ELEKTROKARDIOGRAFI

Departemen Kardiologi dan Kedokteran Vaskuler Fakultas Kedokteran Universitas Sumatera Utara

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DEFINISI KONFIGURASI EKG

-------- = depolarisasi ventrikel

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T U Q S

P

Gel. P = defleksi akibat depolarisasi atrium Gel. R¶(r¶) = defleksi negatif awal akibat depolarisasi ventrikel yg mengiGel. Q(q) = defleksi negatif awal akibat depolarisasi ventrikel yg kuti gel. (R) Gel.T = defleksi akibat repolarisasi ventr. mendahului gel. (R) Gel. U = defleksi (biasanya positif) seteGel. R(r) = defleksi positif awal akibat lah gel T dan mendahului gel P depolarisasi ventrikel -------- = depolarisasi atrium Gel. S(s) = defleksi negatif awal akibat depolarisasi ventrikel yg mengikuti -------- = depolarisasi dan repolarisasi ventrikel gel. (R)

The diagram illustrates ECG waves and intervals as well as standard time and voltage measures on the ECG paper. Gelombang ECG dan INTERVAL: Apa arti dari gelombang EKG ? y Gelombang P : sekuensial depolarisasi atrium kiri dan kanan y Kompleks QRS complex: depolarisasi ventrikel kiri dan kanan y Gelombang ST-T : repolarisasi ventrikel y Gelombang U : sumber gelombang ini masih dalam perdebatan y Interval PR interval: waktu mulai dari depolarisasi atrium (gelombang P) sampai permulaan depolarisasi ventrikel (kompleks QRS) y Durasi QRS duration: durasi depolarisasi otot ventrikel (lebar kompleks QRS) y Interval QT: durasi depolarisasi dan repolarisasi ventrikel y Interval PP : rate dari atrium atau sinus cycle y Interval RR : rate dari ventricular cycle .

2 detik Vertikal menyatakan voltage elektris jantung dalam millivolt 10 mm = 1 mV Pada pemeriksaan rutin kecepatan rekaman kertas EKG 25 mm/detik 1 mm = 0.2 detik .DEFINISI KONFIGURASI GELOMBANG EKG Kertas EKG Horizontal menyatakan kecepatan kertas dalam waktu 1 mm = 0.04 detik 5 mm = 0.04 detik 5 mm = 0.1 mV 10 mm = 1 mV 1 mm = 0.

< 0.5 mm Interval PR : 0.20 detik Kompleks QRS : durasi : 0.NILAI NORMAL : Gelombang P : durasi : 0.42 .44 detik Interval QTc : QT ¥ RR Gelombang T : 1/8 ± 2/3 dari tinggi gelombang R Segmen ST : isoelektris .10 detik tinggi : > 5 mm standard limb lead .12 ± 0.06 ± 0.08 ± 0. > 10 mm chest lead Interval QT : < 0.12 detik tinggi (voltase) : < 2.10 / 0.

DEPOLARISASI + + + + + + + + Stimulasi sel otot + - - + Defleksi atas Defleksi bawah - + Defleksi bifasik .

SISTEM HANTARAN JANTUNG dan GELOMBANG EKG .

II. aVR.II.III. aVL. Unipolar lead (Wilson 1932) yaitu V1 sampai V9 dan V3R sampai 9R serta 3V1-9 sampai 3V3R-9R dan adalagi esofageal lead (E lead) EKG rutin terdiri dari 12 lead yaitu : I. aVR. III dan aVR. aVF dan V1-6 pada dewasa serta pada anak yaitu : I. aVF dan V1-6 ditambah V3R dan V4R Standard Lead . Bipolar standard lead (Einthoven) yaitu :I.III. aVF 2.II.SANDAPAN JANTUNG (LEAD) Lead jantung ada 2 : 1. aVL. aVL.

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CHEST LEAD Posisi chest lead dari belakang Posisi chest lead dari depan .

Ilustrasi posisi unipolar chest lead pada potongan transversal toraks .

