1. Dasar-dasar EKG

5/23/2018 1. Dasar-dasar EKG

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Dr. Bagus Ari Pradnyana D.S., SpJP
http://www.pdfcomplete.com/cms/hppl/tabid/108/Default.aspx?r=q8b3uige22


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Konsep dasarEKG Sistem sandapanpada EKG Konsep vektor Interpretasi EKG

EKG normal


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KONSEP DASAR

ELEKTROKARDIOGRAFI

Ketut Susila

SMF Penyakit Jantung RSUD KabupatenBuleleng
http://www.pdfcomplete.com/cms/hppl/tabid/108/Default.aspx?r=q8b3uige22http://www.pdfcomplete.com/cms/hppl/tabid/108/Default.aspx?r=q8b3uige22


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August D. Waller


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An early electrocardiogram


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Sel-sel otot jantung:

susunan ion yang

berbeda intra danekstra sel: Na+/K+

Sel-sel otot jantung:

susunan ion yang

berbeda intra danekstra sel: Na+/K+


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K+ Na

+ + + + + + + + + + + + + + +

+ + + + + + + + + + + + + + +

- - - - - - - - - - - - - - - - - - - - -

- - - - - - - - - - - - - - - - - - - - -

K+ Na+

-+- 90 mV


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K+ Na

+ + + + + + + + + + + + + + +

+ + + + + + + + + + + + + + +

- - - - - - - - - - - - - - - - - - - - -

- - - - - - - - - - - - - - - - - - - - -

K+ Na+

00

0 mV


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+ + + + +

+ + + + +

- - - - - - -

- - - - - - -

+ + + + +

+ + + + +

+ + +

+ + +

- - - - -

- - - - -

- - - - - - -

- - - - - - -

Istirahat(polarisasi)

Repolarisasi)Aktivasi(depolarisasi)


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The summation of myocyte potentials


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POTENSIAL AKSI

Perbedaan potensial listrik antara intra dgn ekstra selsaat mendapat stimulus , maka perubahan potensial ygterjadi sbg fungsi waktu > potensial aksi

Kurva potensial aksi mempunyai karakteristk yg khas tdri4 fase

- Fase 0 lonjakan potensial mencapai+ 20mv karena masuknya ion Na

- Fase 1 masa repolarisasi awal potensial

kembali dari + 20 mv ke 0 mv.

- Fase 2 fase ini masuk ion Ca menghimbangi gerak

keluar ion K.

- Fase 3 fase repolarisasi cepat dmn potensial kembali

secara tajam ke tingkat awal yaitu fase 4


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Sistim konduksi Jantung


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Sistim Sandapan pada EKG


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Electrocardiographic leadsBipolar limb leads ( I,II,III)

Unipolar limb leads( aVR,aVL,aVF )

Unipolar precordial leads ( V1,V2,V3,V4,V5,V6 )


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Bipolar limb leads


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Unipolar limb leads


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Unipolar precordial leads


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Konsep Vektor

pada

Elektrokardiografi


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Relationship of vectors to deflections


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Relation of vectors to deflections


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Impulse origination and atrial depolarization


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Relationship of vectors to deflections


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Septal depolarization


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Apical and early ventricular

depolarization
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Late ventricular depolarization


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Sumbu bidang frontal


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Einthoven s triangle


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Limb Lead Axis (vertical axis)


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Frontal plane axis (mean QRS vector)


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Hexaxial reference system


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Activity related to Precordial Leads

(Horizontal Axis)


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Sumbu bidang horizontal


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Interpretasi EKG normal

Terminologi.- Kalibrasi sblm lakukan rekaman EKG

kecepatan standar kertas 25 mm/dt depleksi yg

sesuai 10 mm sesuai dgn 1 mV.

- Garis mendatar tanpa potensial listrik = grs

isoelktrik.

- Depleksi mengarah keatas = depleksi positif,

depleksi kebawah = depleksi negatif.


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Basic Principles of ECG Interpretation

Be Systematic Rate: Fast-Normal-Slow

Rhythm: Sinus, Blocks, Atrial, VentricularAxis: Normal, Right, Left

Intervals and Durations

Waveforms and Segments (Morphology)


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Rate always the 1st Step!


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Extra slides

Name of patient

1. Calculate Heart Rate

2 Basic Methods


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Big-Box Method

3

0

0

1

5

0

6

0

1

0

07

5


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Pengukuran waktu

Penentuan frekuensi .

Kecepatan atrium atau ventrikel dihitungberdasarkan kecepatan kertas. Kecepatan kertas25 mm/dt, kertas menempuh 60 x 25 mm =1500 mm/mnt frekuensi jantung = 1500 : jaraksiklus dlm mm ( jarak R-R)

Penetuan interval

Kecepatan 25 mm/dt : 1 mm = 1/25 dt = 0,04dt atau 5 mm = 0,20 dt


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Be SystematicRate: Fast-Normal-Slow

Rhythm: Sinus, Blocks, Atrial, VentricularRhythm Sinus? Fast or Slow?

Regular or Irregular ?


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Rhythm: Sinus, Blocks, Atrial, VentricularAxis: Normal, Right, LeftAxis Normal ? Right ? Left ?


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-IRA LA+I

+AVF

-AVF

RA&LA

+I/+AVF

+I/-AVF

-I/+AVF

Left Axis

Right Axis

Extreme

Axis

Normal

Axis


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Horizontal & Transverse Axis

http://www.UpToDate.com


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Intervals and Durations:Short ? Long ?


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Intervals, segments, and durations


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Intervals

QRS durationPR interval QT Interval

Normal: .12-.20 sec

(3-5 small boxes)Normal: .07-.10 sec Normal (corrected for rate

or QTc): .440-.470 sec

QT Interval

PR Interval

QRS Duration


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Waveforms and Segments (Morphology)

Waveforms and Segments(Morphology)


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Inferior Myocardial Infarction

I

II

aVF

aVR

aVL

III


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Waves & Segments

Waves: P-QRS-T

Segments: PR, ST, TP

http://medstat.med.utah.edu


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The electrocardiogram normal


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Nilai normal untuk interval-interval

Interval P : < 0,12 dt Interval PR : 0,12 0,20 dt Interval QRS : 0,07 0,10 dt

Interval QT- HR 60 x / mnt : 0,33 0,43 dt.- HR 80 x/mn : 0,29 0,33 dt.- HR 100x/mnt : 0,27 0,35 dt

QT sebagai fungsi frekuensi jantungrumus Bazett QT

QT-c = R-RQT-c : QT terkoreksi ( corected QT )

QT : QT yg terukurR-R : interval R-R yang terukurNormal QT-c = 0,33 0,43 dt.


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The electrocardiogram


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TERIMAKASIH

SELAMAT SIANG

Om Shanti Shanti Shanti Om

1. Dasar-dasar EKG

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