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MEDICAL SURGICAL

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SUPLEMEN
MEDICAL SURGICAL

BANYUMAS
HOSPITAL IMRON

SUPLEMEN
MEDICAL SURGICAL

BANYUMAS
HOSPITAL IMRON

SUPLEMEN
MEDICAL SURGICAL

BANYUMAS
HOSPITAL IMRON

SUPLEMEN
MEDICAL SURGICAL

BANYUMAS
HOSPITAL IMRON

SUPLEMEN
MEDICAL SURGICAL

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HOSPITAL IMRON

SUPLEMEN
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Heart
: SA node
Sinoatrial node
Top of R atrium
pacemaker
Spontaneous, cyclic depolarization
.Slow Ca2+ channels
No RMP

Ectopic pacemakers (around SA

.node)

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SA node AP
Unique, rhythmic
action potentials (AP)
.at the SA node
:Depolarization
VG fast Ca2+ channels

:Repolarization
.VG K+ channels
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Myocardial APs
SA node spreads APs
. to myocardial cells
Depolarization: VG
Na+ channels
Plateau phase: VG
slow Ca2+ channels
.open
Slow inward Ca2+
.+balances outflow of K
Repolarization: VG K+

.channels

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Myocardial APs

Long AP due to
plateau phase
leads to
refractory period
and periodic
!beating of heart

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Heart
APs spread from cell to cell through-
.through gap junctions (intercalated discs)
myocardial cells contract as syncytium-
.(one giant, multinucleate cell)
. contraction lasts almost 300 msec-
!Lifelong periodic beating-
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Heart

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Depolarisasi Atrium

Depolarisasi Ventrikel

Repolarisasi Ventrikel

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ECG
:P wave
Atrial depolarization,
.contraction

: QRS complex
Ventricular
depolarization,
contraction
.Atrial repolarization

:T wave
Ventricular
.repolarization

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Summary
Systole
Lub (AV closes)
QRS to T~
Ventricles contract

Diastole
Dub (semilunar
close)
T to ~ QRS
Ventricles relax
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GAMBARAN UMUM EKG

NORMAL

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SUPLEMEN
MEDICAL SURGICAL

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SUPLEMEN
MEDICAL SURGICAL

BANYUMAS
HOSPITAL IMRON

SUPLEMEN
MEDICAL SURGICAL

BANYUMAS
HOSPITAL IMRON

SUPLEMEN
MEDICAL SURGICAL

BANYUMAS
HOSPITAL IMRON

SUPLEMEN
MEDICAL SURGICAL

BANYUMAS
HOSPITAL IMRON

SUPLEMEN
MEDICAL SURGICAL

BANYUMAS
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SUPLEMEN
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Puisi PQRST

P : tonjolan kecil di depan QRS kompleks

Q : lekukan ke bawah pertama pada QRS kompleks
R : setiap ke atas pada QRS kompleks
S : lekukan kebawah setelah R pada QRS
kompleks (melewati garis tengah)
T : tonjolan besar setelah QRS kompleks
P dan T tonjolannya bisa ke atas atau ke bawah
( bukan berarti normal lho)
QRS kompleks belum tentu terdiri dari Q,R,S tetapi
bisa hanya terdiri dari QR, QS, RS atau R saja

