ELECTROCARDIOGRAFI

Oleh:
TEAM ECG
The Heart
Coronary Arteries and Veins
Anatomy
THE ELECTROCARDIOGRAM (ECG)

• Contraction of heart muscle is caused by

electrical changes
• Can be detected by electrodes attached to
the surface of the body
• These electric potentials can
be amplified and recorded onto
moving paper to produce
the electrocardiogram
THE ELECTROCARDIOGRAM (ECG)
• The various waves on the ECG are named
P,Q,R,S, and T
• The P wave reflects atria activation
• The QRS complex signifies contraction of
the larger ventricular muscle mass
• The T wave represents ventricular
repolarization
THE ELECTODE LEADS
There are twelve standard electrode leads
which look at the heart from different angles

Leads I,II,and III are bipolar

THE ELECTODE LEADS
Lead aVR, aVL, aVF and V1 – V6 are Unipolar

Leads I, II, III ,aVR,aVL,aVF are

known as frontal plane leads
 Precordial or Chest leads
Leads V1 – V6 are orientated in the horizontal plane
or Chest Leads are known as Precordial
Electrocardiographic Paper
The ECG graph paper is made
up of horizontal and vertical
lines
The horizontal lines measure time
in seconds
The vertical lines measure
voltage or height in millimeter

Each small square measured

horizontally represents 0.04
second in time

Each small square measured

vertically represents 1 mm in
height
P WAVE
The P wave is the first waveform on the ECG

Normally small,smooth < 0.3 or 3 mm in height

and < 0,12 second in width

Upright in leads I, II,aVF,V3-V6

Inverted in lead aVR

Upright, inverted or biphasic in leads III,aVL,

V1 and V2

LAH P Mitral

RAH P Pulmonale
PR INTERVAL
PR Interval is measured from the
beginning of the P wave as it leaves
the isoelectric line to the beginning of
the QRS
It is normally 0.12 to 0.20 seconds in
duration
PR Interval shorter than 0.12 seconds
are seen in WPW ( Wolff- Parkinson –
White syndrome and Lown Ganong
Levine Syndrome
PR Interval longer than 0.20 seconds
are seen in heart blocks
QRS Complex
The QRS complex represents
ventricular depolarization.
depolarisasi ventrikel

The QRS complex is measured

from the beginning of the QRS
until the end of the QRS

The normal QRS duration is 0.04 –

0.12 seconds
To know
Bundle Brach Block
Infarct Myocardial
Hypertrophy Ventricular
 QRS Complex

• The QRS complex is composed of

three waveform : Q , R, and S waves
• Many variations exist in the shape of
the QRS
• A QRS complex may contain only one
or two or all three waveforms
• Whatever the variation, the complex is
still termed the QRS complex
T WAVE
The T wave represents ventricular repolarisation

The T wave is a rounded waveform,

taller and wider than the P wave

Normal T wave are upright in the

most common leads I, II, aVF, V3-
V6

To know
Ischemia Miocard
Electrolit imbalance
 ST- SEGMENT
Normal : isoelectic Elevation

Depression Depression
 HOW TO
INTERPRETATION ECG
ECG INTERPRETATION

 Determine Rhythm
 Calculate Heart Rate
 Examine P wave
 Measure PR Interval
 Measure QRS Complex
 Calculate Axis
 Others
 Rhythm
R1 R2 R R R R R R R

Regular or Irregular
 Calculate Heart Rate
R R’

Regular
• 300/ R – R’ ( big squares)
• 1500/ R – R’ ( small squares)

Irregular
• Count the number of R waves in a 5 second strip and
multiply by 10
Identify and examine P waves
One P wave should precede each QRS
complex

All P wave are identical in size, shape and

position
Measure the PR Interval
PR Interval is measured from the
beginning of the P wave as it leaves the
isoelectric line to the beginning of the
QRS
Count the number of squarrres contained
in the interval and multiply by 0.04
seconds
 Measure QRS Complex
The QRS complex is measured from the
beginning of the QRS until the end of the
QRS

