Common
AV block
First – degree Common Rare
Second degree
Mobitz I Common None
Mobitz II None Common
Third degree incidence 7-27% 1-5%
Potensial listrik sel miokardium.
Beda potensial antara elektrode di luar dan di dalam sel
merupakan potensial listrik sebuah sel.
ƒ Hubungan antara perbedaan konsentrasi ion dan
selisih potensial listrik diterangkan dengan
potensial kesetimbangan Nernst, dalam
persamaan:

ƒ RT Co
ƒ V = ------- ln -------
ƒ zF Ci

ƒ V = potensial membran, R = konstanta gas, T =

temperatur mutlak, z = valensi ion, F = konstanta
Faraday, Co dan Ci = konsentrasi ion di luar dan
di dalam sel.
ƒ Ion logam basa Na+ dan K+ mempunyai z = 1.
Persamaan potensial membran ion logam
tersebut dapat ditulis dalam logaritma biasa,
misalnya pada suhu 37oC ditulis V = 61,5 log
Co/Ci. Jika Co/Ci = 10, perbedaan potensial
yang dihasilkan sebesar + 61,5 mV; jika Co /
Ci = 0,1; V = -61,5 mV.

ƒ Pada waktu otot jantung istirahat [K+]o

mendekati 4,0 mM dan [K+]i mendekati 140
mM, persamaannya menjadi V = 61,5 ln
4/140 = 61,5 x log 0,029 = -95 mV. Batas
normal potensial istirahat diperkirakan
berkisar antara -80 sampai -95 mV (intrasel
negatif terhadap ekstrasel).
GAMBAR 1. HUBUNGAN POTENSIAL AKSI DAN ELEKTROKARDIOGRAM
Dikutip dari: Ramo BW dan Wagner GS. The Physiology of Normal and
Abnormal Rhythms. Dalam Waugh RA, Ramo BW, Wagner GS, Gilbert M,
Penyunting. Cardiac Arrhythmias a Practical Guide for The Clinician. Edisi ke 2.
Philadelphia: FA Davis Company; 1994. h. 5.
GAMBAR 3. RANGKAIAN ELEKTRONIKA ELEKTROKARDIOGRAF
Dikutip dari: Carr JJ, Brown JM. Introduction to Biomedical Equipment Technology. New
Jersey: Prentise Hall; 1993. h. 137.
www.healthyheart.nhs.uk/heart_works/
Frontal and Horizontal Plane Lead Diagram-KH
Frank G. Yanowitz, M.D.
http://medlib.med.utah.edu/kw/ecg
Unipolar Precodial (Chest) Leads

1 2
3 6
4 5

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
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
Calibration Signal - Marquette-KH
Marquette Electronics Copyright 1996

http://medlib.med.utah.edu/kw/ecg
Diagram: Frontal Plane Leads-KH
Frank G. Yanowitz, M.D., copyright 1997
http://medlib.med.utah.edu/kw/ecg
LOCATION OF CHEST ELECTRODES IN 4TH AND 5TH INTERCOSTAL SPACES:
http://medlib.med.utah.edu/kw/ecg
Behold: Einthoven's Triangle! Each of the 6 frontal plane leads has a
negative and positive orientation (as indicated by the '+' and '-' signs).
http://medlib.med.utah.edu/kw/ecg
clem.mscd.edu/~raoa/heart2/
clem.mscd.edu/~raoa/heart2/
clem.mscd.edu/~raoa/heart2/
clem.mscd.edu/~raoa/heart2/
Electrical and Mechanical Events Diagram - Marquette-KH
Marquette Electronics Copyright 1996
http://medlib.med.utah.edu/kw/ecg
clem.mscd.edu/~raoa/heart2/
clem.mscd.edu/~raoa/heart2/
clem.mscd.edu/~raoa/heart2/
ECG Components Diagram - Marquette-KH
Marquette Electronics Copyright 1996
http://medlib.med.utah.edu/kw/ecg
http://www.med.umich.edu/lrc/ecgoftheweek/cases/case04/
Electrocardiogram(ECG or EKG)

The electrocardiogram
(ECG) illustrates
conduction of electrical
impulses in the heart.
The depolarization of the
ventricles occurs from
the endocardium
(inside) to the
epicardium (outside)
[e]
The repolarization of the
ventricles occurs in the
opposite direction. [g]

www.eb.uah.edu/~wells/cpe496_sp_03/ mddsi/Documents/16 IX 2003

 KLASIFIKASI ARITMIA
1. Gangguan pembentukan impul :
a. Ekstrasistole
b. Takikardi
c. Flutter
d. Fibrilasi
e. Escappe Beat
f. Arrest
g . Wandering Pace-maker

2. Gangguan penghantaran impuls

a. Blok : Blok SA, Blok AV, Blok intraventrikular/B.B.B
b. Hantaran yang dipercepat : Syndrome Wolf Parkinson White
AV BLOCK
 Kesimpulan: Pertanyaan
ƒ Apakah yang dimaksud ekg-sederhana?
ƒ Dapatkah utk deteksi aritmia? Infark?
(Medis: dapat menyebabkan kematian)

- Bipolar saja? - Unipolar saja?

- Kanal: 1 saja (12-lead)?
- Glb P, QRS? - ST segment?
(Medis: Bentuk dan ukurannya)
Terima Kasih, Hatur Nuhun,mauliate
Godang, Matur Suksma, Mator Sake
langkong, Bujur Melala, Matur Nuw
un, Tarimo Kasih, Makaseh, Trimo
Kasih, Nayak, Tarima Kasih, Hatur

thank you
Nuhun, Mauliate Godang,Matur Suks
Suks
ma, Mator SakeLangkong, Bujur Me
lala, Matur Nuwun, Tarimo Kasih,
Makaseh, Trimo Kasih, Nayak, Teri
ma Kasih, hatur Nuhun, Mauliate Go
dang, Matur Suksma, Mator Sake-
langkong, Bujur Melala, Matur nuw-
un sanget, Tarimo Kasih, Makaseh,
Trimo Kasih, Mator Sakelangkong,
Bujur Melala, Matur
Nuwun Makaseh
Alan E. Lindsay, MD: A Teacher of Substance and Style
Frank Yanowitz Copyright 1996
http://medlib.med.utah.edu/kw/ecg