Elektrokardiografi Dasar

Dr. Eka Ginanjar, SpPD

Divisi Kardiologi Departemen Ilmu Penyakit Dalam
Fakultas Kedokteran / Universitas Indonesia
Anatomi Jantung Normal
 By changing the
arrangement of The Concept of a "Lead"
which arms or legs Leads I II III
are positive or LA
negative, two other RA
- -
leads ( II & III ) can
be created and we
have two more
"pictures" of the RA - + LA
heart's electrical LEAD I
activity from different
angles.
LEAD III +LL
We can also LL
+
arrange other LEAD II
electrodes &
voltages so that we
can obtain many
other leads. For our
purposes we will use Remember, the RL
a 12-lead system is always the ground
ECG basics Paper Speed & Heart Rate

.1 mv paper
Voltage

.5 mv

.04 seconds Time .20 seconds

Paper speed = 25mm / second

Heart Rate = number of R-waves in a 6 second strip divided by 10
= 1500 divided by the number of small boxes between
consecutive R-waves
= large square estimation counts
( 300 - 150 - 100 - 75 - 60 - 50 - 43 )
 ECG Basics - the ECG Complex

By examining the R
different leads, and the
shape, time intervals, PR ST
contour, frequency, and segment segment T
type of the ECG
complexes, we can,
among other things, P
diagnose cardiac U
illnesses, suggest
whether or not the heart
is receiving enough Q
oxygen, determine if the
person has suffered a
S
heart attack, and get an
idea as to the size and .12 - .20 <.10 .35 - .45
sec sec sec
performance of the main
pumping chamber (left
ventricle) PR QRS QT
interval width interval
 ECG Electrode Placement
Exercise Configuration
The right & left arm
electrodes are transferred
Standard Configuration to the upper torso while Standard Configuration
Right Arm (white) the leg electrodes are Right Leg (green - ground)
transferred to the lower
Left Arm (black) torso Left Leg (red)

Precordial
Leads

V1 red V3 green V5 orange

V2 yellow V4 blue V6 violet
 Each of the precordial leads is unipolar (1 electrode constitutes a lead) and
is designed to view the electrical activity of the heart in the horizontal or
transverse plane V1 - 4th intercostal space - right margin of sternum
V2 - 4th intercostal space - left margin of sternum
V3 - linear midpoint between V2 and V4
V4 - 5th intercostal space at the mid clavicular line
V5 - horizontally adjacent to V4 at anterior axillary line
V6 - horizontally adjacent to V5 at mid-axillary line

V1 V2
V3
V4 V5 V6
 Pola Membaca EKG
Irama
Rate QRS
Aksis QRS
Morfologi Gelombang P
Interval PR
Durasi QRS
Morfologi QRS
Deviasi Segmen ST
Morfologi Gelombang T
Morfologi Gelombang U
Lain-lain (LVH,LV Strain,BBB,
QT interval) Nilai Normal :
Kesimpulan EKG Interval PR 0,12 s/d 0,20
Durasi QRS 0,04 s/d 0,12
Aksis Normal - 300 s/d + 1100
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 )
2. RHYTHM

Normal cardiac rhythm : SINUS rhythm

Sinus rhythm characteristics :

Rate 60-100 bpm
Constant R R interval
Negative P wave in aVR and positive di II
P wave is always followed by QRS complex
1. RATE
Normal heart rate : 60 100 x/minutes
> 100 x/minutes : Sinus Tachycardia
< 60 x/minutes : Sinus Bradicardia

Determination heart rate (normal paper speed 25 mm/s):

300
Count number of large square (bold boxes in one R R interval)
1500
Count number of small square in one R R intervals
Number of QRS complex in 6 seconds, multiply by 10
3. AXIS
Aksis QRS
4. HYPERTROPHIC SIGNS
 EKG Abnormal
Penyakit Jantung Koroner
Sindroma Koroner Akut
Takiaritmia
Bradiaritmia
Gangguan Elektrolit
Kelainan Struktur Jantung : Kelainan Katup,
Pembesaran Ruang Jantung, Efusi Perikard,
penyakit jantung bawaan.
INFERIOR INFARCTION
Inferior myocardial infarction
Small inferior distal RCA occlusion

ECG changes in leads II, III, and aVF

 Proximal large RCA occlusion

ST elevation in leads II, III, aVF, V5, and V6

with precordial ST depression
ANTERIOR INFARCTION
ECG demonstrates large anterior infarction
Mid LAD occlusion
after the first septal
ECG : large anterior MI
perforator (arrow)
Unstable angina
Subendocardial ischemia.
Anterolateral ST-segment depression
Acute anteroseptal myocardial infarction.
Hyperacute T-wave changes are noted
Acute anterolateral myocardial infarction
POSTEROLATERAL INFARCTION
Occlusion of diagonal
branch ( arrow )

ST elevation in I and aVL

High lateral infarction
Acute inferoposterior myocardial infarction
Early repolarization
ARRHYTHMIA
 Physiologic Basis of Pacemaker
Cells

Pacemaking &
Conduction System
Macroreentry Microreentry

Atrial Flutter Atrial Fibrillation

 Junctional Tachycardia (RJT)
Reentry within the atrioventriocular (AV) junction can
result in a single junctional premature beat (JPB) or in
sustained junctional tachycardia
Produces narrow-complex regular tachycardia without
preceding atrial depolarization waves
RJTs often produce retrograde atrial depolarization but
these waves are usually buried within the QRS complex
Supraventricular tachycardia
First-degree AV block

Rhythm : Regular
Rate : Usually normal
P wave : Sinus P wave present; one P wave to each QRS
PR : Prolonged ( greater than 0.20 seconds )
QRS : Normal
Second -degree AV block, Mobitz I

Rhythm : Irregular
Rate : Usually slow but can be normal
P wave : Sinus P wave present;
some not followed by QRS complexes
PR : Progressively lengthens
QRS : Normal
Second-degree AV block, Mobitz II

Rhythm : Regular usually;

can be irreguler if conduction ratios vary
Rate : Usually slow
P wave : Two, three, or four P waves before each QRS
PR : PR interval of beat with QRS is constant;
PR interval may be normal or prolonged
QRS : Normal if block in His bundle;
wide if block involves bundle branches
Third-degree AV block

Rhythm : Regular
Rate : 40 60 if block in His bundle;
30 40 if block involves bundle branches
P wave : Sinus P wave present; bear no relationship to QRS;
can be found hidden in QRS complexes and T waves
PR : Varies greatly
QRS : Normal if block in His bundle;
wide if block involves bundle branches
DISCUSSION
Sinus arrhythmia
Early repolarization
Subendocardial ischemia.
Anterolateral ST-segment depression
Unstable angina
acute anterolateral myocardial infarction
Lateral myocardial infarction
Right ventricular infarction
Acute inferoposterior myocardial infarction
Mobitz I
Wolff-Parkinson-White syndrome
Wolff-Parkinson-White syndrome
Atrial fibrillation
Atrial flutter
premature ventricular contraction
Wide complex tachycardia
Supraventricular tachycardia
Ventricular flutter
Idioventricular rhythm
THANK YOU