Eletrokardiogram

dr. Cut Aryfa Andra

Conduction System

SA Node Internodal branch AV Node Hiss Bundle Purkinje Fiber Contraction

Sandapan EKG (standar - 12 lead)

Sandapan bipolar - Merekam perbedaan potensial dari 2 elektroda I = lengan kanan (-) lengan kiri (+) II = lengan kanan (-) tungkai kiri (+) III = lengan kiri (-) tungkai kiri (+) Sandapan unipolar - Merekam potensial listrik pada satu elektroda yang lain sebagai elektroda indiferen (0) - Ada dua sandapan: ekstremitas & prekordial - Sandapan unipolar ekstremitas avR, avL, avF - Sandapan prekordial V1,V2,V3,V4,V5,V6

Sandapan EKG (non standar)

Pada keadaan tertentu diperlukan sandapan ditempat

yang bukan standar

Pada kecurigaan infark Ventrikel Kanan V3R, V4R (merupakan cermin V3, V4)

Pada kecurigaan infark miokard porterior V7,V8,V9 ( selevel V4,V5,V6 ke arah posterior)

Cara pemasangan
Limb lead Merah (R) Kuning (L) Hijau (F) Hitam (RF)

Tangan kanan Tangan kiri Kaki Kiri Kaki kanan

Cara pemasangan
Chest lead V1 ( merah ) inter costal 4 RSB V2 ( Kuning ) Intercostal 4 LSB V3 ( hijau ) antara V2 dan V4 V4 (Ungu ) Intercostal 5 mid clav V5 ( coklat ) Intercostal 5 linea axila anterior V6 ( hitam ) Intercostal 5 mid axila

Nomenclature ECG
Depolarisasi ventrikel R

Q S Depolarisasi atrium Repolarisasi ventrikel

Normal Sinus Rhythm Rhythm : Regular Rate : 60 100 P wave : Normal in configuration; precede each QRS PR : Normal ( 0. 12 0.20 seconds ) QRS : Normal ( less than 0.12 seconds )

SINUS BRADYCARDIA SINUS TACHYCARDIA

SINUS ARRYTMIA

Anatomi Koroner dan EKG 12 sandapan ( LEAD )

Sandapan V1 dan V2 menghadap septal area ventrikel kiri Sandapan V3 dan V4 menghadap dinding anterior ventrikel kiri Sandapan V5 dan V6 ( ditambah I dan avL ) menghadap dinding lateral ventrikel kiri Sandapan II, III dan avF menghadap dinding inferior ventrikel kiri

Aritmia
Gangguan irama jantung berupa segala jenis irama jantung selain IRAMA SINUS

Supraventrikular
QRS sempit seperti normal (kecuali beberapa hal: BBB, WPW,aberans)

Ventrikular
QRS lebar > 0,12 dt

Aritmia Supraventrikular

Premature beat / ekstra sistolik

Takikardi aritmia

Atrial Flutter Atrial fibrilasi

Supra Ventrikel Takikardi/ 150 - 250 x/mnt

Atrial Fibrilasi

ATRIAL FLUTTER

I II III V1 V2

V6

SVT

Aritmia Ventrikular

Premature beat / ekstra sistolik

Takikardi aritmia

Ventrikel Takikardi N
100-250 x/mnt

Ventrikel Fibrilasi N
> 350 x/mnt

The Deadly Rhythms

PEA

VT VF

(Pulse less Electrical Activity)

Asystole

Ventricular Tachycardia (VT) Abnormal Looking at the ECG you'll see that: Rhythm - Regular Rate - 180-190 Beats per minute QRS Duration - Prolonged P Wave - Not seen Results from abnormal tissues in the ventricles generating a rapid and irregular heart rhythm. Poor cardiac output is usually associated with this rhythm thus causing the pt to go into cardiac arrest. Shock this rhythm if the patient is unconscious and without a pulse

Ventricular Fibrillation (VF) Abnormal

Disorganised electrical signals cause the ventricles to quiver instead of contract in a rhythmic fashion. A patient will be unconscious as blood is not pumped to the brain. Immediate treatment by defibrillation is indicated. This condition may occur during or after a myocardial infarct. Looking at the ECG you'll see that: Rhythm - Irregular Rate - 300+, disorganised QRS Duration - Not recognisable P Wave - Not seen

This patient needs to be defibrillated!! QUICKLY

Asystole - Abnormal Looking at the ECG you'll see that: Rhythm - Flat Rate - 0 Beats per minute QRS Duration - None P Wave - None Carry out CPR!!

Pulseless Electrical Activity

 50 th , apneu, pulsasi tak teraba.

Normal

Progression of an Acute Myocardial Infarction

An acute MI is a continuum that extends from the normal state to a full infarction:
Ischemia

IschemiaLack of oxygen to the cardiac tissue, represented by ST segment depression, T wave inversion, or both InjuryAn arterial occlusion with ischemia, represented by ST segment elevation InfarctionDeath of tissue, represented by a pathological Q wave

Injury

Infarction

Acute anteroseptal myocardial infarction. Hyperacute T-wave changes are noted

 45 th dengan sesak napas disertai keringat dingin, 6 jam sebelumnya nyeri dada berlangsung selama > 1 jam , saat di EMG dada masih terasa nyeri.

Acute Anterolateral MI

 49 th dengan nyeri dada kiri, menjalar ke lengan kiri, timbul setelah bangun tidur > 15 menit.