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HEART RATE .

yang sama dengan 68 denyut /min.60. Sebagai contah. Dengan menghitung jumlah kotak besar diantara gelombang R mengikuti rate: 300 . .100 .150 .adalah dengan membagi 300 dengan jumlah kotak besar (garis panah biru pada diagram).Menentukan Heart Rate dari Electrocardiogram Ada berbagai metode yang dapat digunakan untuk menghitung denyut jantung dari EKG.4 (68 denyut /min). adalah "count off" method. Sebagai contoh jika ada 3 kotak besar diantara gelombang R denyut jantung adalah 100 denyut/min. dengan kecepatan kertas EKG25 mm/sec.75 . Salah satu metode adalah membagi 1500 dengan jumlah kotak kecil diantara dua gelombang R (garis panah merah). Alternatif lain. rate diantara beat 1 dan 2 pada EKG diatas adalah 1500/22. yaitu 300/4. Metode lain.

HR = (jumlah RR dalam 6 detik x 10 atau).1500 / jarak RR (kotak kecil) 2. Hitung jumlah RR dalam 6 detik atau.MENGHITUNG DENYUT JANTUNG DARI EKG : a. 2. kemudian 1. HR = (jumlah RR dalam 5 detik x 12). atau 2. Irama Sinus : 1. Sinus aritmia : 1. atau 3. HR = (jumlah RR dalam 10 detik x 6) . Hitung jumlah RR dalam 10 detik. 300 / jarak RR (kotak besar) b. Hitung jumlah RR dalam 5 detik atau. 3.

0 5 6 10 HR = jumlah gel R x 60/5 atau jumlah gel R x 60/6 .

³Count off" method 1 kotak besar = 300 2 kotak besar = 150 3 kotak besar = 100 4 kotak besar = 75 5 kotak besar = 60 6 kotak besar = 50 7 kotak besar = 43 8 kotak besar = 37 0 1 2 3 4 5 6 7 8 .

AKSIS JANTUNG .

Aksis QRS 2. Aksis QRS : arah depolarisasi gelombang QRS pada frontal plane yang ditentukan oleh posisi anatomi jantung 2. Aksis gelombang P 3. Aksis T : arah repolarisasi gelombang T pada frontal plane .AKSIS JANTUNG Stimulus depolarisasi dan repolarisasi didalam jantung menyebar ke berbagai arah didalam jantung sesuai dengan posisi anatomi jantung Aksis jantung : 1. Aksis P : arah depolarisasi gelombang P pada frontal plane 3. Aksis gelombang T 1.

Determining the Mean Electrical Axis (QRS axis) Lead I : 4 ± 0 = 4 Lead aVF : 12 ± 2 = 10 .

= 180° I + = 0°/360° aVF + = 90° .= 270° Lead I : 4 ± 0 = 4 Lead aVF : 12 ± 2 = 10 ..

Determining the Mean Electrical Axis (QRS axis) Axis nomenclature 1. Right axis deviation (+90 to +180) 4. it should also be down in lead II. 3. Left axis deviation (-30 to -90) Also check lead II. If the QRS is upright in II. the axis is still normal (0 to -30). Indeterminate axis (-90 to -180) Lead I Positive Positive Negative Negative Lead aVF Positive Negative Positive Negative . To be true left axis deviation. Normal axis (0 to +90 degrees) 2.

ARTI KLINIS AKSIS QRS Differential Diagnosis LVH. exhalation. PVC from the left ventricle. left posterior fascicular block. RVH. Ascites. WPW syndrome activating the left ventricle. lateral wall MI. PVC from the right ventricle. WPW syndrome activating the right ventricle. Inhalation Left axis deviation Right axis deviation . Abdominal tumor. inferior wall MI. Pregnancy. Emphysema. left anterior fascicular block.

HIPERTROFI .

c.V1 : defleksi terminal negatif bertambah.V1 : defleksi terminal negatif bertambah b. Biatrial : gabungan . Hipertrofi atrium kiri . Ventrikel kanan c. Biventrikel 1.5mm.Hipertrofi Jantung Hipertrofi Jantung : 1. a. . . Ventrikel : a. Biatrial 2. Pembesaran atrium : (leads II and V1).lead II : Amplitudo gelombang P > 2. Atrium : a. Hipertrofi atrium kanan . Atrium kanan c.lead II : Notched wide (> 3mm) gelombang P. Atrium kiri b. Ventrikel kiri b.

Hipertrofi atrium : (leads II and V1). P Pulmonal P Mitral .

Hipertrofi atrium ka nan Hipertrofi atrium kiri Biatrial .

