Dr.H.

Bayu Samudra

Conduction System

SA Node Internodal branch AV Node Hiss Bundle Purkinje Fiber Contraction

The Electrocardiogram ( ECG )

P wave : atrial depolarisation
QRS complex : ventricular depolarisation T wave : ventricular repolarisation Atrial repolarisation hidden by QRS
R

P Wave

P Pulmonale

P Mitrale

PR Interval

QRS Complex

ST Segment

T Wave

Normal Sinus Rhythm Rhythm : Regular Rate : 60 100 P wave : Normal in configuration; precede each QRS PR : Normal ( 0. 12 0.20 seconds ) QRS : Normal ( less than 0.12 seconds )

First-degree AV block 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 AV block, Mobitz I 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 II 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 AV 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

Wolff-Parkinson-White syndrome

ST depresi dan perubahan gelombang T

ST depresi dianggap bermakna bila > 1 mm di bawah garis dasar PT di titik J Titik J didefinisikan sebagai akhir kompleks QRS dan permulaan segmen ST

Bentuk segmen ST :
up-sloping ( tidak spesifik ) horizontal ( lebih spesifik untuk iskemia ) down-sloping ( paling terpercaya untuk iskemia )

Perubahan gelombang T pada iskemia kurang begitu spesifik Gelombang T hiperakut kadang2 merupakan satu-satunya perubahan EKG yang terlihat

Anatomi Koroner dan EKG 12 sandapan

Sandapan V1 dan V2 menghadap septal area ventrikel kiri Sandapan V3 dan V4 menghadap dinding anterior ventrikel kiri Sandapan V5 dan V6 ( ditambah I dan avL ) menghadap dinding lateral ventrikel kiri Sandapan II, III dan avF menghadap dinding inferior ventrikel kiri

Unstable angina

Acute anteroseptal myocardial infarction. Hyperacute T-wave changes are noted

Acute anterolateral myocardial infarction

High lateral infarction

Inferior myocardial infarction

Acute inferoposterior myocardial infarction

LVH

LVH

LVH

RVH

RVH

RVH