Eletrokardiografi Dasar

Untuk Paramedik

dr. Irnizarifka, SpJP, FIHA

JMS 119
RS UNS – RSUD Moewardi
Surakarta
 CURRICULUM VITAE
FULL NAME IRNIZARIFKA

NICK NAME NIZAR

PERMANENT ADDRESS PERUM SRONDOL ASRI C.25, BANYUMANIK SEMARANG

EMAIL dr.irnizarifka@gmail.com

WEB nizarmd.wordpress.com

EDUCATION 2012 - 2016 Cardiology and Vascular Medicine Program, Faculty of Medicine, Universitas Indonesia
2008 - 2009 Medical Doctor (International Program), Faculty of Medicine, Gadjah Mada University
2004 - 2008 Bachelor of Medicine (International Program), Faculty of Medicine, Gadjah Mada University
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WORKING 2017 - present Staff and General Cardiologist at Department of Cardiology and Vascular Medicine, Faculty of Medicine,
Universitas Sebelas Maret and Sebelas Maret University Hospital
STATUS
2016 - 2017 General Cardiologist of Tarakan General Hospital, North Kalimantan
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ORGANIZATION 2018 - present UNS Hospital Medical Committee (Quality and Proffesional) Sub-committee
2018 - present European Heart Rhythm Association Member
2017 - present European Heart Failure Association HoT Member
2016 - present Indonesian Working Group on Heart Failure and Pulmonary Hypertension Committee
2016 - 2017 Division of Cardiology and Vasc. Medicine, Tarakan General Hospital, North Kalimantan Head
2015 - 2016 KELAKAR (The Organization of Cardiology Resident, Universitas Indonesia) President
2010 - 2011 Siantan Timur Primary Health Care, Anambas, Kepulauan Riau Province Head of PHC
Goals
 To make ECG “less scary”
 Pearls of interpretation

“When you are stressed,

your IQ drops significantly”
(R. Lepage)

12-2-9
 The Electrocardiogram is a graph that
record the electrical activity of the heart
Nomenclature ECG
PR interval : 0,12 - 0,20 dtk
QRS duration QTc < 0,42 ( tergantung HR)
R

ST segmen
P T
U

Q
S

PR
interval QT interval
Standarisasi

25 mm/sec
 SA Node

AV Node
Berkas His / His Bundle

His Cabang Kanan / Right Bundle Branch

His - Purkinje
System
His Cabang Kiri / Left Bundle Branch

Serabut Purkinje / Purkinje Fibre

Aktivitas Listrik otot Jantung

Depolarisasi – Repolarisasi – Resting

Chest lead
V1 Merah ISC 4 Right Sternal Border
V2 Kuning ICS 4 Left Sternal Border
V3 Hijau Antara V2 dan V4
V4 Ungu ICS 5 Linea Midclavicularis Sinistra
V5 Coklat ICS 5 Linea Axilaris Anterior
V6 Hitam Linea Axilaris Media
 V2R
V1 V2
V1R
V3R V3

V4R V4
V5 V6 V7 V8 V9
Cara pembacaan EKG

 Irama : sinus / tidak sinus

 Frekuensi : kali / menit
 Aksis : normal / LAD ( bergeser ke kiri ) /
RAD ( bergeser ke kanan ) / Superior
 Gelombang P : normal / LAE ( P mitral ) / RAE ( P Pulmonal )
 Interval PR : normal / memendek / memanjang
 Lebar QRS : normal / melebar
 Morfologi QRS : normal / LVH / RVH / RBBB / LBBB / WPW
 Segmen ST : normal / depresi / elevasi ( ukuran dan letak )
 Gelombang T : normal / negatif ( letak )

Kesan ……
Irama Dasar
Sinus = artinya Impuls listrik utama berasal dari SA node
•Gelombang : P – QRS
•Gelombang P : Positif di lead II
Negatif di lead aVR

•Macam-macam sinus : Sinus bradikdardi

Sinus normal
Sinus Takikardi
Sinus Aritmia
Menentukan frekuensi nadi ( heart rate )

1. 300
Jumlah kotak besar antara R-R

2. 1500
Jumlah kotak kecil antara R-R
1 kotak besar : 300 x/mny
Takikardi
2 kotak besar : 150 x/mnt
3 Kotak besar : 100x/mnt 3. Jika Irreguler, buat lead II lead
4 kotak besar : 75x/mnt Normal panjang (6 detik = 30 kotak besar) :
5 kotak besar : 60 x/mnt
6 kotak besar : 50x/mnt Bradikardi HR = Jumlah QRS komplek X 10
Aksis
GELOMBANG P
Gambaran yang ditimbulkan oleh depolarisasi atrium

Normal
Tinggi : < 0,3 mvolt
Lebar : < 0,12 detik
Selalu positif di L II
Selalu negatif di aVR

Kepentingan
Mengetahui kelainan di Atrium
P Mitrale
P Pulmonale
PR Interval
 Interval PR
Diukur dari permulaan P s/d permulaan QRS

Normal : 0,12 - 0,20 detik

 GELOMBANG QRS

Gambaran yang ditimbulkan oleh depolarisasi ventrikel

Normal :
Lebar : 0,06 - 0,12 detik
Tinggi : Tergantung lead

Normal gelombang Q
Lebar : < 0,04 detik
Dalam : < 1/3 tinggi R
QRS COMPLEX
Designations of different QRS patterns
ST Segment
T Wave
Cara pembacaan EKG

 Irama : sinus / tidak sinus

 Frekwensi : kali / menit
 Aksis : normal / LAD ( bergeser ke kiri ) /
RAD ( bergeser ke kanan ) / Superior
 Gelombang P : normal / LAE ( P mitral ) / RAE ( P Pulmonal )
 Interval PR : normal / memendek / memanjang
 Lebar QRS : normal / melebar
 Morfologi QRS : normal / LVH / RVH / RBBB / LBBB / WPW
 Segmen ST : normal / depresi / elevasi ( ukuran dan letak )
 Gelombang T : normal / negatif ( letak )

Kesan ……
 REMEMBER……!!!!!!!
“When you are stressed,
your IQ drops significantly”
(R. Lepage)

12-2-9
Contoh EKG
SINUS???
Menentukan frekuensi nadi ( heart rate )

SINUS???

300
Jumlah kotak besar antara R-R
Menentukan frekuensi nadi ( heart rate )

SINUS???

300
Jumlah kotak besar antara R-R
SINUS???
AXIS???
P WAVE???
P WAVE???
QRS COMPLEX???
QRS COMPLEX???
ST SEGMENT???
 TAKE HOME POINT
“Easy if you don’t memorize it”
THANK YOU
End of Presentation