INTERPRETASI ELEKTROKARDIOGRAFI

dr. Erlina Marfianti, MSc, SpPD Departemen Ilmu Penyakit Dalam Fakultas Kedokteran UII

Definisi
‡ EKG adalah grafik hasil catatan potensial listrik yang dihasilkan oleh denyut jantung ‡ EKG merupakan alat pembantu diagnostik. Penderita dengan kelainan jantung organik bisa menunjukkan gambaran EKG normal ‡ EKG bisa menunjukkan kelainan non spesifik pada orang sehat

Kegunaan EKG
‡ Beberapa kelainan jantung yang dapat diketahui dari EKG
± Hipertrofi ± Infark miokard ± Aritmia ± Gangguan elektrolit ± Efek obat-obatan: misal digitalis ± dll

Physiologic Properties of Myocardial Cells ‡ Automaticity ‡ Excitability ‡ Conducticity ‡ Contractility : Ability to initiate an impulse : Ability to respond to an impulse : Ability to transmit an impulse : Ability to respond with pumping action .

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LEAD .

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Components of a NSR .

Pada garis horosontal Tiap 1mm = 1 kotak kecil = 1/25 detik = 0. Kecepatan rekaman : 25 mm/detik b.04 detik Tiap 5mm = 1 kotak sedang = 5/25 detik = 0.20 detik Tiap 25 mm = 1.Rekaman EKG baku telah ditetapkan bahwa: a. Kekuatan voltage : 1 mv = 10 mm Bearti ukuran di kertas EKG: a.00 detik .

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aVF.5 mm . 2. 3. 4. and V4 V6 Normal negative in lead aVR Duration < 0.12 sec Amplitudo < 2. Describe the sequence of right and left atrial Normal positif in lead I. II. 5.Components of a NSR: P wave 1.

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.22 sec ( 3-5. Short PR interval preeksitasion syndrome 4.5 small box) 3. Time needed to transmit impuls from SA node to AV node 2.Components of a NSR : PR interval 1. Prolonged PR interval think about A-V block. Normal 0.12 0.

Components of a NSR : QRS complex

1. 2. 3. 4.

Describe activation of left and right ventrikel Duration 0,05 0,10 sec (<2,5 small box). Measure usually in limbs lead If the amplitudo less than 10 mm in all leads low voltage. 5. Abnormal complex QRS seen in conduction defect

Components of a NSR : QRS complex

Nomenclature of complex QRS first negative deflection named Q wave first positive deflection named R wave negative deflection after R wave called S wave R wave always above the baseline Q`and S wave always below the baseline

Components of a NSR : QRS complex

Q wave 1. Normal Q wave seen in lead I, aVL, and V5-6. describe activation of septum left to right 2. Q wave in V1-2 is abnormal 3. Pathologic Q : duration > 0,04 sec and/ or height > dari 1/3 complex QRS

Point at the end of QRS complex named J point . elevation < 1 mm in extremity still normal 2.5 mm 3. Depression < 0. Usually isoelectric.Components of a NSR: ST segment Normal ST segment 1.

Normal negative in lead III .II and V3-V6 3.Components of a NSR: T wave T wave criteria 1. Normal positif in leads I. Describe repolarization of ventricel 2.

Normal QT correction 0. variation according to heart rate.02 sec 5. Prolonged QTc predispose R on T VT . Describe total sistolic time 2.Components of a NSR: QT duration QT duration 1. QT interval must be < ½ R-R interval in HR 65-90/mnt 4.44 + 0. gender and age 3.

Interval .Heart rate : CONCLUSION : .Sign : Hipertrophi.Axis . iskemia. infark : : : : : : .How to report Rhythm .QRS .PR .Transisional Zone .QT .

Rate .

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Rhytm (Irama) .

Gelombang P negatif di aVR dan positif di II .ARITMIA .Tiap gelombang P diikuti oleh kelompok QRS T Penyimpangan .Irama Sinus Normal Irama jantung yang normal ialah irama yang ditentukan oleh simpul SA dan disebut irama sinus: .Frekuensi antara 60-100 x/menit .Teratur .

AXIS Setiap vektor jantung mempunyai: -Polaritas -Arah -Ukuran/Intensitas .

Axis Deviation -900 Left Axis -300 Extreme Right Axis 1800 Normal Right Axis 900 .

Tentukan di sandapan manakah terdapat keadaan ekuipotensial (nol) .Penentuan Sumbu QRS di Bidang Frontal 1. Secara praktis tentukan di sandapan I dan AVF 2.

60 -90 +120 +150 +180 -120 .30 .Amplitudo di I Positif AVF positif Ekuipotensi al di III aVL I aVF Sumbu +30 +60 +90 0 .150 Positif Negatif II aVR I Negatif Positif aVR II aVF Negatif Negatif aVL III .

AKSIS -30 s/d -15 -15 s/d +15 + 15 s/d +45 + 45 s/d +75 + 75 s/d +110 +110 s/d + 180 -30 s/d -90 -90 s/d 180 Posisi Jantung Horizontal Semi horizontal Intermediate Semi Vertikal Vertikal Deviasi Sumbu ke kanan Deviasi sumbu ke kiri Deviasi ke kanan hebat .

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PATHOLOGY .

aVL. aVF V7. V1-V6 V1.RCA Righ Cor.V9 LAD.V3 I.V6 II. III.CORRELATION BETWEEN LOCATION OF ISCHAEMIC. . ECG AND CORONARY ARTERY ANATOMY LOCATION OF INFARCT/ ISCHAEMIC ECG CORONARY ARTERY INVOLVED ANTERIOR EKSTENSIVE ANTEROSEPTAL ANTEROLATERAL INFERIOR POSTERIOR (POSTEROLATERAL) RV I.LCX circumflex. V4. PDA PL V3R ± V5R RCA/ RV BRANCH LAD Left Anterio Descenden. LCX LAD LCX RCA. aVL.Art.

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MYOCARDIAL INFARCTION ‡ Myocardial infarction is characterized by the necrosis of a portion of the myocard resulting from a lack of sufficient blood suply to keep the muscle viable. ‡ The most common cause is complete occlusion of coronary artery by atherosclerotic coronary trombosis. .

Terminology of infarct ‡ Acute infarct : several hours untill days ECG : ST elevation ‡ Recent infarct : several days. ECG : Q wave or QS complex or slow progression of R wave .weeks. ECG : evolution ‡ Old infarct : more than 6 months.

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R plus S in any chest leads > 45 mm Limb leads (Gubner.CRITERIA LVH Chest lead (Sokolow. Lyon) : S wave in V1 + R wave in V5 or V6 > 35 mm R in V5 or V6 > 26 mm. Ungerleider) : R in I + S in III > 25 mm R in aVF > 20 mm R in aVL > 11 mm R in aVR > 15 mm LV Strain (Strain Pattern) = perubahan segmen ST dan gelombang T= depresi semen ST dan inversi T .

Hipertrofi ventrikel kanan ‡ Deviasi aksis ke kanan (>+110) ‡ R V1> S V1 ‡ Gelombang R yang tinggi di sandapan aVR ‡ Rotasi searah jarum jam .