Gelombang S (terbesar) di V1 atau V2 (dlm mm) ditambah gelombang R (terbesar) di V5 atau V6 (dlm mm) > 35mm. ‡ LAD ‡ QRS duration upper limit of normal ‡ Shift in the ST segment or T wave (strain pattern) V5 and V6 . ("voltage criteria³) b. Ventrikel kanan c. Ventrikel kiri b. a. Gelombang R > 12 mm di aVL (LVH is more likely with a "strain pattern" which is asymmetric T wave inversion in those leads showing LVH). Ventrikel kiri ‡1. Ventrikel : a. LVH: (Left ventricular hypertrophy). Summary : ‡ S wave V1 or V2 or R wave V5 or V6 of 30mm or greater. Biventrikel a.2.

Strain pattern V1 or V2 and in limb leads with the tallest R wave . R to S ratio of >1. Summary of Criteria for RVH Remember. again. In summary. Ventrikel kanan ‡RVH: (Right ventricular hypertrophy). that the electrocardiographic criteria for chamber enlargement have both low sensitivity and speci¿city. RAD 3. these are the things to look for when trying to diagnose RVH: 1.0 in V1 or V2 2. Normal QRS duration 4. Gelombang R > gelombang S di V1 dan Gelombang R menurun dari V1 sampai V6.b.

Pulmonal stenosis .c. Mitral regurgitasi. Ebstein anomali 2. Biventrikel Merupakan gabungan kriteria RVH dan LVH ARTI KLINIS HIPERTROFI JANTUNG : 1. ASD. Mitral regurgitasi 3. Aortic regurgitasi. PAPVR. Hipertrofi ventrikel kanan : PPOK. Aortic stenosis. PDA 4. Pembesaran atrium kanan : ASD. Pembesaran atrium kiri : Mitral stenosis. VSD. Hipertrofi ventrikel kiri : Hipertensi.

RAE LAE .

RVH LVH .

ISKEMIA & INFARK .

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Infarct . injury and ischaemic .

represented by ST segment elevation Infarction²Death of tissue. T wave inversion. represented by a pathological Q wave Injury Infarction . or both Injury²An arterial occlusion with ischemia. represented by ST segment depression.Normal Progression of an Acute Myocardial Infarction An acute MI is a continuum that extends from the normal state to a full infarction: Ischemia Ischemia²Lack of oxygen to the cardiac tissue.

Anterior infark Extensive (anterolateral infarction) c. Anteroseptal infark. a. b. dan lead elektrocardiogram. Infark lateral isolated infarction c .a b Hubungan antara lokasi infark dan oklusi arteri koroner (panah).

d. Infark Inferior

f. Right ventricular ³infarction´ (combined to inferior infarction) d

e

e. Infark Posterior

f

Ishemia ± Injury - Infarct
Accurate ECG interpretation in a patient with chest pain is critical. Basically, there can be three types of problems - ischemia is a relative lack of blood supply (not yet an infarct), injury is acute damage occurring right now, and finally, infarct is an area of dead myocardium. It is important to realize that certain leads represent certain areas of the left ventricle; by noting which leads are involved, you can localize the process. The prognosis often varies depending on which area of the left ventricle is involved (i.e. anterior wall myocardial infarct generally has a worse prognosis than an inferior wall infarct). V1-V2 V3-V4 V5-V6 II, III, aVF I, aVL V1-V2 anteroseptal wall anterior wall anterolateral wall inferior wall lateral wall posterior wall (reciprocal)

NON-TRANSMURAL = SUB ENDOCARDIAL = non Q-WAVE M.I.

depresion TRANSMURAL = MYOCARDIAL = Q-WAVE M.I.

elevation

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plus pathologic Q wave = necrosis. Correlation between the ECG and the stage of myocardial ischemia (ST elevation = lesion. c. plus negative T wave = ischemia). Monophasic ST deformation /³transmural´ lesion = lesion / injury. Acute infarction: correlation between the electrocardiogram (ECG) and the stage of myocardial ischemia. b. Evolution of subacute infarction to chronic infarction .Figure. a. Subacute infarction.

(d) 1 week.Figure V3 lead: Evolution of QRS and ST/T morphologies in STEMI due to occlusion of LAD. (b) 1 hour. . (c) 1 day. (a) Few minutes.

A Q wave is beginning to form by 1 hour. and the T wave is fully inverted. Note that the admission tracing shows only ST elevation.3. By 24 hours. . By 1 year. and ST elevation is on the way down. Q wave formation is complete.Figure 9. as seen in lead III of a 55-year-old white male. a pathologic Q wave is the only remaining evidence of infarction. The evolution of an inferior wall myocardial infarction.

