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Martin Winardi
12 Standard Leads
3 sandapan bipolar: I, II dan III 3 sandapan unipolar ekstremitas: aVR, aVL dan aVF 6 sandapan unipolar prekordial: V1 - V6
Membaca EKG
--1 second -0,2 s
0,04 s
ST segment
PR interval : awal P - awal Q QRS duration : awal Q - akhir S QT interval : awal Q - akhir T (N = 0,12 - 0,20 s) (N < 0,12 s) (QTc: 0,35 - 0,45 s)
Membaca EKG
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Irama (Rhytm) Frekuensi (Rate) Sumbu (Axis) P wave PR interval QRS complex ST segment T wave QT interval U wave
ST segment
Rhytm
Cardinal features of sinus rhythm: The P wave is upright in leads I and II Each P wave is followed by a QRS complex The heart rate is 60-99 beats/min
Rate
Heart rate = 1500 / RR(mm) = 300 / jml kotak sedang (5mm) Jarak 1 kotak sedang : 300 x/menit Jarak 2 kotak sedang : 150 x/menit
13mm
Rhytm?
Sinus aritmia
1 second 2s 3s 4s 5s 6s
Axis
Bidang frontal Bidang horizontal
LAD
RAD
LAD
aVF
RAD
Axis?
Normo axis
Axis?
RAD
Axis
LAD:
Left ventricular hypertrophy LBBB Infark miokard inferior
RAD:
Right ventricular hypertrophy Emboli paru PPOK Infark miokard lateral
P wave
P wave = depolarisasi atrium P wave normal:
Lead II: + aVR: V1: bifasik Durasi < 3 kotak kecil (<0,12s) Amplitudo < 2,5 kotak kecil
P wave abnormal:
Lihat di lead II dan V1
P wave abnormalities
PR interval
Normal: 0,12 - 0,20 s (3 - 5 kotak kecil) < 0,12s : Wolff Parkinson White (WPW) syndrome > 0,12s: AV blok
QRS interval
Normal < 0,12 s (< 3 kotak kecil) Abnormal: Bundle branch block
RBBB: V1 = RSR
LBBB: V6 = M
BBB?
BBB?
LVH
Left ventricle hypertrophy:
Etiologi: Hipertensi, aorta stenosis & aorta insufisiensi, kardiomiopati Sokolow-Lyon: S V1 + R V5 atau V6 > 35 mm (7 kotak sedang)
LVH
RVH
Right ventricle hypertrophy:
Etiologi: Cor pulmonal (PPOK), TR, ASD, VSD Kriteria: R > S di V1 R di V1 > 7 mm S di V5 atau V6 > 7 RAD
RVH
ST segment
Dinilai dari J point Normal: isoelektrik Abnormal: ST elevasi / ST depresi
ST elevasi
Etiologi: Infark miokard ST elevasi spesifik Perikarditis Aneurisma ventrikel Emboli paru Perdarahan intrakranial
ST Depresi
Etiologi: Myocardial ischemia Left ventricular hypertrophy Intraventricular conduction defects Medication (e.g., digitalis) Reciprocal changes in leads opposite the area of acute injury
ST Depresi
T wave
T wave = repolarisasi ventrikel Defleksi normal = sesuai defleksi QRS Positif di lead II Amplitudo normal > 1 mm dan:
< 5 mm di lead eksremitas (I, II, III, aVR, aVL, aVF) < 10 mm di lead prekordial (V1-6)
T wave inversion
Hiperkalemia
Tall T
Hipokalemia
Prominent U wave
QT interval
QT int = lamanya depolarisasi repol. Ventrikel Dipengaruhi oleh heart rate QT corrected (QTc) Bazett formula: QTc = QT interval(s) / (R-R(s)) N = 0,35 - 0,45 s Prolonged QT:
Antiaritmia: amiodaron, procainamide Obat psikiatri: haloperidol, phenothiazine, amitriptilin Antimikroba: macrolide, quinolone, voriconazole, chloroquine Congenital: Long QT syndrome Elektrolit: Hypocalsemia, hipokalemia, hipomagnesemia
QT interval
QT interval
Latihan