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ELECTROCARDIOGRAPHY

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STANDARISASI EKG
Kecepatan kertas standard EKG
25 mm / s (10 25 50 mm / s
Setiap kolom horizontal = 0.04 sec
Setiap kolom vertikal 10 mm = 1 mV

PEMASANGAN ELEKTRODE
PEMASANGAN ELEKTRODE EXTREMITAS
Lengan kanan dan lengan kiri
Kaki kanan dan kaki kiri

PEMASANGAN ELEKTRODE DADA

V1 = Parasternal kanan di ICS-4

V2 = Parasternal kiri di ICS-4
V4 = MCL kiri di ICS-5
V3 = Median antara V2 dgn V4
V5 = Para Axillair Line kiri di ICS-5
V6 = Median Axillair kiri di ICS-5

SISTEM LEADS
STANDARD LIMB LEADS
I, II, III

AUGMENTED UNIPOLAR LIMB LEADS

aVR, aVL, aVF

UNIPOLAR CHEST LEADS

V1, V2, V3, V4, V5, V6

V3R, V4R, V5R, V6R
V7, V8, V9
V7R, V8R, V9R

Unipolar Precodial (Chest) Leads

Midclavicular line
Anterior axillary line
Midaxillary line

V6

V6R
V5R
V4R

V3R

V5

V4

V3

V2
V1

Mervin J. Goldman, MD. 11th edition Principles of clinical Electrocardiography. Clinical Professor of Medicine University of
California School of Medicine San Francisco @1995-1982

Unipolar Precodial (Chest) Leads

Horizontal plane of
V4-6

V7 V8 V9

V9RV8RV7R

Mervin J. Goldman, MD. 11th edition Principles of clinical Electrocardiography. Clinical Professor of Medicine University of
California School of Medicine San Francisco @1995-1982

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

ECG INTERPRETATION
1.
2.
3.
4.
5.
6.

RHYTM
RATE
AXIS
HIPERTROPHIC SIGNS
MYOCARDIAL INFARCTION
ARRHYTHMIA

1. RHYTHM
Normal cardiac rhythm : SINUS rhythm
Sinus rhythm characteristics :
Rate 60-100 bpm
Constant R R interval
Negative P wave in aVR and positive di II
P wave is always followed by QRS complex

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 )

MENGHITUNG DENYUT JANTUNG :

2. RATE
Normal heart rate : 60 100 x/minutes
> 100 x/minutes : Sinus Tachycardia
< 60 x/minutes
: Sinus Bradicardia

Determination heart rate (normal paper speed 25 mm/s):

300
Count number of large square (bold boxes in one R R interval)

1500
Count number of small square in one R R intervals

Number of QRS complex in 6 seconds, multiply by 10

MENENTUKAN AXIS EKG

Menghitung Axis:
Sudut yang dibuat oleh tingginya voltage R di I
dengan tingginya voltage R di aVF
Axis yg normal berada antara -30 dgn +90
Left Axis Dev berada antara -30 dgn -90
Right Axis Dev berada antara +90 dgn +180
I

3. AXIS

Menentukan Axis

P Wave

4. HYPERTROPHIC SIGNS

P Pulmonale

P Mitrale

PR Interval

AV BLOCK

Wolff-Parkinson-White syndrome

QRS Complex

ST Segment

T Wave

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

5. MYOCARDIAL INFARCTION
Ischemia
Injury
Necrosis

ANTERIOR INFARCTION

INFERIOR INFARCTION

POSTEROLATERAL INFARCTION

Acute anteroseptal myocardial infarction.

Hyperacute T-wave changes are noted

Acute anterolateral myocardial infarction

Acute inferoposterior myocardial infarction

LVH

LVH

LVH

RV
H

RVH

RVH

ARRHYTHMIA

First-degree AV block

Rhythm : Regular
Rate : Usually normal
P wave : Sinus P wave present; one P wave to each QR
PR
: Prolonged ( greater than 0.20 seconds )
QRS
: Normal

AV BLOCK

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 wav
PR
: Varies greatly
QRS : Normal if block in His bundle;
wide if block involves bundle branches

Supraventricular tachycardia

Wide complex tachycardia

Ventricular flutter