EKG

 Gelombang P: atrial depolarization

 Kompleks QRS: ventricular depolarization and contraction
 Gelombang T: ventricular repolarization
 Gelombang U: recovery of purkinje conduction fibers, may
not be observable

Interpretation:
1. Rhythm
2. Heart Rate
3. Axis
4. P wave
5. PR Interval
6. QRS complex
7. ST segment
8. T wave
9. QT interval
1. Rhythm
Examine R-R intervals (Ventricular rate)
Examine P-P intervals (Atrial rate)
QRS didahului oleh gelombang P berarti sinus rhythm
Jika tidak asinus

2. Heart Rate
R-R, hitung jumlah kotak
Kotak kecil: 1500/kotak kecil
Kotak besar: 300/kotak besar
Contoh:
1. R-R interval is 21.5. The heart rate is 1500/21.5, which is 69.8.

2. Count the number of QRS complexes over a 6 second interval. Multiply by 10 to determine
heart rate. This method works well for both regular and irregular rhythms. In the first image,
we can count 7 QRS complexes, so the heart rate is 70.
3. Axis
Aksis normal selalu terdapat antara -30° sampai +110°. Lebih dari -30°
disebut deviasi aksis kiri, lebih dari +110° disebut deviasi aksis kanan, dan
bila lebih dari +180° disebut aksis superior.
Kadang kadang aksis tidak dapat ditentukan, maka ditulis undeterminable,
misalnya pada EKG dimana defleksi positif dan negatif pada kompleks QRS
di semua sandapan sama besarnya.
4. P wave
The amplitude is normally 0.05 to 0.25mV (0.5 to 2.5 small boxes).
Normal duration is 0.06-0.11 seconds (1.5 to 2.75 small boxes).
The shape of a P-wave is usually smooth and rounded.
P-wave questions:
 Are they present?
 Do they occur regularly?
 Is there one P-wave for each QRS complex?
 Are the P-Waves smooth, rounded, and upright?
 Do all P-Waves have similar shapes?
 P-pulmonal atau P-mitral?
5. PR Interval
AV conduction time.
From where the P wave begins until the beginning of the QRS complex.
Normally this interval is 0.12 to 0.20 seconds (3 to 5 small boxes) in adults, longer in
elderly people. This interval shortens with increased heart rate.
Lebih dari 0.2 detik disebut blok AV derajat satu. Kurang dari 0,1 detik disertai adanya
gelombang delta menunjukkan Wolff-Parkinson- White syndrome.
6. QRS complex
Measure the QRS interval from the end of the PR interval to the end of the S wave
Normally this interval is 0.08 to 0.10 seconds.
If the wave immediately after the P wave is an upward deflection, it is an R wave; if it is a
downward deflection, it is a Q wave:
 small Q waves correspond to depolarization of the interventricular septum. Q waves
can also relate to breathing and are generally small and thin. They can also signal an
old myocardial infarction (in which case they are big and wide)
 the R wave reflects depolarization of the main mass of the ventricles –hence it is the
largest wave
 the S wave signifies the final depolarization of the ventricles, at the base of the heart
QRS questions:
 Does the QRS interval fall within the range of 0.08-0.10 seconds?
 Are the QRS complexes similar in appearance across the ECG tracing?
7. ST segment
It should be flat or slightly upsloping and level with the baseline. Elevation of more than
two small squares in the chest leads or one small square in the limb leads, combined with
a characteristic history, indicates the possibility of MI
ST depression is diagnostic of ischemia It is worth noting that although ST elevation can
localize the lesion (eg, anterior MI, inferior MI), ST depression cannot. Concave upwards
ST elevation in all 12 leads is diagnostic of pericarditis.
Elevasi segmen S-T pada sandapan precordial menunjukkan adanya infark dinding
anterior, sedangkan infark dinding inferior dapat diketahui dengan adanya elevasi
segmen S-T pada sandapan II, III, dan aVF. Untuk perikarditis biasanya tidak dapat
dipastikan tempatnya dan akan tampak elevasi di hampir semua sandapan. Elevasi
segmen S-T pada V4R ditemukan pada infark ventrikel kanan
Bukanlah suatu kelainan, apabila elevasi segmen S-T tidak melebihi 1 mm atau depresi
tidak melebihi 0,5 mm, paling kurang pada sandapan standar. Secara klinik elevasi atau
depresi segmen S-T pada 3 sandapan standar, biasanya disertai deviasi yang sama pada
sandapan yang sesuai, menunjukkan adanya insufisiensi koroner.
8. T wave
In a normal ECG, T waves are upright in every lead except aVR. T-wave inversion can
represent current ischemia or previous infarction. In combination with LVH and ST
depression, it can represent "strain". This form of LVH carries a poor prognosis.
Adanya kelainan gelombang T menunjukkan adanya kelainan pada ventrikel.
Untuk itu dikemukakan beberapa patokan yaitu :
 Arahnya berlawanan dengan defleksi utama QRS pada setiap sandapan.
 Amplitudo gelombang T > 1 mm pada sandapan I atau II dengan gelombang R
menyolok.
 Gelombang T terbalik dimana gelombang R menyolok.
 Lebih tinggi daripada perekaman sebelumnya atau lebih tinggi 8 mm pada
sandapan I,II, III.
Adanya gelombang T terbalik, simetris, runcing, disertai segmen S-T konveks keatas,
menandakan adanya iskemi miokard.
Pada keadaan dimana defleksi QRS positif pada sandapan I, sedangkan gelombang T
pada sandapan I terbalik atau lebih rendah dari gelombang T di sandapan III
menunjukkan adanya insufisiensi koroner.
Gelombang T yang tinggi dan tajam pada semua sandapan kecuali aVR dan aVL
menunjukkan adanya hiperkalemi.
Gelombang T yang tinggi dan simentris dengan depresi segmen S-T menunjukkan adanya
infark dinding posterior.
9. QT interval
The QT interval should be less than half of the R–R interval.
The QT interval represents the time of ventricular activity including both depolarization
and repolarization.
It is measured from the beginning of the QRS complex to the end of the T wave.
Normally, the QT interval is 0.36 to 0.44 seconds (9-11 boxes). The QT interval will vary
with patient gender, age and heart rate. Another guideline is that normal QT Intervals is
less than half of the R-R Interval for heart rates below 100 bpm.