ELEKTROKARDIOGRAM

Kegunaan Pemeriksaan EKG EKG NORMAL Kegunaan Pemeriksaan EKG rekaman EKG 12 lead: Dalam batas normal Kelainan irama jantung Kelainan sistem konduksi Pembesaran atrium atau ventrikel Inflamasi, iskemia atau infark miokard Kelainan atau penyakit yang mempengaruhi kinerja otot jantung

EKG: MEMOTRET JANTUNG DARI SISI FRONTAL DAN HORIZONTAL

Standard limb leads (Sandapan Ekstremitas)

Augmented Leads

EKG NORMAL Gambar 1.1 Sandapan baku bipolar lead I, II dan III dan Sandapan ekstrimitas diperkuat lead aVR, aVL dan aVF  potongan jantung secara vertikal

Precordial Leads (Sandapan Dada)

Sandapan Dada Kanan

EKG NORMAL Gambar 1.3 Sandapan dada unipolar (prekordial) Lead V1, V2, V3, V4, V5 dan V6  potongan jantung secara horizontal

EKG NORMAL Quality check (Q.C) setiap Elektrokardiogram ! 1. Kecepatan rekaman EKG 25 mm/detik (atau 50 mm/detik bila perlu) 2. Standardisasi EKG. Harus ada tanda 1 mV = 10 mm pada permulaan lead 3. Gelombang P “upright” (defleksi keatas, positif) di lead I 4. Gelombang P “downward” (negatif) di lead aVR 5. “R wave progression” 6. Lead I + lead III = Lead II 7. aVR + aVL + aVF = 0

EKG NORMAL Gambar 1.4 Definisi dan ukuran PQRST

EKG: rekaman aktivitas listrik jantung pada permukaan tubuh

EKG NORMAL Standardisasi EKG Gambar 1.5 Tanda 1 mV atau 1/2 mV

EKG NORMAL Gambar 1.7 Progresi gelombang R dan regresi gelombang S dari V1- V6

Tabel 1.1 QRS kompleks : EKG NORMAL QRS interval normal 0,07 –0,11 detik, rata-rata 0,08 detik (2 mm=2 kotak kecil (KK)) amplitudo lebih dari 5 mm (0,05 mv) lead prekordial 10 mm (1,0 mv) Gelombang R tertinggi 30 mm (dewasa) Gelombang Q 0,03 detik, defleksi kebawah kurang dari 1 mm

EKG NORMAL Tabel 2.1 QRS Axis Normal : - 30º sampai + 110º LAD patologis: - 30º sampai – 90º RAD patologis: > + 110º sampai + 180º EAD patologis: - 90º sampai – 180º

EKG NORMAL Gambar 2.2 Mean QRS vektor

EKG NORMAL Gambar 1.2 Sistem HEXAXIAL

AXIS

EKG NORMAL Gambar 2.1 QRS axis berdasarkan lead I dan aVF

Langkah Interpretasi: R hythm R ate A xis H ypertrophy I schemia I nfacrt

Analisis / pembacaan rekaman EKG EKG NORMAL Analisis / pembacaan rekaman EKG 1. Irama (cepat, lambat, reguler, irreguler) Heart rate atau kecepatan denyut jantung 2. Kelainan gelombang P, PR interval adakah extrasystole atrial 3. QRS axis, QRS interval Kelainan gelombang Q, R dan S Adakah extrasystole (PVC, PJC) 4. ST segment (Isoelektrik, depresi, elevasi) ST junction (normal, naik) Kelainan gelombang T QT atau QTC interval QRST angle Kesimpulan : interpretasi EKG

Standar Penulisan hasil analisa EKG Irama: sinus HR: Axis: Gel P: Interval PR: ….dtk QRS kompleks: ….dtk Gel Q patologis Progresi R Segmen ST: isoelektris, elevasi, depresi Gel T: upright, flat, inverted S V1/ SV2 + RV5/RV6 < 35

Sinus tachycardia

Supraven-tricular extrasystole

Review of cardiac arrhythmias (1) : Arrhythmias with extopic impulse formation SUPREVENTRI CULAR ARRHYTHMIAS

