ecg praktis-sesi 1
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Dr Andika SitepuDepartemen Kardiologi dan Vaskuler FKUI
National Cardiac Center Harapan KitaJakarta
TOPIKTOPIK
1. - BASIC ECG- SKILL STATION: PEMASANGAN EKG- QUIZ
2. - ARITMIA- SKILL STATION: DC SHOCK- QUIZ
3. - SINDROMA KORONER AKUT: EKG DAN TERAPI DINI
- QUIZ
OutlineOutline1. Review of the conduction system2. EKG waveforms and intervals3. EKG leads4. Determining heart rate5. Determining QRS axis
What is an ECG?What is an ECG?
The electrocardiogram (ECG) is a representation of the electrical events of the cardiac cycle
What types of pathology can we What types of pathology can we identify and study from EKGs?identify and study from EKGs?
• Arrhythmias• Myocardial ischemia and infarction• Pericarditis• Chamber hypertrophy• Electrolyte disturbances (i.e.
hyperkalemia, hypokalemia)• Drug toxicity (i.e. digoxin and drugs
which prolong the QT interval)
Conduction System
SA Node Internodal branch AV Node Hiss Bundle Purkinje Fiber Contraction
EKG waveforms and intervalsEKG waveforms and intervals
• P wave : atrial depolarisation
• QRS complex : ventricular depolarisation
• T wave : ventricular repolarisation
• Atrial repolarisation hidden by QRS
P
Q
R
S
T
PR Interval
QRS Complex
ST Segment
T Wave
EKG LEADSEKG LEADS
• STANDARD LIMB LEADS • I, II, III
• AUGMENTED LIMB LEADS • aVR, aVL, aVF
• PRECORDIAL LEADS• V1, V2, V3, V4, V5, V6
Standard Limb LeadsStandard Limb Leads
Standard Limb LeadsStandard Limb Leads
Augmented Limb LeadsAugmented Limb Leads
All Limb LeadsAll Limb Leads
Precordial LeadsPrecordial Leads
Adapted from: www.numed.co.uk/electrodepl.html
PEMASANGAN PEMASANGAN ELEKTRODEELEKTRODE
• PEMASANGAN ELEKTRODE EXTREMITAS• Lengan kanan dan lengan kiri• Kaki kanan dan kaki kiri
• PEMASANGAN ELEKTRODE DADA• V1 = Parasternal kanan di ICS-4• V2 = Parasternal kiri di ICS-4• V4 = MCL kiri di ICS-5• V3 = Median antara V2 dgn V4• V5 = Para Axillair Line kiri di ICS-5• V6 = Median Axillair kiri di ICS-5
STANDARISASI EKGSTANDARISASI EKG• Kecepatan kertas standard EKG
• 25 mm / s (10 – 25 – 50 mm / s)
• Setiap kolom horizontal = 0.04 sec
• Setiap kolom vertikal = 0,1 mV
MENGHITUNG DETAK JANTUNGMENGHITUNG DETAK JANTUNG
• Menggunakan Mistar EKG
• 300 dibagi jumlah kotak besar antara interval R-R
• 1500 dibagi jumlah kolom horizontal antara interval R-R
• Hitung banyaknya voltage R dalam 6 sec dan dikalikan 10
What is the heart rate?What is the heart rate?
(300 / 6) = 50 bpm
www.uptodate.com
What is the heart rate?What is the heart rate?
(300 / ~ 4) = ~ 75 bpm
www.uptodate.com
What is the heart rate?What is the heart rate?
(300 / 1.5) = 200 bpm
The Rule of 300The Rule of 300It may be easiest to memorize the following table:
# of big boxes
Rate
1 300
2 150
3 100
4 75
5 60
6 50
What is the heart rate?What is the heart rate?
22 x 10 = 220 bpm
The QRS AxisThe QRS AxisBy near-consensus, the normal QRS axis is defined as ranging from -30° to +90°.
-30° to -90° is referred to as a left axis deviation (LAD)
+90° to +180° is referred to as a right axis deviation (RAD)
The Quadrant ApproachThe Quadrant ApproachExamine the QRS complex in leads I and aVF to determine if they are predominantly positive or predominantly negative. The combination should place the axis into one of the 4 quadrants below.
Quadrant Approach: Example 1Quadrant Approach: Example 1
Negative in I, positive in aVF RAD
The Alan E. Lindsay ECG Learning Center http://medstat.med.utah.edu/kw/ecg/
Quadrant Approach: Example 2Quadrant Approach: Example 2
Positive in I, negative in aVF LAD
The Alan E. Lindsay ECG Learning Center http://medstat.med.utah.edu/kw/ecg/
– Tentukan jenis ritme– Hitung frekwensi-nya – Hitung axis– Hitung interval PR, QRS– Analisa gelombang P, QRS, ST dan T
Sistematika membaca EKGSistematika membaca EKG
Normal Sinus Rhythm
Rhythm : RegularRate : 60 – 100P wave : Normal in configuration; precede each QRSPR : Normal ( 0. 12 – 0.20 seconds )QRS : Normal ( less than 0.12 seconds )
PEMASANGAN ELEKTRODAPEMASANGAN ELEKTRODA• STANDART• RIGHT VENTRICLE• POSTERIOR• DEXTROCARDIA
SOAL 1SOAL 1
SOAL 2SOAL 2
SOAL 3SOAL 3
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