ECG Praktis-Sesi 1

Dr Andika SitepuDepartemen Kardiologi dan Vaskuler FKUI

National Cardiac Center Harapan KitaJakarta

TOPIKTOPIK

1. - BASIC ECG- SKILL STATION: PEMASANGAN EKG- QUIZ

2. - ARITMIA- SKILL STATION: DC SHOCK- QUIZ

3. - SINDROMA KORONER AKUT: EKG DAN TERAPI DINI

- QUIZ

OutlineOutline1. Review of the conduction system2. EKG waveforms and intervals3. EKG leads4. Determining heart rate5. Determining QRS axis

What is an ECG?What is an ECG?

The electrocardiogram (ECG) is a representation of the electrical events of the cardiac cycle

What types of pathology can we What types of pathology can we identify and study from EKGs?identify and study from EKGs?

• Arrhythmias• Myocardial ischemia and infarction• Pericarditis• Chamber hypertrophy• Electrolyte disturbances (i.e.

hyperkalemia, hypokalemia)• Drug toxicity (i.e. digoxin and drugs

which prolong the QT interval)

Conduction System

SA Node Internodal branch AV Node Hiss Bundle Purkinje Fiber Contraction

EKG waveforms and intervalsEKG waveforms and intervals

• P wave : atrial depolarisation

• QRS complex : ventricular depolarisation

• T wave : ventricular repolarisation

• Atrial repolarisation hidden by QRS

P

Q

R

S

T

PR Interval

QRS Complex

ST Segment

T Wave

EKG LEADSEKG LEADS

• STANDARD LIMB LEADS • I, II, III

• AUGMENTED LIMB LEADS • aVR, aVL, aVF

• PRECORDIAL LEADS• V1, V2, V3, V4, V5, V6

Standard Limb LeadsStandard Limb Leads

Standard Limb LeadsStandard Limb Leads

Augmented Limb LeadsAugmented Limb Leads

All Limb LeadsAll Limb Leads

Precordial LeadsPrecordial Leads

Adapted from: www.numed.co.uk/electrodepl.html

PEMASANGAN PEMASANGAN ELEKTRODEELEKTRODE

• 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

STANDARISASI EKGSTANDARISASI EKG• Kecepatan kertas standard EKG

• 25 mm / s (10 – 25 – 50 mm / s)

• Setiap kolom horizontal = 0.04 sec

• Setiap kolom vertikal = 0,1 mV

MENGHITUNG DETAK JANTUNGMENGHITUNG DETAK JANTUNG

• Menggunakan Mistar EKG

• 300 dibagi jumlah kotak besar antara interval R-R

• 1500 dibagi jumlah kolom horizontal antara interval R-R

• Hitung banyaknya voltage R dalam 6 sec dan dikalikan 10

What is the heart rate?What is the heart rate?

(300 / 6) = 50 bpm

www.uptodate.com

What is the heart rate?What is the heart rate?

(300 / ~ 4) = ~ 75 bpm

www.uptodate.com

What is the heart rate?What is the heart rate?

(300 / 1.5) = 200 bpm

The Rule of 300The Rule of 300It may be easiest to memorize the following table:

# of big boxes

Rate

1 300

2 150

3 100

4 75

5 60

6 50

What is the heart rate?What is the heart rate?

22 x 10 = 220 bpm

The QRS AxisThe QRS AxisBy near-consensus, the normal QRS axis is defined as ranging from -30° to +90°.

-30° to -90° is referred to as a left axis deviation (LAD)

+90° to +180° is referred to as a right axis deviation (RAD)

The Quadrant ApproachThe Quadrant ApproachExamine the QRS complex in leads I and aVF to determine if they are predominantly positive or predominantly negative. The combination should place the axis into one of the 4 quadrants below.

Quadrant Approach: Example 1Quadrant Approach: Example 1

Negative in I, positive in aVF RAD

The Alan E. Lindsay ECG Learning Center http://medstat.med.utah.edu/kw/ecg/

Quadrant Approach: Example 2Quadrant Approach: Example 2

Positive in I, negative in aVF LAD

The Alan E. Lindsay ECG Learning Center http://medstat.med.utah.edu/kw/ecg/

– Tentukan jenis ritme– Hitung frekwensi-nya – Hitung axis– Hitung interval PR, QRS– Analisa gelombang P, QRS, ST dan T

Sistematika membaca EKGSistematika membaca EKG

Normal Sinus Rhythm

Rhythm : RegularRate : 60 – 100P wave : Normal in configuration; precede each QRSPR : Normal ( 0. 12 – 0.20 seconds )QRS : Normal ( less than 0.12 seconds )

PEMASANGAN ELEKTRODAPEMASANGAN ELEKTRODA• STANDART• RIGHT VENTRICLE• POSTERIOR• DEXTROCARDIA

SOAL 1SOAL 1

SOAL 2SOAL 2

SOAL 3SOAL 3