Count the number of squares contained in

the interval and multiply by 0.04 seconds
 Others
• Q pathologis
• ST Depresion
• ST Elevation
• T Tall
• Hypertrophy
 Normal Rhythm Sinus Rhythm
Criteria Sinus rhythm
 Ryhthm: Regular
 HR : 60 - 100 X/menit
 P wave ( P : QRS = 1 : 1 )
 PR Interval ( 0,12 - 0,20 sec )
 QRS Complex ( 0,06 - 0,12 sec)
Analizing ECG
 Normal Sinus Rhythm
• Rhythm : Regular
• P wave : Before each QRS
• Heart Rate : 60 – 100 x/min
• PR Interval : 0.12 – 0.20 sec
• QRS complex : 0.04 – 0.11 sec
 SINUS ARRYTHMIA
• Rhythm : Irregular
• P wave : Before each QRS
• Heart Rate : 60 – 100 x/min
• PR Interval : 0.12 – 0.20 sec
• QRS complex : 0.04 – 0.11 sec
 SINUS BRADYCARDIA
• Rhythm : Regular
• P wave : Before each QRS
• Heart Rate : 40 – 60 x/min
• PR Interval : 0.12 – 0.20 sec
• QRS complex : 0.04 – 0.11 sec
 SINUS TACHYCARDIA
• Rhythm : Regular
• P wave : Before each QRS
• Heart Rate : More than 100 x/min
• PR Interval : 0.12 – 0.20 sec
• QRS complex : 0.04 – 0.11 sec
 SINUS ARREST
• Failure of the S-A node to initiate one more
impuls
PREMATURE ATRIAL CONTRACTION
(PAC)
• Impuls early
• P wave : Premature
Configuration variable
• QRS complex :Normal
• Usually followed by Compensatory pause
 ATRIAL TACHYCARDIA
• Rhythm : Regular
• P wave : Before each QRS,
sometimes hidden in T
wave
• Heart Rate : 150 - 250 x/min
• PR Interval : Less than 0.12 sec
• QRS complex : 0.04 – 0.11 sec
 ATRIAL FLUTTER
• Rhythm : Regular, sometimes
irregular
• P wave : Sawtooth baseline,
220 - 350 x/min
• Heart Rate : Depends on degree of
AV Block
• PR Interval : Variable
• QRS complex : 0.04 – 0.11 sec
 ATRIAL FIBRILLATION
• Rhythm : Irregular
• P wave :Irregular, undulant or
absent
• Heart Rate :Irregularity
• PR Interval : Not measureable
• QRS complex : 0.04 – 0.11 sec
 Premature Nodal Contractions
The ectopic focus is in or near the A-V Node
The premature QRS Complex has a nodal P
wave unless the P is buried in the QRS and
not seen
 Nodal Rhythm
• Rhythm : Regular
• P wave :Inverted, before after or
is buried in the QRS
Complex
• Heart Rate :40 – 60 x /min
• PR Interval : Not measureable
• QRS complex : 0.04 – 0.11 sec
 Accelerated Nodal Rhythm
• Rhythm : Regular
• P wave :Inverted, before after or
is buried in the QRS
Complex
• Heart Rate : 60 - 100 x /min
• PR Interval : Not measureable
• QRS complex : 0.04 – 0.11 sec
 Nodal Tachycardia
• Rhythm : Regular
• P wave : Inverted, before after or
is buried in the QRS
Complex
• Heart Rate :Over 100 x /min
• PR Interval : Not measureable
• QRS complex : 0.04 – 0.11 sec
 PREMATURE VENTRICULAR
CONTRACTION ( PVC)
• Impuls early
• P wave : Absent before
premature QRS
• QRS complex : Bizarre and widened
more than 0.11 sec
• Usually followed by Compensatory pause
 IDIOVENTRICULAR RYTHM
• Rhythm : Regular
• P wave :Absent
• Heart Rate :20 - 40 x/min
• PR Interval : Absent
• QRS complex : Broad MORE THAN
0.12 SEC
Accelerated Ventricular Rhythm
• Rhythm : Regular
• P wave :Absent
• Heart Rate :40 – 60 x/min
• PR Interval : Absent
• QRS complex : Broad more than
0.12 sec
 VENTRICULAR TACHYCARDIA (VT)
• Rhythm : Regular
• P wave :Absent
• Heart Rate :150 – 250 x/min
• PR Interval : Absent
• QRS complex : Broad MORE THAN
0.12 SEC
 VENTRICULAR FIBRILLATION (VF)
• Rhythm : Irregular
• P wave :Absent
• Heart Rate :More than 250 x/min
• PR Interval : Absent
• QRS complex : Broad MORE THAN
0.12 SEC
Sino Atrial Block (SA Block)
 First-degree AV block
• The PR Interval exceeds the upper limit of normal, more than 0.20
sec and constant

