INTERPRETASI

ELEKTROKARDIOGRAFI

dr. Erlina Marfianti, MSc, SpPD

Departemen Ilmu Penyakit Dalam
Fakultas Kedokteran UII

Definisi

EKG adalah grafik hasil catatan potensial

listrik yang dihasilkan oleh denyut jantung

EKG merupakan alat pembantu diagnostik.

Penderita dengan kelainan jantung organik
bisa menunjukkan gambaran EKG normal

EKG bisa menunjukkan kelainan non

spesifik pada orang sehat

Kegunaan EKG

Beberapa kelainan jantung yang

dapat diketahui dari EKG

Hipertrofi
Infark miokard
Aritmia
Gangguan elektrolit
Efek obat-obatan: misal digitalis
dll

Physiologic Properties of Myocardial Cells

Automaticity
Excitability
Conducticity
Contractility

: Ability to initiate an impulse

: Ability to respond to an impulse
: Ability to transmit an impulse
: Ability to respond with pumping action

LEAD

Components of a
NSR

Rekaman EKG baku telah ditetapkan bahwa:

a. Kecepatan rekaman : 25 mm/detik
b. Kekuatan voltage : 1 mv = 10 mm

Bearti ukuran di kertas EKG:

a. Pada garis horosontal
-

Tiap 1mm = 1 kotak kecil = 1/25 detik = 0,04 detik

Tiap 5mm = 1 kotak sedang = 5/25 detik = 0,20 detik

Tiap 25 mm = 1,00 detik

Components of a NSR:
P wave

1.
2.
3.
4.
5.

Describe the sequence of right and left atrial

Normal positif in lead I, II, aVF, and V4 V6
Normal negative in lead aVR
Duration < 0,12 sec
Amplitudo < 2,5 mm

Components of a NSR :
PR interval

1. Time needed to transmit impuls from SA node to AV no

2. Normal 0,12 0,22 sec ( 3-5,5 small box)
3. Short PR interval
preeksitasion syndrome
4. Prolonged PR interval
think about A-V block.

Components of a NSR :
QRS complex

1.
2.
3.
4.

Describe activation of left and right ventrikel

Duration 0,05 0,10 sec (<2,5 small box).
Measure usually in limbs lead
If the amplitudo less than 10 mm in all leads
low voltage.
5. Abnormal complex QRS seen in conduction defect

Components of a NSR :
QRS complex

Nomenclature of complex QRS

first negative deflection named Q wave

first positive deflection named R wave
negative deflection after R wave called S wave
R wave always above the baseline
Q`and S wave always below the baseline

Components of a NSR :
QRS complex

Q wave
1. Normal Q wave seen in lead I, aVL, and V5-6.
describe activation of septum left to right
2. Q wave in V1-2 is abnormal
3. Pathologic Q : duration > 0,04 sec and/ or height
> dari 1/3 complex QRS

Components of a NSR:
ST segment

Normal ST segment
1. Usually isoelectric, elevation < 1 mm in
extremity still normal
2. Depression < 0,5 mm
3. Point at the end of QRS complex named J point

Components of a NSR:
T wave

T wave criteria
1. Describe repolarization of ventricel
2. Normal positif in leads I,II and V3-V6
3. Normal negative in lead III

Components of a NSR:
QT duration

QT duration

1. Describe total sistolic time

2. variation according to heart rate, gender and age
3. QT interval must be < R-R interval in HR 65-90/mnt
4. Normal QT correction 0,44 + 0,02 sec
5. Prolonged QTc predispose R on T VT

How to report
Rhythm

- Axis

- Transisional Zone

- Interval
- PR

- QRS

- QT

- Sign : Hipertrophi,
iskemia, infark

CONCLUSION :

- Heart rate

Rate

Rhytm
(Irama)

Irama Sinus Normal

Irama jantung yang normal ialah irama
yang ditentukan oleh simpul SA dan
disebut irama sinus:
- Frekuensi antara 60-100 x/menit
- Teratur
- Gelombang P negatif di aVR dan positif
di II
- Tiap gelombang P diikuti oleh
kelompok QRS T
Penyimpangan - ARITMIA

AXIS

Setiap vektor jantung

mempunyai:
-Polaritas
-Arah
-Ukuran/Intensitas

Axis Deviation

-900
Left Axis

Extreme
Right Axis

-300

1800
Normal
Right Axis

900

Penentuan Sumbu QRS di

Bidang Frontal
1.

2.

Secara praktis tentukan di

sandapan I dan AVF
Tentukan di sandapan manakah
terdapat keadaan ekuipotensial
(nol)

Amplitudo di
I
Positif

Positif

Negatif

Negatif

AVF
positif

Negatif

Positif

Negatif

Ekuipotensi
al di

Sumbu

III

+30

aVL

+60

+90

aVF

II

- 30

aVR

- 60

-90

aVR

+120

II

+150

aVF

+180

aVL

-120

III

- 150

AKSIS
-30 s/d -15
-15 s/d +15
+ 15 s/d +45
+ 45 s/d +75
+ 75 s/d
+110
+110 s/d +
180
-30 s/d -90
-90 s/d 180

Posisi Jantung
Horizontal
Semi horizontal
Intermediate
Semi Vertikal
Vertikal
Deviasi Sumbu ke kanan
Deviasi sumbu ke kiri
Deviasi ke kanan hebat

PATHOLOGY

CORRELATION BETWEEN LOCATION

OF ISCHAEMIC, ECG AND CORONARY
ARTERY ANATOMY
LOCATION OF INFARCT/
ARTERY INVOLVED
ISCHAEMIC

ECG

ANTERIOR EKSTENSIVE

I, aVL, V1-V6

ANTEROSEPTAL

V1- V3

ANTEROLATERAL

I, aVL, V4- V6

CORONARY

LAD, LCX
LAD
LCX

INFERIOR
PDA

II, III, aVF

RCA,

POSTERIOR
(POSTEROLATERAL)

V7- V9

PL

RV
V3R V5R
BRANCH
LAD Left
Anterio Descenden.LCX circumflex.RCA Righ Cor.Art.

RCA/ RV

MYOCARDIAL INFARCTION

Myocardial infarction is characterized by the

necrosis of a portion of the myocard resulting
from a lack of sufficient blood suply to keep
the muscle viable.
The most common cause is complete occlusion
of coronary artery by atherosclerotic coronary
trombosis.

Terminology of infarct

Acute infarct : several hours untill days

ECG : ST elevation
Recent infarct : several days- weeks.
ECG : evolution
Old infarct
: more than 6 months.
ECG : Q wave or QS
complex or slow
progression of R wave

CRITERIA LVH

Chest lead (Sokolow, Lyon) :

S wave in V1 + R wave in V5 or V6 > 35 mm R in V5 or V6 >
26 mm.
R plus S in any chest leads > 45 mm

Limb leads (Gubner, Ungerleider) :

R
R
R
R

in
in
in
in

I + S in III > 25 mm
aVF > 20 mm
aVL > 11 mm
aVR > 15 mm

LV Strain (Strain Pattern) = perubahan segmen ST dan

gelombang T= depresi semen ST dan inversi T

Hipertrofi ventrikel kanan

Deviasi aksis ke kanan (>+110)

R V1> S V1
Gelombang R yang tinggi di
sandapan aVR
Rotasi searah jarum jam