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Reviewing
Yassin Oki Purbayanto
DEFINITION
Electrocardiography : the
procedure to record electrical
activity of the heart by means
of placing electrodes on the
surface of the heart.
Electrocardiograph the
recordings result
Goldberger AL, Goldberger E. Clinical Electrocardiography: A
Simplified Approach. 7th ed. St. Louis: Mosby Year Book, 2006
PHYSIOLOGY OF CONDUCTION SYSTEM
Sino-atrial node
(generate action
potential)
Impulse spread
across two atria
atrial systole Left
Anterior
AV node delay Bundle
0,1 s Branch
Bundle of His Left Purkinje
Bundle Left Fibre
Branch Posterio
r Bundle
Branch
Ventricula
Right r
Bundle myocytes
Branch
Levick, JR. An Introduction to Cardiovascular Physiology, 3 rd ed. London:
ECGs Paper
Standard calibration : 1 mV = 10 mm
deflection, speed 25 mm/s , so it is 0,04
s /mm.
Depolarization Gambar
begins at the left Lilly hal
to right side of 90
the septum, and
then forces
progress
posteriorly
toward the left
ventricle. Thus Thaler, M.S., The Only ECG Book Youll Ever Need 5 th ed. Lippincott,2007
deflection
followed by a
downward wave,
whereas V6
14 feature to analyze
an
ECG
Standardization ( calibration ) and technical quality
Heart rate
Rhythm
P wave
PR interval
QRS width
QRS axis
QRS voltage
QT interval
R wave progression in chest lead
Abnormal Q wave
ST segment
T wave
U wave
Heart Rate
Tentukan frekuensi ( heart rate ), caranya ;
300 dibagi kotak sedang antara R-R
1500 dibagi kotak kecil antara R-R,
lead panjang 6 detik - jml gel QRS dikali 10.
Heart Rate (contd)
1 kotak sedang : 300 x/mnt
2 kotak sedang : 150 x/mnt
3 Kotak sedang : 100x/mnt
4 kotak sedang : 75x/mnt
5 kotak sedang : 60 x/mnt
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 ARRYTMIA
SINUS TACHYCARDIA
Inget syarat syarat normosinus
rhythm
1. Ada gelombang P
2. Ada kompleks QRS yang mengikuti
gelombang P
3. Jarak R-R atau P-P selalu sama.
4. HR 60 100 BPM
R
Gelombang P
Depolarisasi Atrium
Diikuti kontraksi atrium
Sinus Ritme : + di II
Sinus Ritme : - di avR
N ; lebar < 0,12 dtk
N : tinggi < 0,3 mV
P T
U
Q
S
Depolarisasi
atrium
Nomenclature ECG
QRS duration
R
PR interval : 0,12 - 0,20 dtk
QTc < 0,42 ( tergantung HR)
ST segmen
P T
U
Q
S
PR
interval QT interval
Nomenclature ECG
Gelombang QRS
Depolarisasi ventrikel
Depolarisasi ventrikel
R Diikuti kontraksi ventrikel
Lebar 0,06 - 0,12 dtk
Tinggi tergantung lead
Q patologis: tanda infark
miokard
Transisisonal zone untuk gel.
R
Q
S
QRS COMPLEX
Nomenclature ECG
Depolarisasi ventrikel
P T
U
Q
S
Depolarisasi
atrium Repolarisasi ventrikel
Ini yg dimaksud tinggi QRS
tergantung lead
ST segment
entuk segmen ST :
Gelombang T hiperakut
kadang2 merupakan satu-satunya
perubahan EKG yang terlihat
ST DEPRESSION
HORIZONTAL
DOWN
SLOOPING
UP SLOOPING
Acute anterolateral myocardial
Nomenclature ECG
Gelombang T
Repolarisasi ventrikel
Diikuti relaksasi ventrikel
+ di lead : I,II,V3-V6
- di lead avR
Repolarisasi ventrikel
Ini apaa hayoo?
Determining Axis
How to determine it?
-90o
1. Buat dulu gambar kuadran
180
o
0o I
+90
o
AVF
2. Lead I (sumbu X) 2. Lead AVF (sumbu Y)
Amplitudo Amplitudo
gelombang R gelombang R
Amplitudo Amplitudo
gelombang S gelombang S
3. Kalau udah ketemu (x,y) tarik garis dari titik
(0,0) kearah titik (x,y) itu.
Atrial Hypertrophy
LAH RAH
1. Durasi P di lead II 1. P tinggi & lancip
0,12 detik (tinggi 2,5mm,
2. Ada gambaran P lebar 0,11s) di
mitrale. II,III,AVF
3. Defleksi akhir yang 2. P pulmonale
lebar ( 0,04 s) dan 3. Defleksi awal di V1
dalam(1mm) pada 1,5 mm
gelombang P bifasik
di V1
Ventricular
Hypertrophy
LVH
LVH
RVH
RVH
Myocardial Infarction
Normal/abnorma
P wave l
P wave + QRS 1P followed 1
complex QRS?
PR segment
prolonged/tidak?
Terimakasih