SEJARAH (evolusi)

Willem Einthoven

Mac 400

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 Kegunaan EKG :
1. Hipertropi atria dan ventrikel
2. Infark miokard
3. Aritmia .
4. Perikarditis
5. Efek obat obatan (digitalis, kina)
6. Gangguan elektrolit (K)
7. Beberapa penyakit sistemik (hipertiroid)
8. dsb

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ANATOMI JANTUNG

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 SIRKULASI ARTERI KORONARIA

A : Anterior View B : Posterior View 5

 Bipolar Leads : Lead I, Lead II, Lead III
Unipolar Leads : aVR, aVL, aVF
Precordial Leads: V1, V2, V3, V4, V5, V6

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Lead Positive Negative View of
electrode electrode Heart

I LA RA Lateral
II LL RA Inferior
III LL LA Inferior

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Lead Positive View of
electrode Heart

aVR RA None
aVL LA Lateral
aVF LL Inferior

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Lead Positive electrode View of
Placement Heart

V1 4th Intercostal space Septum

to right of sternum
V2 4th Intercostal space Septum
to left of sternum
V3 Directly between V2 Anterior
and V4
V4 5th Intercostal Anterior
space at left
midclavicular line
V5 Level with V4 at left Lateral
anterior
axillary line
V6 Level with V5 at left Lateral
midaxillary line

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Lead Positive electrode
Placement

V1R 4th Intercostal space to left

of sternum

V2R 4th Intercostal space to

right of sternum

V3R Directly between V2R and

V4R
V4R 5th Intercostal space at
right midclavicular line

V5R Level with V4R at right

anterior axillary line

V6R Level with V5R at right

midaxillary line

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Cardiac Physiology Electrocardiography Diagnosis

SA
P T node

AV
node
Q
S
Cardiac Physiology Electrocardiography Diagnosis

SA
P T node

AV
node
Q
S
 QRS Complex
(Ventricular Depolarization)

P wave T wave
(Atrial (Ventricular
Depolarization) Repolarization) P wave

One Cardiac Cycle

1. Ritme : Sinus / Aritmia
2. Ventrikular Rate / Atrial Rate
3. Aksis (Electrical Position)
4. Gelombang P : Interval dan Amplitudo
5. PR interval
6. QRS compleks
7. Gelombang Q
8. Gelombang R
9. Gelombang S
10. Gelombang T
11. S-T segmen
12. Kesimpulan
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TERMINOLOGI
qRs Rs R rS RS

QR Q/QS RsR rSr rSR

P
E
N
G
H
I
T
U
N
G
A
N

E
K
G
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Menghitung Heart Rate

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Frekuensi jantung normal : 60 100 x/I
> 100 x/i (sinus) takikardi
< 60 x/i (sinus) bradikardi
140 250 x/i takikardi abnormal
250 350 x/i flutter
> 350 x/i fibrillasi

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 CONTOH

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 CONTOH

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Menentukan Axis (Electrical Position)

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 I II III

aVL
aVF V1 V2

V3 V4 V5 V6

V3R V4R
V7 V8 V9
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 Gelombang P
Menggambarkan aktivitas depolarisasi atria
Arah gelombang P normal selalu positif di II & selalu negatif
di aVR
Nilai Normal :
Tinggi < 3mm
Lebar < 3mm

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 Gelombang Q
Menggambarkan awal fase depolarisasi ventrikel
Ciri ciri Q patologis :
1. Lebarnya sama atau lebih dari 1mm (0,04 detik)
2. Dalamnya lebih dari 25 % amplitudo gelombang R
Kepentingan : menentukan adanya nekrosis miokard (infark miokard)

Gelombang T
Menggambarkan repolarisasi ventrikel
Arah normal : sesuai arah gelombang QRS
Amplitudo normal
Kurang dari 10 mm di sandapan dada
Kurang dari 5mm di sandapan ekstremitas
Minimum 1 mm
Kepentingan :
1. menandakan infark atau iskemik
2. Menandakan kelainan elektrolit , dll 38
Extremely tall, pointed T
waves seen in
hyperkalemia

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T Inverted
 Interval P-R

Batas normal : 0,12 0,20 detik

Kepentingan :
1. Interval P-R < 0,12 detik : terdapat pada hantaran dipercepat
(WPW syndrome)
2. Interval P-R > 0,20 detik : terdapat pada blok AV
3. Interval P-R berubah ubah : terdapat pada wandering
pacemaker

QRS interval = 0.06 0.10 sec

QT interval = 0.32 0.43 sec
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Gelombang R

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 V1 V6

RBBB

LBBB

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 Need reference point
Compare to TP segment
DO NOT use PR segment as reference!

ST TP
 Find J-points and ST segments
 Find J-points and ST segments
 Primary Causes of ST
Segment Elevation
Early repolarization (normal
variant in young adults)
Pericarditis
Ventricular aneurysm
Pulmonary embolism
Intracranial hemorrhage
Primary Causes of ST Segment
Depression
Myocardial ischemia
Left ventricular hypertrophy
Intraventricular conduction
defects
Medication (e.g., digitalis)
Reciprocal changes in leads
opposite the area of acute injury49
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PROGRESIFITAS MYAKARD INFARK AKUT

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 Tiga tanda infark
miokard akut :

Elevasi segment ST
T Inversi
Q formasi

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CONTOH

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CONTOH

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CONTOH

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CONTOH

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ST Depresi
Wassalamualaikum ww

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