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(ECG)
PELATIHAN KEGAWATDARURATAN
KARDIOVASKULAR
FAKULTAS KEDOKTERAN
UNIVERSITAS PRIMA INDONESIA
OUTLINE
Sinoatrial node
AV node
Bundle of His
Bundle Branches
Purkinje fibers
NORMAL ECG
The PQRST
P wave -
Atrial depolarization
QRS complex -
Ventricular
depolarization
T wave -
Ventricular
repolarization
Standard calibration The ECG
25 mm/s Paper
0.1 mV/mm
Horizontally
One small box - 0.04 s
One large box - 0.20 s
Vertically
One large box - 0.5 mV
ECG Leads
PELATIHAN KEGAWATDARURATAN
KARDIOVASKULAR
FAKULTAS KEDOKTERAN
UNIVERSITAS PRIMA INDONESIA
The 12 Lead ECG is at the center of the
decision pathway in the management of
patients with ischemic chest pain.
- AHA Guidelines 2000 -
Coronary Heart Disease
ISCHEMIC : ST depression
or T inversion
INJURY : ST Elevation
One way to
diagnose an
acute MI is to
look for elevation
of the ST
segment.
Myokardial Injury:
a. Downsloping (convex) ST elevation
epicardial injury
b. Upsloping (concave) not spesific
c. Deep ST depression
subendokardial injury
ISKEMIA
MIOKARD
3 type of ST depression :
1. Horizontal spesific
2. Downsloping spesific
3. Upsloping
Spesific for
Iskemia:
Diameter 2
mm with
dynamic T wave
inversion
Circulation 2010
22
Now, where do you think this person is
having a myocardial infarction?
5/2/17 24
ECG in
Tachyarrythmia
PELATIHAN KEGAWATDARURATAN
KARDIOVASKULAR
FAKULTAS KEDOKTERAN
UNIVERSITAS PRIMA INDONESIA
TACHYARRHYTHMIA
Irama
Irama Teratur
tidak teratur
Ventricular Ventricular
Tachycardia Fibrillation
Rhythm #1
Rate? 70 bpm
Regularity? regular
P waves? flutter waves
PR interval? none
QRS duration? 0.06 s
Interpretation? Atrial Flutter
Rhythm #4
Rate? none
Regularity? irregularly irreg.
P waves? none
PR interval? none
QRS duration? wide, if recognizable
Interpretation? Ventricular Fibrillation
ECG in
Bradyarrythmia
PELATIHAN KEGAWATDARURATAN
KARDIOVASKULAR
FAKULTAS KEDOKTERAN
UNIVERSITAS PRIMA INDONESIA
BRADYARRHYTHMIA
Classification:
Sinus Bradycardia
Junctional Rhythm
Atrioventricular block derajat 1,2,3
Sinus Bradycardia
Junctional Rhythm
AV Block
FirstDegree AV Block
Second Degree AV Block
Third Degree AV Block
First Degree AV Block
Delay in the conduction through the conducting system
Prolong P-R interval
AllP waves are followed by QRS
Associated with : AC Rheumati Carditis, Digitalis, Beta
PELATIHAN KEGAWATDARURATAN
KARDIOVASKULAR
FAKULTAS KEDOKTERAN
UNIVERSITAS PRIMA INDONESIA
Rhythm
Ventricular Tachycardia
Ventricular Fibrillation
Pulseless electrical activity (PEA)
Asystole
Ventricular Tachycardia
Ventricular Fibrillation
Asystole