Electrocardiography

Dr.H. Syamsu Indra, SpPD,K-KV, FINASIM,MARS

Division of Cardiology, Department of Internal Medicine
Moh Hoesin Hospital, Palembang
 Anatomical Position
of the Heart
Lies in the mediastinum behind the sternum
between the lungs, just above the diaphragm
the apex (tip of the left ventricle) lies at the fifth intercostal space,
mid-clavicular line
Location of The Heart in The Thorax
Surfaces of the Left Ventricle
Inferior - underneath

Anterior - front

Lateral - left side

Posterior - back
Coronary Artery System
 Coronary Artery Circulation
Left Main Stem Artery divides in two:
Left Anterior Descending
Artery
antero-lateral surface of
left ventricle
2/3 interventricular
septum

Circumflex Artery
left atrium
lateral surface of left
ventricle

From : Sheelagh Scott, Practice Development Centre, NHS Lanarkshire

What does cardiovascular system do?
The Conduction System of The Heart.
 Conduction System
Sinoatrial (SA) node
– Natural pacemaker
– Automaticity
– Atrial contraction
– Produces the P wave
 Conduction System
Atrio-Ventricular Node
– Allows conduction from
atria to ventricles
– Occurs slowly
– Normal delay of
0.12 to 0.20 seconds
– Produces PR interval
on EKG
 Conduction System
His Bundle & Bundle Branches
– Beginning of ventricular system
– Depolarization occurs rapidly
– Immediately bifurcates
His Bundle
into L & R bundles
– Bundles are Purkinje fibers L Bundle

R Bundle
 Conduction System
Purkinje fibers then
depolarize the ventricles
Produces a QRS complex
on the EKG
Sistim konduksi jantung

Aktifita SA node (pace maker alamiah)

Miokardium atrial : Depolarisasi (P): repolarisasi

(Ta)

Jalur internodal

Nodus AV

Bundle His

Bundle Branches

Miokardium ventrikel: depolarisasi (QRS), repolarisasi

(T)
Gambar sistim konduksi Jantung
 Apa yang direkam ?

Potensial listrik yang merupakan jumlah

keseluruhan dari arus listrik yang
dihasilkan oleh setiap sel otot jantung.
Tahun 1903 Willem Einthoven dengan
menggunakan string galvanometer
menghasilkan beberapa konvensi
mengenai kelistrikan ini.
 Electrophysiology
If an electrode is placed so that wave of
depolarization spreads toward the
recording electrode, the ECG records a
positive (upward) deflection.
If wave of depolarization spreads away
from recording electrode, a negative
(downward) deflection occurs.
Electrophysiology
Cardiac Current Flow
Cardiac Current Flow
 ECG Time & Voltage
ECG machines can run at 50 or 25
mm/sec.
Major grid lines are 5 mm apart, at
standard 25 mm/s, 5 mm corresponds
to .20 seconds.
Minor lines are 1 mm apart, at
standard 25 mm/s, 1 mm corresponds
to .04 seconds.
Voltage is measured on vertical axis.
Standard calibration is 0.1 mV per mm
of deflection.
 Electrophysiology
When myocardial muscle is completely
polarized or depolarized, the ECG will not
record any electrical potential but rather a
flat line, isoelectric line.
After depolarization, myocardial cells
undergo repolarization to return to
electrical state at rest.
Dimana Lokasi Merekam ?
Pertimbangkan aspek anatomi !
Limb leads Chest Leads
 Limb Leads
3 Bipolar Leads
form (Einthovens Triangle)

Lead I - measures electrical potential

between right arm (-) and left arm (+)

Lead II - measures electrical

potential
between right arm (-) and left leg (+)

Lead III - measures electrical

potential
between left arm (-) and left leg (+)
 Limb Leads
3 Unipolar leads

avR - right arm (+)

avL - left arm (+)
avF - left foot (+)

note that right foot is a ground lead

EKG NORMAL
 ELEKTRO KARDIOGRAFI
PENGERTIAN
Elektrokardiografi adalah ilmu yg mempelajari aktivitas listrik jantung.
Elektrokardigram ( EKG ) adalah suatu grafik yg menggambarkan rekaman listrik
jantung.

