dasar dasar interpretasi ekg radityo prakoso hary s muliawan

DASAR-DASAR

INTERPRETASI EKG

Radityo Prakoso, Hary S Muliawan

Department of Cardiology and Vascular Medicine

Faculty of Medicine University of Indonesia

National Cardiovascular Center Harapan Kita

V6V5

V4

V3V2

V1

V6R

V5R

V4R

V3R

Midclavicular line

Anterior axillary line

Midaxillary line

Unipolar Precodial (Chest) Leads

Mervin J. Goldman, MD. 11th edition Principles of clinical Electrocardiography. Clinical Professor of Medicine University of California School of Medicine San Francisco @1995-1982

V7 V8 V9 V9RV8RV7R

Horizontal plane of V4-6

Unipolar Precodial (Chest) Leads

Mervin J. Goldman, MD. 11th edition Principles of clinical Electrocardiography. Clinical Professor of Medicine University of California School of Medicine San Francisco @1995-1982

ECG INTERPRETATION

1. RATE

2. RHYTHM

3. AXIS

4. HIPERTROPHIC SIGNS

5. MYOCARDIAL INFARCTION

6. ARRHYTHMIA

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

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

12

Gelombang P

3. AXIS

Determining Axis: An Example

4. HYPERTROPHIC SIGNS

Atrial Hypertrophy

Atrial Hypertrophy

P Pulmonale: Right (RAH)

P Mitrale: Left (LAH)

5. MYOCARDIAL INFARCTION

Ischemia

Injury

Necrosis

ANTERIOR INFARCTION

INFERIOR INFARCTION

POSTEROLATERAL INFARCTION

ARRHYTHMIA

Causes of Cardiac Arrhythmias

Disturbed automaticity : this may involved a speeding up or

slowing down of areas of automaticity such as the sinus

node, the atrioventricular (AV) node, or the myocardium.

Abnormal beats (depolarizations) may arise through this

mechanism from the atria, the AV junction, or the ventricles.

Disturbed conduction : conduction may be either too rapid (as

in Wolff- Parkinson-White syndrome) or too slow (as in AV

block)

Combinations of disturbed automaticity and disturbed

conduction

Sinus Rhythm

First Degree Heart Block

Second Degree Block Type I

*

Second Degree Block Type II

Third Degree Heart Block

Premature Atrial Contraction

*

Premature Ventricular

Contraction

Atrial Fibrillation

Atrial Flutter

Supraventricular Tachycardia

Ventricular Fibrillation

Ventricular Tachycardia

Torsade de Pointes

Bundle Branch Blocks

Characteristic QRS

pattern in lead I, V1,

and V6

Left Bundle Branch Block

*

Right Bundle Branch Block

*

DISCUSSION

Sinus arrhythmia

Limb lead reversal

Early repolarization

Subendocardial ischemia.

Anterolateral ST-segment depression

Unstable angina

acute anterolateral myocardial infarction

High lateral infarction

Lateral myocardial infarction

Right ventricular infarction

Acute inferoposterior myocardial infarction

left ventricular aneurysm

Mobitz I

High-grade atrioventricular block

Wolff-Parkinson-White syndrome

Wolff-Parkinson-White syndrome

Atrial fibrillation

Atrial flutter

premature ventricular contraction

Supraventricular tachycardia

Wide complex tachycardia

Ventricular flutter

Idioventricular rhythm