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 : Ability to initiate an impulse

• Excitability : Ability to respond to an impulse
• Conducticity : Ability to transmit an impulse
• Contractility : 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. Describe the sequence of right and left atrial

2. Normal positif in lead I, II, aVF, and V4 – V6
3. Normal negative in lead aVR
4. Duration < 0,12 sec
5. Amplitudo < 2,5 mm
 Components of a NSR :
PR interval

1. Time needed to transmit impuls from SA node to AV node

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. Describe activation of left and right ventrikel

2. Duration 0,05 – 0,10 sec (<2,5 small box).
3. Measure usually in limbs lead
4. 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

wave

. Normal Q wave seen in lead I, aVL, and V5-6.

 describe activation of septum left to right
. Q wave in V1-2 is abnormal
. 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 < ½ 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 : - Heart rate :

- Axis :
- Transisional Zone :
- Interval
- PR :
- QRS :
- QT :
- Sign : Hipertrophi,
iskemia, infark

CONCLUSION :
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
-300
Right Axis

1800
Normal
Right Axis

900
Penentuan Sumbu QRS di Bidang
Frontal
1. Secara praktis tentukan di sandapan I
dan AVF
2. Tentukan di sandapan manakah terdapat
keadaan ekuipotensial (nol)
 Amplitudo di Ekuipotensi Sumbu
I AVF al di

Positif positif III +30

aVL +60
I +90
aVF 0
Positif Negatif II - 30
aVR - 60
I -90
Negatif Positif aVR +120
II +150
aVF +180
Negatif Negatif aVL -120
III - 150
AKSIS Posisi Jantung
-30 s/d -15 Horizontal
-15 s/d +15 Semi horizontal
+ 15 s/d +45 Intermediate
+ 45 s/d +75 Semi Vertikal
+ 75 s/d +110 Vertikal
+110 s/d + 180 Deviasi Sumbu ke kanan
-30 s/d -90 Deviasi sumbu ke kiri
-90 s/d ± 180 Deviasi ke kanan hebat
PATHOLOGY
 CORRELATION BETWEEN LOCATION OF
ISCHAEMIC, ECG AND CORONARY ARTERY
ANATOMY
LOCATION OF INFARCT/ ECG CORONARY ARTERY INVOLVED
ISCHAEMIC

ANTERIOR EKSTENSIVE I, aVL, V1-V6 LAD, LCX

ANTEROSEPTAL V1- V3 LAD

ANTEROLATERAL I, aVL, V4- V6 LCX

INFERIOR II, III, aVF RCA, PDA

POSTERIOR V7- V9 PL
(POSTEROLATERAL)

RV V3R – V5R RCA/ RV BRANCH

LAD Left Anterio Descenden.LCX circumflex.RCA Righ Cor.Art.

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