Rhythm : Regular
Rate : Usually normal
P wave : Sinus P wave present; one P wave to each QRS
PR : Prolonged ( greater than 0.20 seconds )
QRS : Normal
Second Degree A-V Block mobitz I
• There is a progressive lengthening of the PR Interval
to the point where an impulse does not reach the
ventricle and a beat is dropped.
Rhythm : Irregular
Rate : Usually slow but can be normal
P wave : Sinus P wave present;
some not followed by QRS complexes
PR : Progressively lengthens
QRS : Normal
Second Degree AV Block Mobitz 2
• PR Interval : Fixed Interval , Some P wave
not conducted ( 2:1 , 3:1)
Rhythm : Regular usually;
can be irreguler if conduction ratios vary
Rate : Usually slow
P wave : Two, three, or four P waves before each QRS
PR : PR interval of beat with QRS is constant;
PR interval may be normal or prolonged
QRS : Normal if block in His bundle;
wide if block involves bundle branches
 Third Degree A-V Block
Rhythm : Regular
Rate : 40 – 60 if block in His bundle;
30 – 40 if block involves bundle branches
P wave : Sinus P wave present; bear no relationship to QRS;
can be found hidden in QRS complexes and T waves
PR : Varies greatly
QRS : Normal if block in His bundle;
wide if block involves bundle branches
AXIS
 Right Axis Deviation Left Axis Deviation

LAD

RAD
Inferior myocardial infarction
Left ventricular aneurysm
 Irama
• Sinus Ritme
• SinusTakikardi
• Sinus Bradikardi
• Sinus Aritmia
• Irama Jungtional
• Irama Idioventrikular
• Irama Ventrikular
• Takiaritmia (SVT,Atrial
Fibrilasi, Atrial
Fluter,VT)
• Bradiaritmia (blok
konduksi AV)

Sinus Aritmia
HOW TO RECORD ECG
PROSEDUR PEREKAMAN EKG
Persiapan
• Alat
»Mesin EKG; kabel listrik, kabel
elektroda, kabel ground,plat
elektroda ekstremitas, elektoda
dada
»Jelli
»Kertas tissu
»Spidol
»Kertas EKG
PROSEDUR PEREKAMAN EKG

Persiapan
• Pasien
»Rileks
»Jelaskan tujuan pemeriksaan
»Hal-hal yang harus diperhatikan;
aksesoris tangan dilepas
Cara perekaman
• Cuci tangan
• Cek kembali kelengkapan alat
alat
• Nyalakan mesin EKG
• Baringkan pasien ditempat
tidur, kaki tidak saling
bersentuhan
• Bersihkan dada dengan kertas
tissue
Cara perekaman
• Beri jelli pada plat elektroda
ekstremitas
• Pasang elektroda ekstremitas
pada kedua pergelangan
tangan dan kaki
• Beri jelli pada permukaan
dada sesuai lokasi V1 –V6
• Pasang elektroda dada sesuai
lokasi V1 –V6
Cara perekaman
• Tentukan kecepatan mesin
25 mm/dtk, dengan voltase
kalibrasi 1 mv, bila perlu ½
mv atau 2 mv
• Buat kalibrasi tiga kali
• Rekam setiap sandapan
/lead 3 -4 beat
• Setelah selesai semua lead
buat kembali kalibrasi
• Matikan mesin EKG
Cara perekaman
• Lepas elektroda, dimulai dari
dada kemudian tangan dan
kaki
• Bersihkan jelli dari tubuh
pasien dengan kertas tissue
• Beritahu pasien bahwa
perekaman sudah selesai
• Rapikan alat-alat
• Cuci tangan
Penulisan pada kertas EKG

• Nama pasien
• Umur pasien
• Waktu perekaman (jam,
tanggal, bulan, tahun )
• Nama sandapan
• Nama yang membuat
• Dokumentasikan EKG
Mr. x, 40 yrs
15/04/07 ,07.00

Ns. Y