EKG NORMAL Gambar 1.3 Sandapan dada unipolar (prekordial) Lead V1, V2, V3, V4, V5 dan V6

HIPERTROFI

Electrolytes & ECG Most important being Potassium(K+), Calcium(Ca2+) Hyperkalemia Renal Failure Drugs eg. Slow K, ACE inhibitor, Spironolactone 19/2/2000

Hyperkalaemia Tall, symmetrical, ‘tented’ T wave - hallmark widened QRS PR interval prolonged P wave flattened, eventually disappear rarely, ST elevation in praecordial leads Arrhythmias - VF 19/2/2000

Hyperkalemia

Hyperkalemia 19/2/2000

Hyperkalemia 19/2/2000

Hypokalemia Progressive T wave flattening Progressive U wave prominence PR interval prolonged 1o/2o AVB Severe: T inversion and ST depressions 19/2/2000

Hypokalemia 19/2/2000

Hypokalemia

Hypercalcaemia Hypocalcaemia Shortened QT interval may, T inversion Loss of ST segment or ST depressions Hypocalcaemia prolonged QT interval 19/2/2000

Hypocalcaemia 19/2/2000

Renal failure & Hypocalcaemia

Hypercalcaemia (QTc 0.31sec)

ISKEMIA DAN INFARK

UNSTABLE ANGINA/NSTEMI

Classic Myocardial Infarction The classic electrocardiographic findings associated with MI are reviewed above. Any of the three, however, may be found alone. The accompanying diagram shows an infarcted zone surrounded by zones of injury and ischemia

Diagrammatic representation of the various surfaces of the left ventricular anatomical cone, and their relationship to the frontal and horizontal plane leads

Lateral Infarction In lateral MI, the initial vector of ventricular depolarization, the initial QRS vector, moves away from the lateral area, hence the formation of significant Q waves in these leads. The Q wave represents initial vectorial forces moving away from the electrode at the point of recording

Lateral Infarction Lateral MI may also be seen electrocardiographically with significant Q waves in the lateral precordial leads, with the initial QRS vector moving away from these leads

Inferior (Diaphragmatic) Infarction In inferior (diaphragmatic) MI, the initial vector of ventricular depolarization moves away from the diaphagmatic area. Significant Q waves are thereby formed in these leads

Apical Infarction In apical MI, the initial QRS vector, pointing away from the apical myocardium and from leads I, II, and III, produces Q waves in all three leads. The questions arises, “did one MI produce the abnormalities, or are they the results of the occurrence of more than one infarction at different time?” serial electrocardiograms are vital in this determination

Anterior Infarction In anterior MI, the initial QRS vector moves away from the anterior surface and away from the anterior chest leads; hence the occurrence of significant Q waves in these leads. When the Q waves are limited to leads V1 to V3, the infarction is labeled “anteroseptal”. The right-sided chest leads normally do not have Q waves of any size

Posterior Infarction In posterior MI, the initial QRS moves away from the posterior wall of the left ventricle, located posteriorly and to the left. This initial vector therefore moves anteriorly and to the right, toward lead V1, inscribing a positive deflection, a predominant R wave in lead V1. This R wave in posterior MI represents the same phenomenon as the Q wave in anterior MI. the prominent R wave in lead V1 may also represent right ventricular hypertrophy, right bundle branch block (RBBB), and Wolff-Parkinson-White (W-P-W) syndrome. The last two conditions will be studied shortly

EKG NORMAL Latihan EKG Kasus No. 1 : Laki umur 35 tahun sehat ANALISIS EKG 1. Irama : sinus HR : 75 /menit PR interval : 0,13 detik 2. QRS kompleks : 0,08 detik Axis : Normal (+ 45) 3. ST –T : Normal QT interval : 0,36 detik INTERPRETASI EKG : Dalam Batas Normal (Within Normal Limits)

semoga bermanfaat

Coarse ventricular fibrillation

Fine ventricular fibrillation (“coarse” asystole)