FUNGSI EKG
EKG mempunyai fungsi diagnostik diantaranya :
Aritmia jantung
Hipertrofi atrium dan ventrikel
Iskemik dan infark miokard
Efek obat-obatan seperti ( digitalis, anti aritmia dll )
Gangguan keseimbangan elektrolit khususnya kalium
Penilaian fungsi pacu jantung
ANATOMI JANTUNG
PEMBULUH DARAH KORONER

RCA

LM

LCX

LAD
 Perspektif lead vertikal
dan horizontal

Limb lead tampak dari jantung dalam bidang vertikal

Lead prekordial terletak dalam bidang horizontal
 RIGHT LEFT

Inferior Antero-Septal
II, III, AVF V1,V2, V3,V4

Lateral
I, AVL, V5,
V6
V1-V2: 4th intercostal space –R/L of sternum
V4: 5th intercostal space – midclavicle line
V3: Between V2 and V4
V5: At horizontal level of V4, anterior to axilla
V6: Midaxillary at horizontal level of V4
ELEKTRODE PREKORDIAL

Lokasi Lead Prekordial

V1 : Sisi kanan sternum ICS 4

V2 : Sisi kiri sternum ICS 4
V3 : Antara V2 dan V4
V4 : Mid klavikula kiri ICS 5
V5 : Garis aksilaris ant ICS 5
V6 : Garis mid aksilaris ICS 5
V3R : simetris V3, di kanan
V4R : simetris V4, di kanan
ELEKTRODE
EKSTRIMITAS
DAN
PREKORDIAL
Limb leads Chest Leads
 The standard 12 Lead ECG
6 Limb Leads 6 Chest Leads (Precordial
leads)
avR, avL, avF, I, II, III V1, V2, V3, V4, V5 and V6

Rhythm Strip
 Bagaimana Merekam ?

Pasien dalam keadaan tenang / rileks.

Letakkan 12 lead dgn benar dan firm.
Limb lead
– Lead I, II dan III
Augmented limb lead
– aVR, aVL dan aVF
Precordial / Chest lead
– V1 – V6
Recording an ECG
1. Explain procedure to patient,
obtain consent and check for
allergies
2. Check cables are connected
3. Ensure surface is clean and
dry
4. Ensure electrodes are in
good contact with skin
5. Enter patient data
6. Wait until the tracing is free
from artifact
7. Request that patient lies still.
8. Push button to start tracing
Ingat bahwa ke – 12 lead tersebut akan
merekam secara sama persis dengan
kejadian / aktivitas listrik di dalam
jantung !!!
Posisi dan orientasi lead yang berbeda
akan memberikan hasil yang berbeda.
 Mengelola Rekaman
Identitas pasien
Waktu --- sekuensial
Layak baca ??
– Identitas dan waktu rekam
– Ada tanda kalibrasi ½, 1 atau 2 mV dan kecepatan
(EKG non computer reading)
– Gelombang P di lead aVR hampir selalu negatif
– Rekaman di V1-6 tidak boleh sama.
 Kalibrasi EKG

Meek, S. et al. BMJ 2002;324:415-418

Copyright ©2002 BMJ Publishing Group Ltd.

Kertas Grafik EKG

Kecepatan kertas (standard)

25 mm/menit
0,20 SEC Bisa 50,100/mnt

0,5 mV
5 mm

0,04 sec

0,1 mV
1 mm
 Cara Membaca EKG

Menentukan irama
Menentukan heart rate
Menentukan aksis
Menentukan Interval
 Kesimpulan
EKG yang layak baca harus menyampaikan hasil
perekaman yang benar yaitu :

Ada data pasien yang direkam

Dilakukan peneraan sebelum proses perekaman
Gelombang P selalu positif di lead II dan negative di aVR
TERIMA KASIH