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Gambaran EKG Pada Iskemia

Dr Isman Firdaus, SPJP

SA node
Sumber impuls normal/
alamiah , 60 – 100

AV node
Bisa mengeluarkan
impuls 40-50x/menit

Berkas His
Serabut Purkinje

Ventrikel
Bisa mengeluarkan impuls
30 x/menit

Atrial Depolarization

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12 second .Ventricle Depolarization 0.

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2 detik 5 kotak sedang = 1 kotak besar = 1 detik Paper speed : 25 mm/second .04 detik 5 kotak kecil = 1 kotak sedang = 0.1 kotak kecil = 0.

MENGHITUNG LAJU JANTUNG : A. Jarak R – R : -1 kotak sedang -2 kotak sedang -3 kotak sedang -4 kotak sedang -5kotak sedang -6 kotak sedang = 300 x / menit = 150 x / menit = 100 x / menit = 75 x / menit = 60 x / menit = 50 x / menit B. 1500 / jarak R-R ( dlm mm ) = heart rate / menit .R dalam 6 kotak besar = 6 detik Jumlah R x 10 = heart rate / menit C. Hitung jumlah R.

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CAUSE OF CARDIAC ARRHYTHMIAS : • Disturbances in automaticity : bertambah cepat atau bertambah lambatnya suatu daerah otomatisitas. • Disturbances in conduction : konduksi terlalu cepat (WPW) atau terlalu lambat (blok AV). dll. VT. • Combinations of altered automaticity and conduction. . AV node. ventrikel. AV junction. Misal di sinus node. abnormal beats/ depolarisasi atrium.

Perbedaan lokal pola potensial aksi .

Physiologic Basis of Pacemaker Cells Pacemaking & Conduction System .

Macroreentry Atrial Flutter Microreentry Atrial Fibrillation .

Macroreentrant and Microreentrant Tachycardias .

ELEKTROFISIOLOGI-ABLASI TRANSKATETER .

not the monitor” .How to identify arrhythmias ? “Treat the patient.

QRS complex Regular / irregular ? QRS complex Normal-looking QRS complex? Wide / narrow ? P wave ? Relationship between P and QRS ? .

NORMAL SINUS RHYTHM .

PSVT : -due to re-entry mechanism -narrow QRS complex -regular -retrograde atrial depolarization -P wave ? .

PSVT .

-no uniform atrial depolarization .Atrial Fibrillation : -from multiple area of re-entry within atria -or from multiple ectopic foci -irregular. narrow QRS complex -very rapid atrial electrical activity (400-700 x/min).

“sawtooth” .Atrial Flutter : -The result of a re-entry circuit within the atria -Irregular / regular QRS rate -Narrow QRS complex -Rapid P waves (300x/min).

-normal-looking QRS. -due to the failure of sinus node to initiate time impulse or conduction problem. -P wave may preceede. or follow the QRS . -retrograde P wave.Junctional rhythm: -AV junction can function as a pace maker (40-60 x/min). coincide with.

SR VES .

Sinus rhythm with Multifocal VES VES VES SR SR SR SR SR SR .

Sinus rhythm with VES co .

R .Sinus Rhythm with VES.

Ventricular Tachycardia .

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Torsade de Pointes .

Ventricular Fibrillation .

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1st degree AV block Prolonged PR interval .

2nd degree AV block. typ Missing QRS Missing QRS .

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ty Missing QRS .2nd degree AV block.

Total AV Block / 3rd degree AV blo QRS P P QRS P P QRS P P P .

!!! SELESAI . . . not the monitor . . . . .Treat the patient. . . .