Faisal Habib

Fakultas Kedokteran Universitas Indonesia

Pusat Jantung Nasional Harapan Kita
Conduction System

SA Node
Internodal branch
AV Node
Hiss Bundle
Purkinje Fiber
Contraction
The Electrocardiogram ( ECG )

P wave : atrial
depolarisation R

QRS complex :
ventricular
P T
depolarisation

T wave : ventricular
repolarisation Q
S
Atrial repolarisation
hidden by QRS
PR Interval
QRS Complex
ST Segment
T Wave
 Pola Membaca EKG
Irama
Rate QRS
Aksis QRS
Morfologi Gelombang P
Interval PR
Durasi QRS
Morfologi QRS
Deviasi Segmen ST
Morfologi Gelombang T
Morfologi Gelombang U
Lain-lain (LVH,LV Strain,BBB,
QT interval) Nilai Normal :
Kesimpulan EKG Interval PR 0,12 s/d 0,20
Durasi QRS 0,04 s/d 0,12
Aksis Normal - 300 s/d + 1100
 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
MENGHITUNG LAJU JANTUNG :
A. Jarak R R :

-1 kotak sedang = 300 x / menit

-2 kotak sedang = 150 x / menit
-3 kotak sedang = 100 x / menit
-4 kotak sedang = 75 x / menit
-5kotak sedang = 60 x / menit
-6 kotak sedang = 50 x / menit

C. 1500 / jarak R-R ( dlm mm ) = heart rate / menit

P Pulmonale
P Mitrale
Pemasangan Lead Terbalik
Normal Sinus Rhythm

Rhythm : Regular
Rate : 60 100
P wave : Normal in configuration; precede each QRS
PR : Normal ( 0. 12 0.20 seconds )
QRS : Normal ( less than 0.12 seconds )
First-degree AV block

Rhythm : Regular
Rate : Usually normal
P wave : Sinus P wave present; one P wave to each QR
PR : Prolonged ( greater than 0.20 seconds )
QRS : Normal
Second -degree AV block, Mobitz I

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 II

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 AV 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 wav
PR : Varies greatly
QRS : Normal if block in His bundle;
wide if block involves bundle branches
ST depresi dan perubahan gelombang T

ST depresi dianggap bermakna bila > 1 mm di bawah garis dasar PT di titik J

Titik J didefinisikan sebagai akhir kompleks QRS dan permulaan segmen ST

Bentuk segmen ST :

up-sloping ( tidak spesifik )

horizontal ( lebih spesifik untuk iskemia )
down-sloping ( paling terpercaya untuk iskemia )

Perubahan gelombang T pada

iskemia kurang begitu spesifik

Gelombang T hiperakut
kadang2 merupakan satu-satunya
perubahan EKG yang terlihat
 LOKASI ISKEMIA
BERDASARKAN PERUBAHAN DI SANDAPAN EKG
SANDAPAN LOKASI ISKEMIA / INFARK

II,III, aVF Inferior

V1,V2,V3 Anteroseptal
V1-V4 Anterior
V1- V6 Anterior ekstensif
I,aVL ,V5,V6 Lateral
I, V6 Apikal
V7-V9 Posterior
V3R-V4R Ventrikel kanan
Unstable angina
Acute anteroseptal myocardial infarction.
Hyperacute T-wave changes are noted
Acute anterolateral myocardial infarction
High lateral infarction
Inferior myocardial infarction
Acute inferoposterior myocardial infarction
Wolff-Parkinson-White syndrome
A Fib/Flutter spectrum
PSVT :
-due to re-entry mechanism
-narrow QRS complex
-regular
-retrograde atrial depolarization
-P wave ?
Junctional rhythm:
-AV junction can function as a pace maker
(40-60 x/min).
-due to the failure of sinus node to initiate
time impulse or conduction problem.
-normal-looking QRS.
-retrograde P wave.
-P wave may preceede, coincide with, or
follow the QRS
SR

VES
 Sinus rhythm
with
Multifocal VES

VES VES

SR SR
SR SR SR SR
Sinus rhythm with VES couple
Sinus Rhythm with VES, R on
Ventricular Tachycardia
 Sustained VT
If the tachycardia lasts more than 30 seconds
if the tachycardia is associated with hemodynamic
compromise (dizziness, hypotension, or near syncope),
even if the duration of the VT is <30 seconds.
Torsade de Pointes
Ventricular Fibrillation
Wolff-Parkinson-White syndrome