ECG 12 leads

RSU Dr.Zainoel Abidin Banda Aceh By.Budiman

The Prime TM ECG electrocardiac mapping system (Source: Meridien Medical Technologies, Inc)

Penempatan Leads

Lead = Kamera

lead berfungsi seperti kamera yang melakukan monitor aktivitas listrik jantung dari berbagai sudut.

Segitiga Einthovent
Sandapan ekstrimitas Bipolar dan Unipolar
aVR
I

aVL

II

Vektor Listrik Jantung

III

aVF

Morfologi ECG pada tiap Sandapan

Defleksi Positif atau Negatif ECG tergantung dari : - Posisi sandapan - Arah aliran listrik

Aliran listrik

Sandapan ekstrimitas dan thoraks

Vektor listrik & ECG

V5

Bagaimana membaca ECG secara sistematis

Standarisasi Irama (Sinus atau lainnya) Aksis QRS Kecepatan Morfologi gelombang P & durasi Interval PR Morfologi QRS & durasi Segmen ST-T Morfologi gelombang T Gelombang U Interval QT

Menentukan Irama
Lihat gelombang P di lead II, dan aVR. Irama Sinus, jika : Lead II : defleksi positif. Lead aVR : defleksi negatif.

Fibrilasi Atrial (coarse/kasar, fine/halus) Atrial Flutter (Sawtooth appearance)

Normal Adolescent ECG

aVR

II

Lead II

Coarse Atrial Fibrilation

Iregular R-R

Atrial Flutter

Bagaimana menentukan aksis QRS (I)

Frontal Plane Ukur R-S di lead I Ukur R-S di lead aVF
Superior Axis

Left Axis

180 I
Right Axis
Normal Axis

Normal : -30 - + 120 LAD : < -30 RAD : > 120 Superior Axis : >180

90
aVF

Bagaimana menentukan aksis QRS (II)

Horizontal Plane
Progression of R wave

V1

V2

V3

V4

V5

V6

Transition Zone Clockwise

Counter Clockwise

Formula = 300 : medium block

Morfologi gel.P & durasi

Normal : - Positif di lead I, II, aVF, V3-V6 - Tinggi < 2.5-3 kotak kecil - Durasi < 12 ms

P mitral

: Lebar (>12ms) & notch di lead II Terminal Negative deflection di lead V1

P pulmonal : Tinggi (>3mm) di lead II durasi : normal

Dilatasi atrium kiri : P mitral

Dilatasi atrium kanan = P pulmonal

Right Ventricular Hypertrophy

RAD 110 R wave or R in lead V1 of 5mm
R:S Ratio in V1 > 1 and V6 < 1 QRS complex may be slightly Prolonged but < 0.12 sec. *ST Segment depression, upward convexity, and inverted T wave in lead V1 and V2. *Delayed intrinsicoid deflection in lead V1 (0.034-0.055 sec) *Prominent P wave in lead II

Bundle Branch Block

LBBB

RBBB

RSR pattern at V6

RSR pattern at V1

Right Bundle Branch Block

IRAMA-IRAMA JANTUNG YANG MEMBAHAYAKAN JIWA

Irama Cepat - Supra Ventrikular Takikardia - Ventrikular Takikardia/ Fibrilasi - Torsade de Pointes Irama Lambat - AV blok Derajat 2 - AB blok total

Supra Ventrikular Takikardia

Kriteria Diagnostik :

Delta Wave & Short PR Interval

Wolf Parkinson White

Ventrikular Takikardia

Sustained VT QRS rate : 150-250x/mnt

Non-Sustained VT

Karakteristik : Rate QRS > 120 x/ menit QRS kompleks lebar VES > 3 berturutan

Ventrikel Takikardia - Fibrilasi

Karakteristik : Gelombang QRS lebar > 190 x/mnt Diikuti Gelombang kacau (chaotic rhythm)

Ventrikular Bigemini

Torsade de Pointes

Karakteristik : Takikardia dengan QRS lebar Rate : >270 x/ menit Variasi aksis QRS

AV blok derajat 2
Mobitz Type 1 Mobitz Type 2

MOBITZ TYPE I
-Almost always occurs at the level of the AV node (rarely at His bundle or bundle branch level), & is often due to increased parasympathetic tone or to drug effect (Dig, Prop, Verap.) -Specific treatment is rarely needed unless severe signs & symptoms are present. Find the underlying causes.

MOBITZ TYPE II
PR interval does not lengthen b4 a drop beat - Occurs below the level of the AV Node either at the bundle of His (uncommon), or the bundle branches (common) - Usually associated with an organic lesion in the conduction pathway, - Rarely the result of increased parasympathetic tone or drug effect

Left Anterior Fascicular Block

Sinus arrest