MEMBACA EKG

Bagian dr. Aritantri Darmayani, M.sc,SpPD

1
EKG??
Mengenal Jantung untuk
EKG
Kabel lead Ekstremitas
Einthovens triangle
Lead bipolar ekstremitas
Agmented Voltage leads
(unipolar limb leads)
6 limb leads
Chest Leads
Chest Leads
6 chest leads
Harus Diperhatikan sebelum Baca
EKG!!

IDENTITAS:
Nama pasien
Usia pasien
Jenis Kelamin pasien

WAKTU:
Tanggal pengambilan
Jam pengambilan

KELAYAKAN:
Bisa dibaca
Pemasangan Lead yang benar (gelb p positif di lead II dan
negatif di aVR)
EKG PAPER
Kalibrasi
Gelb P QRS T U
APA YANG HARUS DIBACA PADA
EKG??

Irama
Heart rate
Axis & Posisi
Gelb P/PR interval
Gelb QRS
Segmen ST/ Gelb T
QT interval
Transisi Zone
Lain2
IRAMA
Sinus?
Supraventrikular?
Atrial?
junctional
Ventrikular?
HEART RATE
HR
HR
Hitung berapa HR-nya?
Contoh 1
Contoh 2
Contoh 3
Contoh 4
Axis & Posisi
Axis & Posisi
Axis & Posisi
Axis & Posisi
 Hexaxial Array for Axis
Determination
determination of
the angle of the
HEART AXIS
in the frontal plain
 Hexaxial Array for Axis Determination
Example 1

Lead I

If lead I is mostly
positive, the
axis must lie in
the right half of
of the coordinate
system (the main
vector is moving
mostly toward
the leads
positive
 Hexaxial Array for Axis Determination
Example 1

Lead AVF

If lead AVF is
mostly positive,
the
axis must lie in
the bottom half
of
of the coordinate
system (again,
the main vector
is moving mostly
toward the
 Hexaxial Array for Axis Determination
Example 1
I AVF

Combining the
two plots, we see
that the axis
must lie in the
bottom
right hand
quadrant
 Hexaxial Array for Axis Determination
Example 1
I AVF AVL

Once the quadrant

has been
determined, find the
most equiphasic or
smallest limb lead.
The axis will lie about
90o away from this
lead. Given that AVL
is the most
equiphasic lead, the
axis here is at
approximately 60o.
 Hexaxial Array for Axis Determination
Example 1
I AVF AVL

Since QRS complex

in AVL is a slightly
more positive, the
true axis will lie a
little closer to AVL
(the depolarization
vector is moving a
little more towards
AVL than away from
it). A better
estimate would be
about 50o (normal
 Hexaxial Array for Axis Determination
Example 2

Lead I

If lead I is
mostly
negative, the
axis must lie in
the left half of
of the
coordinate
system.
 Hexaxial Array for Axis Determination
Example 2

Lead AVF

If lead AVF is
mostly positive,
the
axis must lie in
the bottom half
of
of the coordinate
system
 Hexaxial Array for Axis Determination
Example 2
I AVF

Combining the
two plots, we
see
that the axis
must lie in the
bottom
left hand
quadrant (Right
Axis Deviation)
 Hexaxial Array for Axis Determination
Example 2
I AVF II

Once the quadrant

has been
determined, find
the most
equiphasic or
smallest limb lead.
The axis will lie
about 90o away
from this lead.
Given that II is the
most equiphasic
lead, the axis here
is at
 Hexaxial Array for Axis Determination
Example 2
I AVF II

Since the QRS in II

is a slightly more
negative, the true
axis will lie a little
farther away from
lead II than just
90o (the
depolarization
vector is moving a
little more away
from lead II than
toward it). A
better estimate
Precise
Axis
Calculation
Precise
calculation of the
axis can be done
using the
coordinate
system to plot
net voltages of Net voltage
perpendicular Since Lead III is = 12
leads, drawing a the most

=7
Net voltage
resultant equiphasic lead
rectangle, then and it is slightly
connecting the more positive
origin of the than negative,
coordinate this axis could
system with the be estimated at
opposite corner about 40o.
of the rectangle.
A protractor can
Hitung berapa axisnya??
Contoh 1
Contoh 2
Contoh 3
Gelb P / PR interval..
Gelb P / PR interval
Gelb P / PR interval
Gelb P / PR interval

P normal
Gelb P - Right Atrial Enlargement
Gelb P Left Atrial Enlargement
Contoh 1
Contoh 2
Contoh 3
Gelb QRS
Gelb QRS
Gelb QRS
Contoh 1
Contoh 2
Contoh 3
Gelb T /
Segmen ST
Gelb T / Segmen ST
Contoh 1
Contoh 2
Contoh 3
QT Interval

QTC = QT
R-R

QT normal = 0,35
-0,45 dtk
Contoh 1
Contoh 2
Transisi Zone

Normal: V3-V4 (dari ke

+)
Menunjukkan posisi
septum interventrikuler

CCWR (Counterclock
wise rotation) : bergeser
ke arah V1
Ex: LVH

CWR (Clock wise

rotation): bergeser ke
Contoh 1
Contoh 2
TERIMA KASIH