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 STANDARISASI EKG
Kecepatan kertas standard EKG
25 mm / s (10 25 50 mm / s
Setiap kolom horizontal = 0.04 sec
Setiap kolom vertikal 10 mm = 1 mV
PEMASANGAN ELEKTRODE
PEMASANGAN ELEKTRODE EXTREMITAS
Lengan kanan dan lengan kiri
Kaki kanan dan kaki kiri
PEMASANGAN ELEKTRODE DADA
V1 = Parasternal kanan di ICS-4
V2 = Parasternal kiri di ICS-4
V4 = MCL kiri di ICS-5
V3 = Median antara V2 dgn V4
V5 = Para Axillair Line kiri di ICS-5
V6 = Median Axillair kiri di ICS-5
 SISTEM LEADS
STANDARD LIMB LEADS
I, II, III
AUGMENTED UNIPOLAR LIMB LEADS
aVR, aVL, aVF
UNIPOLAR CHEST LEADS
V1, V2, V3, V4, V5, V6
V3R, V4R, V5R, V6R
V7, V8, V9
V7R, V8R, V9R
Unipolar Precodial (Chest) Leads
Midclavicular line
Anterior axillary line
Midaxillary line

V6R V6
V5
V5R
V4
V4R V3
V3R V2
V1

Mervin J. Goldman, MD. 11th edition Principles of clinical Electrocardiography. Clinical Professor of Medicine University of
California School of Medicine San Francisco @1995-1982
Unipolar Precodial (Chest) Leads

Horizontal plane of
V4-6

V7 V8 V9 V9RV8RV7R

Mervin J. Goldman, MD. 11th edition Principles of clinical Electrocardiography. Clinical Professor of Medicine University of
California School of Medicine San Francisco @1995-1982
Conduction System

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

P wave : atrial
depolarisation R

QRS complex :
ventricular T
depolarisation P

T wave : ventricular
repolarisation Q
S

Atrial repolarisation
hidden by QRS
ECG INTERPRETATION

1. RHYTM
2. RATE
3. AXIS
4. HIPERTROPHIC SIGNS
5. MYOCARDIAL INFARCTION
6. ARRHYTHMIA
1. RHYTHM

Normal cardiac rhythm : SINUS rhythm

Sinus rhythm characteristics :

Rate 60-100 bpm
Constant R R interval
Negative P wave in aVR and positive di II
P wave is always followed by QRS complex
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 )
MENGHITUNG DENYUT JANTUNG :
 JUNCTIONAL RHYTM

- Relatively slow regular rhytm with an

escape rate of 35 to 60 per minute
- Normal QRS complexes
- Ectopic P wave may precede or follow
the QRS complex
- PR interval < .12 second
- QRS duration < .12 second
 Idioventricular Rhytm

- Relatively slow regular rhytm with an

escape rate of 20 40 per minute
- Wide QRS complexes
- Ectopic P wave may precede or follow
the QRS complex
- PR interval : Normal or absent
- QRS duration > .12 second
Idioventricular rhythm
2. RATE
Normal heart rate : 60 100 x/minutes
> 100 x/minutes : Sinus Tachycardia
< 60 x/minutes : Sinus Bradicardia

Determination heart rate (normal paper speed 25 mm/s):

300
Count number of large square (bold boxes in one R R interval)
1500
Count number of small square in one R R intervals
Number of QRS complex in 6 seconds, multiply by 10
 MENENTUKAN AXIS EKG

Menghitung Axis:
Sudut yang dibuat oleh tingginya voltage R di I
dengan tingginya voltage R di aVF
Axis yg normal berada antara -30 dgn +90
Left Axis Dev berada antara -30 dgn -90
Right Axis Dev berada antara +90 dgn +180

I
3. AXIS
Menentukan Axis
P Wave
4. HYPERTROPHIC SIGNS
P Pulmonale
P Mitrale
PR Interval
AV BLOCK
Wolff-Parkinson-White syndrome
QRS Complex
ST Segment
T Wave
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
Anatomi Koroner dan EKG 12 sandapan

Sandapan V1 dan V2 menghadap septal area ventrikel kiri

Sandapan V3 dan V4 menghadap dinding anterior ventrikel kiri

Sandapan V5 dan V6 ( ditambah I dan avL ) menghadap

dinding lateral ventrikel kiri

Sandapan II, III dan avF menghadap dinding inferior ventrikel kiri
5. MYOCARDIAL INFARCTION

Ischemia
Injury
Necrosis
ANTERIOR INFARCTION
INFERIOR INFARCTION
POSTEROLATERAL INFARCTION
Acute anteroseptal myocardial infarction.
Hyperacute T-wave changes are noted
Acute anterolateral myocardial infarction
Acute inferoposterior myocardial infarction
LVH
LVH
LVH
RV
H
RVH
RVH
ARRHYTHMIA
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
AV BLOCK
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
Supraventricular tachycardia
Wide complex tachycardia
Ventricular flutter