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Oleh:
TEAM ECG
The Heart
Coronary Arteries and Veins
Anatomy
THE ELECTROCARDIOGRAM (ECG)
LAH P Mitral
RAH P Pulmonale
PR INTERVAL
PR Interval is measured from the
beginning of the P wave as it leaves
the isoelectric line to the beginning of
the QRS
It is normally 0.12 to 0.20 seconds in
duration
PR Interval shorter than 0.12 seconds
are seen in WPW ( Wolff- Parkinson –
White syndrome and Lown Ganong
Levine Syndrome
PR Interval longer than 0.20 seconds
are seen in heart blocks
QRS Complex
The QRS complex represents
ventricular depolarization.
depolarisasi ventrikel
To know
Ischemia Miocard
Electrolit imbalance
ST- SEGMENT
Normal : isoelectic Elevation
Depression Depression
HOW TO
INTERPRETATION ECG
ECG INTERPRETATION
Determine Rhythm
Calculate Heart Rate
Examine P wave
Measure PR Interval
Measure QRS Complex
Calculate Axis
Others
Rhythm
R1 R2 R R R R R R R
Regular or Irregular
Calculate Heart Rate
R R’
Regular
• 300/ R – R’ ( big squares)
• 1500/ R – R’ ( small squares)
Irregular
• Count the number of R waves in a 5 second strip and
multiply by 10
Identify and examine P waves
One P wave should precede each QRS
complex
Rhythm : Regular
Rate : Usually normal
P wave : Sinus P wave present; one P wave to each QRS
PR : Prolonged ( greater than 0.20 seconds )
QRS : Normal
Second Degree A-V Block mobitz I
• There is a progressive lengthening of the PR Interval
to the point where an impulse does not reach the
ventricle and a beat is dropped.
Rhythm : Irregular
Rate : Usually slow but can be normal
P wave : Sinus P wave present;
some not followed by QRS complexes
PR : Progressively lengthens
QRS : Normal
Second Degree AV Block Mobitz 2
• PR Interval : Fixed Interval , Some P wave
not conducted ( 2:1 , 3:1)
Rhythm : Regular usually;
can be irreguler if conduction ratios vary
Rate : Usually slow
P wave : Two, three, or four P waves before each QRS
PR : PR interval of beat with QRS is constant;
PR interval may be normal or prolonged
QRS : Normal if block in His bundle;
wide if block involves bundle branches
Third Degree A-V Block
Rhythm : Regular
Rate : 40 – 60 if block in His bundle;
30 – 40 if block involves bundle branches
P wave : Sinus P wave present; bear no relationship to QRS;
can be found hidden in QRS complexes and T waves
PR : Varies greatly
QRS : Normal if block in His bundle;
wide if block involves bundle branches
AXIS
Right Axis Deviation Left Axis Deviation
LAD
RAD
Inferior myocardial infarction
Left ventricular aneurysm
Irama
• Sinus Ritme
• SinusTakikardi
• Sinus Bradikardi
• Sinus Aritmia
• Irama Jungtional
• Irama Idioventrikular
• Irama Ventrikular
• Takiaritmia (SVT,Atrial
Fibrilasi, Atrial
Fluter,VT)
• Bradiaritmia (blok
konduksi AV)
Sinus Aritmia
HOW TO RECORD ECG
PROSEDUR PEREKAMAN EKG
Persiapan
• Alat
»Mesin EKG; kabel listrik, kabel
elektroda, kabel ground,plat
elektroda ekstremitas, elektoda
dada
»Jelli
»Kertas tissu
»Spidol
»Kertas EKG
PROSEDUR PEREKAMAN EKG
Persiapan
• Pasien
»Rileks
»Jelaskan tujuan pemeriksaan
»Hal-hal yang harus diperhatikan;
aksesoris tangan dilepas
Cara perekaman
• Cuci tangan
• Cek kembali kelengkapan alat
alat
• Nyalakan mesin EKG
• Baringkan pasien ditempat
tidur, kaki tidak saling
bersentuhan
• Bersihkan dada dengan kertas
tissue
Cara perekaman
• Beri jelli pada plat elektroda
ekstremitas
• Pasang elektroda ekstremitas
pada kedua pergelangan
tangan dan kaki
• Beri jelli pada permukaan
dada sesuai lokasi V1 –V6
• Pasang elektroda dada sesuai
lokasi V1 –V6
Cara perekaman
• Tentukan kecepatan mesin
25 mm/dtk, dengan voltase
kalibrasi 1 mv, bila perlu ½
mv atau 2 mv
• Buat kalibrasi tiga kali
• Rekam setiap sandapan
/lead 3 -4 beat
• Setelah selesai semua lead
buat kembali kalibrasi
• Matikan mesin EKG
Cara perekaman
• Lepas elektroda, dimulai dari
dada kemudian tangan dan
kaki
• Bersihkan jelli dari tubuh
pasien dengan kertas tissue
• Beritahu pasien bahwa
perekaman sudah selesai
• Rapikan alat-alat
• Cuci tangan
Penulisan pada kertas EKG
• Nama pasien
• Umur pasien
• Waktu perekaman (jam,
tanggal, bulan, tahun )
• Nama sandapan
• Nama yang membuat
• Dokumentasikan EKG
Mr. x, 40 yrs
15/04/07 ,07.00
Ns. Y