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dr.Mufied Wibisono,SpFK

Our body is full of electric activity with

small amount. The dominant organs
with electrical activity are:
Central and peripheral nervous system
Neuromuscular system

divided into 2 parts: intra and extra cell.

Intra cellular extra cellular

Ion K Ion Na

Cell membrane

Myelinated Unmyelinated

Myelin is a neuron wrapper as a isolator,

so if there is any stimulation,
the electrical potential will not leaked out.
The special of myocardium:

Conductivity current is high.

Refracted period is long, 100x usual muscle.

Automation SA node, AV node, and purkinje fibers.

Consist/regular so the rhythm of cor is regular.

* The contraction of cor follow All or

none law (little stimulus, no contraction)
Activity the organ of body can record
mentionedappropriate with the name of organ:

* Electro-cardiogram (ECG)
* Electro-encephalogram (EEG)
* Electro-myogram (EMG)
* Electro-retinogram (ERG)
* Electro-okulogram (EOG)
* Electro-gastrogram (EGG)
Electro cardiography (ECG)

ECG is electro diagnostic to record the

graphic of electric potential cor at
The tools are important in medical and
discovered by Einthoven.

The + ions in the outer surface of cell membrane

and ion in the inside surface has same amount.
A pair of + and mentioned dipole (doublet).
Potential capacity of membrane is 100 mV.
During polarization, cell membrane has high
electric pressure. So no current ion in the cell
Muscle cell given stimulus so electric resistance
decrease then + ion enter through cell membrane, and
ion goes to outer surface cell membrane.
Because the cell is homogeny conductor so stimulus
distribute to all cell in stimulating poston (active)
depolarization that cor muscle contraction between 0,02
0,04 second after stimulus. During depolarization not
yet there are area that already active and there are quiet
area that has limit line with potential is 0. Dipole
depolarization move with + ion in ahead and ion in
backside until all cell active.

After some time active muscle cell will

undergone process again in motionless state
(polarization) occurs re-polarization
Re-polarization spontaneously occurs the ion
place change with same trip with the
depolarization process, only move with ion - at
front and ion + at behind (the reverse direction of
depolarization). At each depolarization process
or re-polarization causing electric potentials.
Electric potential that is recorded by
exploration electrode depend on:

Electrode position

Dipole movement direction

Distance between electrode and muscle

Factors that influence membrane
potential :
Membrane permeability to the Na+ and K+
ions (Pk > 50 100 x Pna) at the rest
Cell membrane capability of pumping Na+
2 5 x K+.
Organic materials in the cell non diffusible

ECGelectrodes set up in places where

human body get at least 1 (one) leads.
Hypothesition line that connected to the
electrodes called leads line.

Type of Lead
Bipolar leads
Extremity Unipolar leads
Precordial Unipolar leads
Precordial Unipolar Lead
Normal Electrocardiogram
ECG Vector

ECG Vector is a compound of power that have

number, sign, and positive with negative from
mechanic and also electrical power.
The mechanism of depolarization or
repolarization process is the moving of ions
(dipole) until the electrical power can be formed
in vector (cardiac vector).
To show the vector: an arrows sign described
the sign of the power; and the top of an arrow
described the place for positive electrical power.
ECG Vector
Vector a moment
Einthoven Hypothesis in ECG

The theory of ECG confirm in Einthoven

Our body is a conductor with homogeny
The proximal of left arm and left leg is the top of
triangle (same line), that located as far as from
the cardiac
The electrical power that shown by cardiac
assumed as an equivalent dipole or vector
where the location is in the central of that
triangle (same line).
Triaxcial reference system from

Tap I = 0 until + 18
II = +60 until -120
III = +120 until -60
Heart position
In the EKG the position of heart is the position of heart
electricity at the time of contraction and not in the
meaning of anatomy position.

