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Interpretasi Electrocardiogram (EKG)

What is an ECG?
An EKG is a method of measuring, displaying and recording the electrical activity of a heart

Electrical stimuli is amplified to create a rhythm strip by a machine that consistently produces representations of the hearts electrical activity

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

Electrical System of Heart

BASIC TERMINOLOGY
Arrhythmia Baseline : : Abnormal rhythm Flat, straight, isoelectric line

Waveform
Segment Interval Complex

:
: : :

Movement away from the baseline,


up or down A line between waveforms A waveform plus a segment Combination of several waveforms - The first positive deflection : R - The first negative deflection : Q

Components of a NSR

Components of a NSR: P wave

1. 2. 3. 4. 5.

Describe the sequence of right and left atrial Normal positif in lead I, II, aVF, and V4 V6 Normal negative in lead aVR Duration < 0,12 sec Amplitudo < 2,5 mm

Components of a NSR : PR interval

1. Time needed to transmit impuls from SA node to AV node 2. Normal 0,12 0,22 sec ( 3-5,5 small box) 3. Short PR interval preeksitasion syndrome 4. Prolonged PR interval think about A-V block.

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

Components of a NSR: ST segment

Normal ST segment
1. Usually isoelectric, elevation < 1 mm in extremity still normal 2. Depression < 0,5 mm 3. Point at the end of QRS complex named J point

Components of a NSR: T wave

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

Components of a NSR: QT duration

QT duration 1. Describe total sistolic time 2. variation according to heart rate, gender and age 3. QT interval must be < R-R interval in HR 65-90/mnt 4. Normal QT correction 0,44 + 0,02 sec 5. Prolonged QTc predispose R on T VT

Rate Determination
Paper speed is 25 mm/second : 1 small box 1 large box 6 large boxes = 1 mm = 0.04 second = 5 mm = 0.20 second = 30 mm = 1.20 second

Calculation of heart rate 1. Calculate total QRS complex in 6 large box and x 50

Rate Determination 2. Count the total small box between the 2 QRS kompleks and divide to 1500

Electrical Axis

aVR
1800

aVL
00 I

III

900 aVF

II

Use QRS complex in lead I as x axis and lead aVF as Y axis to calculate axis.

Axis Deviation

-900 Left Axis -300

Extreme Right Axis 1800

Normal
Right Axis

900

Normal EKG ? 1. Sinus rhythm

2. Regular rhythm and heart rate 60 100x/mnt


3. Normal AV conduction, normal Intraventricular conduction 4. Normal activation of atrium 5. Normal activation of ventricel (axis) 6. No sign of necrosis 7. Normal repolarisation of ventricel
(ST segmen,gel T,gel U)

How to report
Rhythm - Axis QRS - Transisional Zone - Interval - PR - QRS - QT : : : : : :
-

- Heart rate

Morphology - P wave - QRS complex - ST segmen - T wave

: : : : :

- QTc

- U wave

CONCLUSION :

MORPHOLOGICAL ABNORMALITIES
Electrocardiogram (EKG)

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Surgery For Coronary Artery Disease Coronary By-pass Graft (CABG)

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CORONARY ARTERY DISEASE : MYOCARDIAL ISCHAEMIA


MYOCARDIAL ISCHAEMIA : ANGINA/ CORONARY INSUFFICIENCE :
Changes in the myocardial resulting from

a temporalily insufficient blood supply. Commonly seen during spontaneous angina and induced coronary insufficiency.
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ETIOLOGY
ATHEROSKLEROSIS : STENOSIS CORONARY ARTERY VENTRICULAR HYPERTROPHY AORTIC STENOSIS SYPHILITIC AORTITIS PULMONARY HYPERTENSION POLYCITEMIA

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ECG FINDINGS IN CORONARY INSUFFICIENCY


ST SEGMEN CHANGES T WAVE CHANGES. DIFFERENTIAL DIAGNOSIS : VENTRICULAR HYPERTROPHY DRUG EFFECT HIPOKALEMIA PERICARDITIS MYOCARDITIS
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CORRELATION BETWEEN LOCATION OF ISCHAEMIC, ECG AND CORONARY ARTERY ANATOMY


LOCATION OF INFARCT/ ISCHAEMIC

ECG

CORONARY ARTERY INVOLVED

ANTERIOR EKSTENSIVE ANTEROSEPTAL ANTEROLATERAL INFERIOR

I, aVL, V1-V6 V1- V3 I, aVL, V4- V6 II, III, aVF

LAD, LCX LAD LCX RCA, PDA

POSTERIOR (POSTEROLATERAL)
RV

V7- V9

PL

V3R V5R

RCA/ RV BRANCH
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LAD Left Anterio Descenden. LCX circumflex. RCA Righ Cor.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.

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Terminology of infarct
Acute infarct : several hours untill days ECG : ST elevation Recent infarct : several days- weeks. ECG : evolution Old infarct : more than 6 months. ECG : Q wave or QS complex or slow progression of R wave
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VENTRICULAR HYPERTROPHY
LEFT VENTRICULAR HYPERTROPHY : Etiology : - Hypertension - Aortic stenosis / Insufficiency - Mitral Insufficiency - Longstanding CAD - Nutritional and idiopathic hypertrophy - Congenital heart disease
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CRITERIA
Chest lead (Sokolow, Lyon) : S wave in V1 + R wave in V5 or V6 > 35 mm R in V5 or V6 > 26 mm. R plus S in any chest leads > 45 mm

Limb leads (Gubner, Ungerleider) : R in I + S in III > 25 mm R in aVF > 20 mm R in aVL > 11 mm R in aVR > 15 mm

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THE END
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Thanks for your attention!!

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