INTERPRETASI

ELEKTROKARDIOGRAFI
dr. Erlina Marfianti, MSc, SpPD
Departemen Ilmu Penyakit Dalam
Fakultas Kedokteran UII
Definisi
EKG adalah grafik hasil catatan potensial
listrik yang dihasilkan oleh denyut jantung

EKG merupakan alat pembantu diagnostik.
Penderita dengan kelainan jantung organik
bisa menunjukkan gambaran EKG normal

EKG bisa menunjukkan kelainan non spesifik
pada orang sehat
Kegunaan EKG
Beberapa kelainan jantung yang dapat
diketahui dari EKG
Hipertrofi
Infark miokard
Aritmia
Gangguan elektrolit
Efek obat-obatan: misal digitalis
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Physiologic Properties of Myocardial Cells
Automaticity : Ability to initiate an impulse
Excitability : Ability to respond to an impulse
Conducticity : Ability to transmit an impulse
Contractility : Ability to respond with pumping action
LEAD
Components of a NSR
Rekaman EKG baku telah ditetapkan bahwa:
a. Kecepatan rekaman : 25 mm/detik
b. Kekuatan voltage : 1 mv = 10 mm

Bearti ukuran di kertas EKG:
a. Pada garis horosontal
- Tiap 1mm = 1 kotak kecil = 1/25 detik = 0,04 detik
- Tiap 5mm = 1 kotak sedang = 5/25 detik = 0,20 detik
- Tiap 25 mm = 1,00 detik
Components of a NSR:
P wave
1. Describe the sequence of right and left atrial
2. Normal positif in lead I, II, aVF, and V4 V6
3. Normal negative in lead aVR
4. Duration < 0,12 sec
5. 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. Describe activation of left and right ventrikel
2. Duration 0,05 0,10 sec (<2,5 small box).
3. Measure usually in limbs lead
4. 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


How to report
Rhythm : - Heart rate :
- Axis :
- Transisional Zone :
- Interval
- PR :
- QRS :
- QT :
- Sign : Hipertrophi,
iskemia, infark


CONCLUSION :



Rate
Rhytm
(Irama)
Irama Sinus Normal
Irama jantung yang normal ialah irama
yang ditentukan oleh simpul SA dan
disebut irama sinus:
- Frekuensi antara 60-100 x/menit
- Teratur
- Gelombang P negatif di aVR dan positif
di II
- Tiap gelombang P diikuti oleh kelompok
QRS T
Penyimpangan - ARITMIA
AXIS
Setiap vektor jantung
mempunyai:
-Polaritas
-Arah
-Ukuran/Intensitas
Axis Deviation
-30
0

180
0

-90
0

90
0

Normal
Left Axis
Right Axis
Extreme
Right Axis
Penentuan Sumbu QRS di
Bidang Frontal
1. Secara praktis tentukan di sandapan I
dan AVF
2. Tentukan di sandapan manakah
terdapat keadaan ekuipotensial (nol)
Amplitudo di Ekuipotensi
al di
Sumbu
I AVF
Positif positif III +30
aVL +60
I +90
aVF 0
Positif Negatif II - 30
aVR - 60
I -90
Negatif Positif aVR +120
II +150
aVF +180
Negatif Negatif aVL -120
III - 150
AKSIS Posisi Jantung
-30 s/d -15
-15 s/d +15
+ 15 s/d +45
+ 45 s/d +75
+ 75 s/d +110
+110 s/d +
180
-30 s/d -90
-90 s/d 180
Horizontal
Semi horizontal
Intermediate
Semi Vertikal
Vertikal
Deviasi Sumbu ke kanan
Deviasi sumbu ke kiri
Deviasi ke kanan hebat

PATHOLOGY
CORRELATION BETWEEN LOCATION OF
ISCHAEMIC, ECG AND CORONARY
ARTERY ANATOMY
LOCATION OF INFARCT/ ECG CORONARY ARTERY
INVOLVED
ISCHAEMIC

ANTERIOR EKSTENSIVE I, aVL, V1-V6 LAD, LCX

ANTEROSEPTAL V1- V3 LAD

ANTEROLATERAL I, aVL, V4- V6 LCX

INFERIOR II, III, aVF RCA,
PDA

POSTERIOR V7- V9 PL
(POSTEROLATERAL)

RV V3R V5R RCA/
RV BRANCH
LAD Left Anterio Descenden.LCX circumflex.RCA Righ Cor.Art.
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.
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
CRITERIA LVH
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

LV Strain (Strain Pattern) = perubahan segmen ST dan gelombang T=
depresi semen ST dan inversi T

Hipertrofi ventrikel kanan
Deviasi aksis ke kanan (>+110)
R V1> S V1
Gelombang R yang tinggi di sandapan
aVR
Rotasi searah jarum jam