ST segment changes 3. Hyperacute T wave 2. Resolution of changes of ST segment and T wave 5. Pathological Q wave 4. Reciprocal ST segment depression T wave changes associated with ischaemia .Myocard infark : 1.

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VL.The ECG shows: ‡ Sinus rhythm ‡ Normal axis ‡ Q waves in leads V2-V4 ‡ Raised ST segments in leads V2-V4 ‡ Inverted T waves in leads I. V2-V6 .

inverted Twaves in leads III.The ECG shows: ‡ Sinus rhythm ‡ Normal axis ‡ Small Q waves in leads II. V6. VF ‡ Biphasic T waves in leads II. III. VF ‡ Markedly peaked T waves in leads V1-V2 .

ARITMIA .

PR: 188ms.1.Normal (<5 small Squares. 48 years old. Anything above and this would be 1st degree block) ‡QRS Duration .(60-100 bpm) ‡All P waves are followed by QRS complex ‡P Wave . SINUS RHYTHM Source: Male. Heart Rate: 65bpm.Visible before each QRS complex ‡P-R Interval .Regular ‡Rate . . QRS: 92ms Normal Sinus Rhythm Looking at the ECG you'll see that: ‡Rhythm .Normal ‡Indicates that the electrical signal is generated by the sinus node and travelling in a normal fashion in the heart.

Normal ‡P Wave .‡Sinus Bradycardia Looking at the ECG you'll see that: ‡Rhythm .Regular ‡Rate .Normal ‡Usually benign and often caused by patients on beta blockers & healthy athletic person .Visible before each QRS complex ‡P-R Interval .less than 60 beats per minute ‡QRS Duration .

More than 100 beats per minute ‡QRS Duration . illness and exercise.Normal ‡P Wave .‡Sinus Tachycardia An excessive heart rate above 100 beats per minute (BPM) which originates from the SA node.Regular ‡Rate . Seen during exercise . But if their is no apparent trigger then medications may be required to suppress the rhythm Looking at the ECG you'll see that: ‡Rhythm . Not usually a surprise if it is triggered in response to regulatory changes e. fright. Causes include stress. shock. but they are occurring at a faster pace than normal.g.Visible before each QRS complex ‡P-R Interval .Normal ‡The impulse generating the heart beats are normal.

.‡Atrial Fibrillation Many sites within the atria are generating their own electrical impulses.Not measurable ‡The atria fire electrical impulses in an irregular fashion causing irregular heart rhythm Note ectopic focus top right corner of atria.Irregularly irregular ‡Rate .Not distinguishable as the atria are firing off all over ‡P-R Interval . leading to irregular conduction of impulses to the ventricles that generate the heartbeat.usually 100-160 beats per minute but slower if on medication ‡QRS Duration . Looking at the ECG you'll see that: ‡Rhythm . This irregular rhythm can be felt when palpating a pulse.Usually normal ‡P Wave .

. however.‡Atrial Flutter Looking at the ECG you'll see that: ‡Rhythm .Regular ‡Rate .Around 110 beats per minute ‡QRS Duration .Not measurable ‡As with SVT the abnormal tissue generating the rapid heart rate is also in the atria.1QRS) but sometimes 3:1 ‡P Wave rate . the atrioventricular node is not involved in this case.300 beats per minute ‡P-R Interval .Usually normal ‡P Wave . usually at a ratio of 2:1 (2F .Replaced with multiple F (flutter) waves.

Depends on site of supraventricular pacemaker ‡Impulses stimulating the heart are not being generated by the sinus node.Often buried in preceding T wave ‡P-R Interval . but instead are coming from a collection of tissue around and involving the atrioventricular (AV) node .Usually normal ‡P Wave .‡Supraventricular Tachycardia (SVT) Abnormal A narrow complex tachycardia or atrial tachycardia which originates in the 'atria' but is not under direct control from the SA node. SVT can occur in all age groups Looking at the ECG you'll see that: ‡Rhythm .140-220 beats per minute ‡QRS Duration .Regular ‡Rate .

Normal ‡P Wave .20s in length.Normal ‡QRS Duration . Looking at the ECG you'll see that: ‡Rhythm .Ratio 1:1 ‡P Wave rate .Prolonged (>5 small squares) . The normal P-R interval is between 0.12s to 0.Regular ‡Rate .Normal ‡P-R Interval .‡1st Degree AV Block 1st Degree AV block is caused by a conduction delay through the AV node but all electrical signals reach the ventricles. or 3-5 small squares on the ECG. This rarely causes any problems by itself and often trained athletes can be seen to have it.