Anteroposterior, the way passes the center point of heart

and causes heart spinning in the frontal area.
Longitudinal, the way passes the center from apex to the
base of heart causes heart spinning at the horizontal
Transversal, the way passes the center between the
both side of heart, causes heart spinning at the sagital
Rhythmic Stimulation of Heart
1. Sine nodes (SA node)
Stimulation of normal rhythmic
impulse is produce.
2. Way of internodus
Impulse is going from SA node to AV
3. AV node
Impulse from atrium is going slow
before to ventricle.
4. AV Bundlel
impulse is going from atrium to
5. Bundle of Purkinje fibers, left and right
Impulse is going from heart to
Spreading of impulse
to all part of Heart
Interval time 1/100 second
is needed by impulse of
heart from SA node
until every point of Heart part.
Impuls is spread with medium
speed, through atrium become
slow 0,1 second in AV node
before it is going to bundle of
AV Ventricle septum.
Impulse enter to bundle quickly
and spread through fiber of
Purkinje to all surface of
From ventricle, then it is spread
slowly through muscle of
ventricle to surface of
Premature contraction
Premature contraction is contraction of heart
before contractions time normal occur it also
called extra systole, or premature heart beat or
atrophic beat.

Causes are ectopic focus heart inside so than

normal of impulses in certain time:
Local ischemic
Small chalk myocardium depress
so than excitement purkinje fibers
Because of redicel, nicotine, caffeine,
the toxic irritation will happen in nodes AV,
system purkinje and myocardium
Premature contraction
Fiber AV or nodes AV contraction
Prematured ventricle contraction
Ventricle Fibrilation
ECG visualisation at ventricle fibrilation is
so weird, usually cannot get back to
normal again. For the first stage, a lot of
muscle mass contract together, cause
rough and complicated wave. After few
seconds, it change to a new-low voltage
and complicated-wave pattern.
Ventricle Fibrilation
Ventricle Defibrilation with Electrical
According to the frequency, EEG
can be devided to:

Alfa Beta

Teta Delta
Clinic Application EEG

Practical and specific: syndromes of

brain dysfunction, like epilepsy,
tumour cerebra, hematoma

Attitude : meningitis, sclerosis

multiple, psychiatric condition,
subaracnoid hemorrhagic.

ENMG is a potential action of muscular record

and nerve with skin electrode or tissue so
neuromuscular syndrome can detected by electro
diagnosis. So it can help neurological diagnosis
and physiology.
Action Potential
Action potential is an extra cellular meassure phenomenon.

The impulses on neuron membrane cause a change of membrane

permeability, Na contain (+) electrical diffuse onside the neuron
so the membrane onside (+) and outside (-) called a

And then, the spread of the depolarization wave called action

potential cause deflection above (-). The active nerve fiber ha
sthe characterization that cause a biphasic wave/ trifasik with
lower amplitude than the intra cellular monofasik wave.
Application of Clinic EMG

Disparity motor cornu anterior cell:

Disparity radix:
Disparity Plexus:
Disparity perifer nerve (poly neuropathy):
Disparity motor end plate:
Disparity muscle skeletal ( myopathy )
Nerve Conduction Velocity
Nerve Conduction velocity is inspection to determine
nerve perifer function ( motor and sensory ) so that the
peaky situation, knowable disparity localization.
Perifer nerve consisted of motor, sensory, and simpatis.
Nerve conduction velocity influenced by :
a. Diameter ( big / small ) nerve
b. Myelin, as isolator and prevent electrics leakage
c. Node Of Renvier cell schwan, as electrics hop and
Spinal Reflexes on ENMG

Spinal reflexes test by electrical stimulation, to find peripheral

nerve lesion in part proximal (spinal radix and plexuses).

Principle of physiology at Peripheral Nerve reflex, when

stimulated, electricity spread along :
a. Distal, to the brain, M wave happens.
b. Proximal, follow Peripheral Nerve reflex through
plexus to posterior radix and anterior corn, then to
anterior radix, then to plexus, at last, going back to the
brain (Indirect Response), Hoffman reflex (H Reflex) and F
Wave happen.
Electro-Convultion Therapy
First time used as Schizophrenia Therapy by Carletti and

Therapy technique using electrodes, stimulation and

electrical wave based on E=I.R. Dosage is counted from
combination between voltage and time. At convulsator,
there are voltage-manager and time-counter
automatically. Usual dosage : 70 120 V, time : 0,1 0,2

Dosage of Therapy started 80 volt for 0,2 seconds,

electrical wave between 200 1600 mA through the
brain. When doing this, convultion happens, repeat 3
times. If convultion not happens, repeat it the next day.
ECT indication:

Depression is the main indication.

Threat of suicide.
Psychoneurotic the symptom of neurotic with
depression (acute anxiety).

Side effects :
Jaw luxatio.
Vertebrae fracture compression.
Tear of muscle.