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SUPLEMEN
MEDICAL SURGICAL

BANYUMAS
HOSPITAL IMRON

SUPLEMEN
MEDICAL SURGICAL

BANYUMAS
HOSPITAL IMRON

SUPLEMEN
MEDICAL SURGICAL

BANYUMAS
HOSPITAL IMRON

SUPLEMEN
MEDICAL SURGICAL

BANYUMAS
HOSPITAL IMRON

SUPLEMEN
MEDICAL SURGICAL

BANYUMAS
HOSPITAL IMRON

SUPLEMEN
MEDICAL SURGICAL

BANYUMAS
HOSPITAL IMRON

SUPLEMEN
MEDICAL SURGICAL

BANYUMAS
HOSPITAL IMRON

SUPLEMEN
MEDICAL SURGICAL

BANYUMAS
HOSPITAL IMRON

SUPLEMEN
MEDICAL SURGICAL

BANYUMAS
HOSPITAL IMRON

SUPLEMEN
MEDICAL SURGICAL

BANYUMAS
HOSPITAL IMRON

SUPLEMEN
MEDICAL SURGICAL

BANYUMAS
HOSPITAL IMRON

SUPLEMEN
MEDICAL SURGICAL

BANYUMAS
HOSPITAL IMRON

SUPLEMEN
MEDICAL SURGICAL

BANYUMAS
HOSPITAL IMRON

SUPLEMEN
MEDICAL SURGICAL

BANYUMAS
HOSPITAL IMRON

SUPLEMEN
MEDICAL SURGICAL

BANYUMAS
HOSPITAL IMRON

SUPLEMEN
MEDICAL SURGICAL

BANYUMAS
HOSPITAL IMRON

SUPLEMEN
MEDICAL SURGICAL

BANYUMAS
HOSPITAL IMRON

SUPLEMEN
MEDICAL SURGICAL

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ADA DUA RUMUS MUDAH

1500 DIBAGI R ---- R KOTAK KECIL
300 DIBAGI R ----- R KOTAK SEDANG

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SUPLEMEN
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T. KANAN

aVR

T. KIRI

aVL

III

II
aVF

K. KANAN

K. KIRI
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SADAPAN EKSTREMITAS
I, aVL : menggambarkan jantung sebelah
kiri / lateral high lateral
II, III, aVF : menggambarkan jantung
sebelah bawah / inferior
aVR : menggambarkan jantung sebelah
kanan

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 V1, V2 : menggambarkan jantung anterior

V3,V4 : menggambarkan jantung septal

V5, V6 : menggambarkan jantung lateral
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Antero septal

Antero apikal

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Antero lateral
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Lokasi kelainan
I, Avl
II,III, Avf
V1,v2, v3
V3,v4,v5
V4,v5,v6, I,aVL
V1,v2,v3,v4,v5.v6,I,aVL

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High Lateral
Inferior
Antero septal
Antero apikal
Antero lateral
Anterior extensif

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GAMBARAN KELAINAN
ISKHEMIA
INFARK AKUT / INJURY / AMI
INFARK LAMA / OLD INFARK / OMI
HYPERTROPY ATRIUM
HYPERTROPY VENTRIKEL
RBBB
LBBB
ARITMIA / DISRITMIA
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ISKHEMIA
T INVERTED
ST DEPRESI
T DATAR

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T INVERTED / T KEBALIK

NORMAL DI LEAD aVR dan V1

BILA DITEMUKAN MINIMAL DI 2 LEAD
SELAIN SUPLEMEN
aVR dan V1 BANYUMAS
MEDICAL SURGICAL

HOSPITAL IMRON

ST DEPRESI

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AKUT MIOKARD INFARK

ST ELEVASI (STEMI)
ST DEPRESI DALAM (NSTEMI /
SUBENDOCARDIAL INFARK)

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ST ELEVASI

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OLD MIOKARD INFARK

Q PATHOLOGIS
GELOMBANG Q/S
GELOMBANG R POOR WAVE PADA
LEAD PREKORDIAL

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Q PATHOLOGIS
R
Q

Q>R
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Q/S

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R POOR WAVE
sadapan prekordial

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LATIHAN
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SUPLEMEN
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SUPLEMEN
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IR

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aVF RBANYUMAS
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I:R>S
Avf : R > S

Axis normal

I:R<S
aVF : R < S

Indeterminate

I:R>S
aVF : R < S

LAD

I:R<S
aVF : R > S

R AD

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HYPERTROPY ATRIUM
HYPERTROPY ATRIUM KANAN
HYPERTROPY ATRIUM KIRI

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Gel P
Durasi 0,10 0,12 sec
Amplitudo 0,5 2,5 mm
PR interval 0,12 0,22

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HYPERTROPY ATRIUM KANAN

P

P TINGGI DAN LANCIP

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Hypertrophy atrium kiri

P lebar
P berpuncak 2
P biphasik

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Hypertrophy ventrikel kanan

V1, V2
R>S

RAD
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V5, V6
S dalam
S persisten
BANYUMAS
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Hypertropy v kiri

V1, v2
S dalam, r poor

V5,v6
R > 25 mV (25ktk kcl)

R v5/v6+S v1/v2 = >35 mV /ktk kcl

LAD
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QRS kompleks
Durasi 0,6 0,12 sec
sec 0,12<

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RBBB VS LBBB
COMPLETE : QRS KOMPLEKS LEBAR > 0,15 SEC
INCOMPLETE : QRS KOMPLEKS < 0,15 SEC

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RBBB

V1 / V2
Lebar
RSR

V5 / V6
S dalam lebar
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LBBB

V1,V2
S lebar

V5,V6
QRS lebar M

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SUPLEMEN
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