‡2nd Degree Block Type 1 (Wenckebach) Another condition whereby a conduction block of some.Regularly irregular ‡Rate .Normal but faster than QRS rate ‡P-R Interval . but not all atrial beats getting through to the ventricles.Normal ‡P Wave .3 or 4 cycles then 1:0. this is seen by a dropped QRS complex. Looking at the ECG you'll see that: ‡Rhythm .Normal or Slow ‡QRS Duration .Ratio 1:1 for 2. ‡P Wave rate . There is progressive lengthening of the PR interval and then failure of conduction of an atrial beat.Progressive lengthening of P-R interval until a QRS complex is dropped .

Prolonged ‡P Wave .‡2nd Degree Block Type 2 When electrical excitation sometimes fails to pass through the A-V node or bundle of His. Looking at the ECG you'll see that: ‡Rhythm . this intermittent occurance is said to be called second degree heart block.Normal or Slow ‡QRS Duration .Regular ‡Rate . in the case of type 2 block atrial contractions are not regularly followed by ventricular contraction. 3:1 ‡P Wave rate .Normal or prolonged but constant . Electrical conduction usually has a constant P-R interval.Normal but faster than QRS rate ‡P-R Interval .Ratio 2:1.

The ventricular escape beats are usually 'slow' Looking at the ECG you'll see that: ‡Rhythm .Regular ‡Rate .Prolonged ‡P Wave .‡3rd Degree Block 3rd degree block or complete heart block occurs when atrial contractions are 'normal' but no electrical conduction is conveyed to the ventricles.Variation ‡Complete AV block. The ventricles then generate their own signal through an 'escape mechanism' from a focus somewhere within the ventricle.Normal but faster than QRS rate ‡P-R Interval . No atrial impulses pass through the atrioventricular node and the ventricles generate their own rhythm .Unrelated ‡P Wave rate .Slow ‡QRS Duration .

Regular ‡Rate . Inverted in lead II ‡P Wave rate .‡Junctional Rhythms Looking at the ECG you'll see that: ‡Rhythm .Normal ‡P Wave .Variable Below .Accelerated Junctional Rhythm .Ratio 1:1 if visible.Same as QRS rate ‡P-R Interval .40-60 Beats per minute ‡QRS Duration .

Accelerated Junctional Rhythm Regular Rhythm ‡Heart Rate: 60 to 100 beats per minute (BPM) ‡P Wave: Inverted. absent or after QRS ‡PR Interval: Less then 120ms ‡QRS Interval: Less then 120ms .

Flat ‡Rate .Abnormal Looking at the ECG you'll see that: ‡Rhythm .None ‡P Wave .0 Beats per minute ‡QRS Duration .None ‡Carry out CPR!! .‡Asystole .

p to p is undisturbed PR Interval: 120 to 200ms QRS Interval: Less then 120ms . identical. dropped beat.Sinus Pause Irregular Rhythm Heart Rate: Undetermined P Wave: Before each QRS.

dropped beat.Sinus Arrest Irregular Rhythm Heart Rate: Undetermined P Wave: Before each QRS. p to p is undisturbed PR Interval: 120 to 200ms QRS Interval: Less then 120ms heartrhythmguide.com. © 2008 . identical.

Premature Atrial Contraction Isolated Irregular Rhythm ‡Heart Rate: None ‡P Wave: Premature and abnormal or hidden ‡PR Interval: Less then 200ms ‡QRS Interval: Less then 120ms .

Premature Atrial Contraction Paired Irregular Rhythm ‡Heart Rate: None ‡P Wave: Premature and abnormal or hidden ‡PR Interval: Less then 200ms ‡QRS Interval: Less then 120ms .

Premature Atrial Contraction Atrial Bigeminy Irregular Rhythm Heart Rate: None ‡P Wave: Premature and abnormal or hidden ‡PR Interval: Less then 200ms ‡QRS Interval: Less then 120ms .

Wandering Pacemaker Irregular Rhythm ‡Heart Rate: Less then 60 beats per minute (BPM) ‡P Wave: Multiple forms ‡PR Interval: Variable ‡QRS Interval: Less then 120ms .

