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ELEKTROKARDIOGRAM
disusun oleh :
dr.Abdullah Afif Siregar Sp.A(K); Sp.JP(K)
SN = SA node
A-V NODE = A-V Node
HIS = Bundle of his
BB = Bundle branch
P = Purkinje fibers
SISTEM HANTARAN
JANTUNG
dan
GELOMBANG EKG
Horizontal menyatakan kecepatan kertas
dalam waktu
1 mm = 0,04 detik
5 mm = 0,2 detik
Vertikal menyatakan voltage elektris jantung
dalam millivolt
10 mm = 1 mV
Pada pemeriksaan rutin kecepatan rekaman
kertas EKG 25 mm/detik
10 mm = 1 mV 5 mm = 0,2 detik
Lead nomenclature.
There are different short-cut methods that can be used to calculate rate, all of
which assume a recording speed of 25 mm/sec.
One method is to divide 1500 by the number of small squares between two R
waves. For example, the rate between beats 1 and 2 in the above tracing is
1500/22, which equals 68 beats/min.
Alternatively, one can divide 300 by the number of large squares (red boxes in
this diagram), which is 300/4.4 (68 beats/min).
Another method, which gives a rough approximation, is the "count off" method.
Simply count the number of large squares between R waves with the following
rates: 300 - 150 - 100 - 75 - 60. For example, if there are three large boxes
between R waves, then the rate is 100 beats/min.
Determining the Mean Electrical Axis (QRS axis)
Lead I : 4 0 = 4
Lead aVF : 12 2 = 10
Lead I : 4 0 = 4
- = 270
Lead aVF : 12 2 = 10
- = 180 I
+ = 0/360
aVF
+ = 90
Determining the Mean Electrical Axis (QRS axis)
elevation
Hypertrophy
Hypertrophy criteria are fairly straightforward; we will be looking for
enlargement of any of the four chambers.
1. LVH: (Left ventricular hypertrophy). Add the larger S wave of V1 or
V2 (not both), measure in mm, to the larger R wave of V5 or V6. If the
sum is > 35mm, it meets "voltage criteria" for LVH. Also consider if R
wave is > 12mm in aVL. LVH is more likely with a "strain pattern"
which is asymmetric T wave inversion in those leads showing LVH.
2. RVH: (Right ventricular hypertrophy). R wave > S wave in V1 and R
wave decreases from V1 to V6.
3. Atrial hypertrophy: (leads II and V1). Right atrial hypertrophy -
Peaked P wave in lead II > 2.5mm amplitude. V1 has increase in the
initial positive deflection. Left atrial hypertrophy - Notched wide (>
3mm) P wave in lead II. V1 has increase in the terminal negative
deflection.
SYSTEMATIC INTERPRETATION GUIDELINES for Electrocardiograms
RATE
Rate calculation
Common method: 300-150-100-75-60-50
Mathematical method: 300/# large boxes between R waves
Six-second method: # R-R intervals x10
RHYTHM
Rhythm Guidelines:
1. Check the bottom rhythm strip for regularity, i.e. - regular, regularly
irregular, and irregularly irregular.
2. Check for a P wave before each QRS, QRS after each P.
3. Check PR interval (for AV blocks) and QRS (for bundle branch blocks).
Check for prolonged QT.
4. Recognize "patterns" such as atrial fibrillation, PVC's, PAC's, escape
beats, ventricular tachycardia, paroxysmal atrial tachycardia, AV blocks
and bundle branch blocks.
Hasil pembacaan EKG