1. dasar-dasar ekg
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Dr. Bagus Ari Pradnyana D.S., SpJP
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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
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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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Frontal plane axis (mean QRS vector)
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Frontal plane axis (mean QRS vector)
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Frontal plane axis (mean QRS vector)
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Hexaxial reference system
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Frontal plane axis (mean QRS vector)
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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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Basic Principles of ECG Interpretation
Be Systematic Rate: Fast-Normal-Slow
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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Basic Principles of ECG Interpretation
Be SystematicRate: Fast-Normal-Slow
Rhythm: Sinus, Blocks, Atrial, VentricularRhythm Sinus? Fast or Slow?
Regular or Irregular ?
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Basic Principles of ECG Interpretation
Be Systematic Rate: Fast-Normal-Slow
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
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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
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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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)
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
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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
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