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ELECTROCARDIOGRAPHY

SMF Kardiologi dan Kedokteran Vaskular
RSUD Tanjung Pura
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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

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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 .

V3. V4. V5R. aVL. aVF • UNIPOLAR CHEST LEADS • • • • V1. III • AUGMENTED UNIPOLAR LIMB LEADS • aVR. V8. V5. V4R. V2. V8R. II.SISTEM LEADS • STANDARD LIMB LEADS • I. V9R . V6R V7. V9 V7R. V6 V3R.

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Clinical Professor of Medicine University of California School of Medicine San Francisco @1995-1982 . Goldman.Unipolar Precodial (Chest) Leads Midclavicular line Anterior axillary line Midaxillary line V6 V6R V5R V4R V3R V5 V4 V3 V2 V1 Mervin J. 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. 11th edition Principles of clinical Electrocardiography. MD.

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Conduction System SA Node  Internodal branch  AV Node  Hiss Bundle  Purkinje Fiber  Contraction .

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The Electrocardiogram ( ECG ) • P wave : atrial depolarisation • QRS complex : ventricular depolarisation • T wave : ventricular repolarisation • Atrial repolarisation hidden by QRS R T P Q S .

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3. 2. 5.ECG INTERPRETATION 1. 6. RHYTM RATE AXIS HIPERTROPHIC SIGNS MYOCARDIAL INFARCTION ARRHYTHMIA . 4.

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 .1.

12 – 0. precede each QRS PR : Normal ( 0.Normal Sinus Rhythm Rhythm : Regular Rate : 60 – 100 P wave : Normal in configuration.20 seconds ) QRS : Normal ( less than 0.12 seconds ) .

MENGHITUNG DENYUT JANTUNG : .

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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 .2.

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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 .

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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 .

III dan avF menghadap dinding inferior ventrikel kiri .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.

5. MYOCARDIAL INFARCTION • Ischemia • Injury • Necrosis .

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ANTERIOR INFARCTION .

INFERIOR INFARCTION .

POSTEROLATERAL INFARCTION .

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

Acute anterolateral myocardial infarction .

Acute inferoposterior myocardial infarction .

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LVH .

LVH .

LVH .

RV H .

RVH .

RVH .

ARRHYTHMIA .

one P wave to each QR PR : Prolonged ( greater than 0.First-degree AV block Rhythm : Regular Rate : Usually normal P wave : Sinus P wave present.20 seconds ) QRS : Normal .

AV BLOCK .

Mobitz I Rhythm : Irregular Rate : Usually slow but can be normal P wave : Sinus P wave present.Second -degree AV block. some not followed by QRS complexes PR : Progressively lengthens QRS : Normal .

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Second-degree AV block. can be irreguler if conduction ratios vary Rate : Usually slow P wave : Two. PR interval may be normal or prolonged QRS : Normal if block in His bundle. Mobitz II Rhythm : Regular usually. three. or four P waves before each QRS PR : PR interval of beat with QRS is constant. wide if block involves bundle branches .

wide if block involves bundle branches . 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. 30 – 40 if block involves bundle branches P wave : Sinus P wave present.Third-degree AV block Rhythm : Regular Rate : 40 – 60 if block in His bundle.

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Supraventricular tachycardia .

Wide complex tachycardia .

Ventricular flutter .