dr.

Rangga Putra Nugraha

Sub divisi Imunologi
FK Untan

Electrodes

Bipolar standard limb (extremity) leads

Augmented unipolar limb (extremity) leads
Unipolar chest (precordial) leads

Bipolar

Lead I

: record the electrical potential

between right arm and left arm
Lead II : record the electrical potential
between left foot and right arm
Lead III : record the electrical potential
between left foot and left arm

Unipolar Limb

Lead aVR
Lead aVL
Lead aVF

: records the different

potential between right arm
and left arm with left foot
: records the different
potential between left arm
and right arm with left foot
: records the different
potential between left foot
and right arm with left arm

Unipolar Chest

V1 : at the SIC IV, Linea Sternalis Dextra

V2 : at the SIC IV, Linea Sternalis Sinistra
V3 : between V2 and V4, in the left
parasternal line
V4 : at the SIC V, LMCS
V5 : at the SIC V, LAAS
V6 : at the SIC V, LAMS

Curve

Falls below the base line

: negative
deflection
Rises above the base line : positive
deflection
Negative
: wave has traveled away
from the electrode
Positive
: wave has traveled towards it

Important

Ensure that the patient is warm and relax

Shave electrode area before cleaning
Thoroughly clean the area with alcohol
Before putting the electrodes, ensure that you
have applied a layer of gel between the
electrode and the skin
Put the metal accessories off

Interpretation

P wave

QRS

PR segment
ST segment

: left and right atrial depolarisation

(breath =< 0.12 second and 2.5
mm in height)
: ventricle depolarisation ( breath
=< 0.09 second)
: end of P wave beginning of R
wave
: end of S wave beginning of T
wave

Cont

PR interval
`
QRS interval
ST interval
QT interval

: beginning of P wave beginning

of R wave (0.12-0.21)
: beginning of R wave end of S
wave (0.01 second)
: end of S wave end of T wave
: beginning of Q wave end of T
wave ( =< 0.44 second)

Electrocardiography

Pace maker
Atrium
SA node
AV node
Ventrikel

Gelombang

P
QRS
T
U

: depolarisasi atrium
: depolarisasi ventrikel
: repolarisasi ventrikel
: repolarisasi terlambat dari
ventrikel

Penilaian

Irama jantung
Frekuensi
Arah axis
Zona transisi
Interval
Morfologi gelombang

Irama jantung

Irama sinus
Irama junctional
Irama atrial
Irama idioventrikular

Irama Sinus

P didepan qRs disemua lead

P harus positif
Frekuensi : 60 100x/menit

Aritmia Sinus

Bradikardia
: Atlet
Takikardia
:
Lingkungan
Gagal jantung
PJK
Hipertiroid
Aritmia
: anak dan atlet
Arrest
: PJK

Irama Atrial

P didepan qRS
P tidak normal
Frekuensi : 60

Aritmia Atrial

Takikardia
Flutter
Fibrilasi :
Rapid ventrikel respon
Normal ventrikel respon
Slow ventrikel respon

Irama Junctional

Atas

: di lead II

P didepan qRs normal

P terbalik (defleksi negatif)

Tengah

: di semua lead

qRs tanpa gelombang P

qRs harus normal

Bawah

: di lead II

P dibelakang qRs normal

P terbalik (defleksi negatif)

Cont

Frekuensi
: 50 -60x/menit
> 60x/menit : accelerated Junctional Rytme
> 100x/menit : takikardia Junctional Rytme

Aritmia Junctional

Normal Junctional rhythm

Accelerated Junctional rhythm
Takikardia Junctional rhythm :
Atas
Tengah
Bawah

Aritmia Atrial & Juntional

Gagal jantung
PJK
Hipertiroid
Penyakit jantung rematik
Cardiomyopati
Hipertensi heart disease

Irama Ventrikular

Frekuensi
: 30 40x/menit
Tidak ada gelombang P
Gelombang qRs melebar
Accelerated : 40 100x/menit
Takikardia
: >100x/menit

Aritmia Ventrikuler

Idio-ventrikuler rhythm
Accelerated ventrikuler rhythm
Takikardia ventrikuler rhythm
Ventrikuler flutter
Ventrikuler fibrilasi

Over drive

Pengambil alihan ritme secara

sementara atau permanen
Premature beat : atrial, junctional,
ventrikular

Frekuensi

300 dibagi jumlah kotak besar jarak antara 2R

yang berurutan
1500 dibagi jumlah kotak kecil jarak antara
2R yang berurutan

Posisi dan Axis

Lead aVF dan aVL

Lead aVF dan I
Interpretasi :
Normal intermediate
Left axis deviation
Right axis deviation
Extreme right axis deviation

Zona transisi

Perubahan defleksi negative dari gelombang qRs ke

defleksi positive
Lead prekordial
Interpretasi
:
Normal : V3-V4
Ke V1
: V1-V2-V3
: counter clock wise rotation
Ke V6
: V4, V5, V6
: clock wise rotation

Interval

PR
qRs

QT

: 0.12-0.22
: AV block
: <0.12
: RBBB atau LBBB
: <0.40
: Long QT syndrome

Gangguan Konduksi

AV
AV block derajat I
AV block derajat II
mobits I
mobits II

AV block derajat III

: long PR
:
: dropped beat
: tiba-tiba hilang

: jalan sendiri-sendiri

Serabut His
Right Bundle Branch Block

: Pelebaran qRs

complete or incomplete

Left Bundle Branch Block

complete or incomplete

: Pelebaran qRs

AV blok

Derajat I : Interval PR memanjang (>0.20

detik)
Derajat II Mobitz I : fenomena
Wenckebach)
Interval RR yang makin lama makin panjang
sampai terjadi dropped beat, kemudian siklus
terulang kembali

Cont

Derajat II Mobitz II
: interval PR yang tetap, tapi
secara periodik terdapat impuls sinus (gelombang P)
yang diblok sehingga tidak diikuti oleh kompleks
qRS
Dejarat III : atrium dan ventrikel akan berdenyut
dengan irama masing-masing
Gelombang p tidak berubah dan timbul teratur, dan
kompleks qRs bisa :
Tetap normal
Menjadi lebar

RBBB

Interval qRs > 0.12 detik

Gambaran RR dilead dada kanan (V1-V3)
Pada lead dada kiri (V5-V6) terlihat gelombang S
yang lebar
Perubahan pada segment ST & gelombang T
RBBB tidak lengkap
: ada gambaran RR dilead
dada kanan tapi interval qRs normal

LBBB

Interval qRs > 0.12 detik

Gambaran RR di lead dada kiri (V5-V6)
Perubahan pada segmen ST & gelombang T
LBBB tidak lengkap
: ada gambaran RR dilead
dada kiri, tapi interval qRs normal

Hipertrofi

Atrium kanan

Peak P
P tinggi > 2.5 cm
P pulmonal

Atrium kiri

Broad dan notch P

Lebar P >= 0.10
P mitral

Cont

Ventrikel kanan :
V1 +
s di V6
V3R +

Ventrikel kiri

R di V5/6 > 27
R di V5/6 + S V1 > 35

Penyakit Koroner Jantung

Iskemia : ST segment depresi dan T inversi

Infark : ST segmen elevasi
Lokasi :
II, III, aVF
V1-V2
V3-V4
V5-V6

: inferior
: septal
: apikal
: lateral

Hipo dan Hiper kalemia

Hiperkalemia
Hipokalemia

: Tall T wave dan

simetris
: U prominent dan
luasnya >1/3 T
wave