Ventricle Extra Systole = Ventricle Premature Contraction .

unifocal PVC's as they look alike if they differed in appearance they would be called multifocal PVC's.Regular ‡Rate . Looking at the ECG you'll see that: ‡Rhythm .Normal ‡Also you'll see 2 odd waveforms.(Above .Normal and same as QRS rate ‡P-R Interval . as below) . these are the ventricles depolarising prematurely in response to a signal within the ventricles.Ratio 1:1 ‡P Wave rate .‡Premature Ventricular Complexes Due to a part of the heart depolarizing earlier than it should.Normal ‡P Wave .Normal ‡QRS Duration .

Poor cardiac output is usually associated with this rhythm thus causing the pt to go into cardiac arrest.Regular ‡Rate .Not seen ‡Results from abnormal tissues in the ventricles generating a rapid and irregular heart rhythm.180-190 Beats per minute ‡QRS Duration . Shock this rhythm if the patient is unconscious and without a pulse .‡Ventricular Tachycardia (VT) Abnormal Looking at the ECG you'll see that: ‡Rhythm .Prolonged ‡P Wave .

disorganised ‡QRS Duration .300+.‡Ventricular Fibrillation (VF) Abnormal Disorganised electrical signals cause the ventricles to quiver instead of contract in a rhythmic fashion.Irregular ‡Rate . This condition may occur during or after a myocardial infarct. Looking at the ECG you'll see that: ‡Rhythm .Not recognisable ‡P Wave . A patient will be unconscious as blood is not pumped to the brain. Immediate treatment by defibrillation is indicated.Not seen ‡This patient needs to be defibrillated!! QUICKLY .

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The Deadly Rhythms PEA VT VF (Pulse less Electrical Activity) Asystole .

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Wolff-Parkinson-White syndrome .

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A secondary R wave (R¶) in V1 or V2 3. QRS duration >0. ST segment depression and T wave inversion in the right precordial leads RIGHT BUNDLE BRANCH BLOCK (RBBB) . and V6 Associated feature 1. Wide slurred S wave in leads I.Diagnostic criteria for right bundle branch block 1.12 s 2. V5.

Left axis deviation²common but not invariable finding .12 s 2. rather than monophasic complex. V5. QRS duration of >0. in leads V5 and V6 4. and V6 3. Displacement of ST segment and T wave in an opposite direction to the dominant deflection of the QRS complex (appropriatediscordance) 2. Absence of Q waves in leads V5 and V6 Associated features 1. Poor R wave progression in the chest leads 3. Broad monophasic R wave in leads 1. RS complex.LEFT BUNDLE BRANCH BLOCK (LBBB) Diagnostic criteria for left bundle branch block 1.

Gelombang R kecil di lead III 3. Normal QRS durasi LEFT ANTERIOR HEMIBLOCKS . LAD.KRITERIA LAH : 1. Gelombang Q kecil di lead I 4. sering mendekati í60 derajat 2.

sering mendekati +120 derajat 2. Gelombang Q kecil di lead III 3.KRITERIA LPH : 1. Normal QRS durasi LEFT POSTERIOR HEMIBLOCKS . RAD. Gelombang R kecil di lead I 4.

TERIMA KASIH

12´) .12´) . KOMPLIT : .INTRAVENTRICULAR CONDUCTION DELAY 1. 2.kiri : INCOMPLETE LEFT BUNDLE BRANCH BLOCK .kanan : INCOMPLETE RIGHT BUNDLE BRANCH BLOCK (<0. INKOMPLIT : . 3.kanan : RIGHT BUNDLE BRANCH BLOCK (>0. 4.kiri : LEFT BUNDLE BRANCH BLOCK 2. RIGHT BUNDLE BRANCH BLOCK (RBBB) LEFT BUNDLE BRANCH BLOCK (LBBB) LEFT ANTERIOR HEMI BLOCK (LAH) LEFT POSTERIOR HEMI BLOCK (LPH) BUNDLE BRANCH BLOCK : 1.

Dextroposisi dan Dextrocardia Normal .

Dextroversi / Dextroposisi .

Dextrocardia .

Cara membedakan normal/dextroposisi dengan dextrocardia Normal LA-RA LL-RA LL-LA I II III aVR aVL aVF Dextrocardia -I III II aVL aVR aVF .

Normal LA-RA LL-RA LL-LA I II III aVR aVL aVF Dextrocardia -I III II aVL aVR aVF .

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