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Electrocardiography
OVERVIEWOVERVIEW
Cardiac Physiology
Electrocardiography
Diagnosing Heart Conditions
Electrocardiography
Cardiac Physiology Electrocardiography Diagnosis
ARTERIESdistributes blood from
heart
VEINSbrings blood back to heart
Cardiac Physiology Electrocardiography Diagnosis
Atria
Ventricles
Cardiac Physiology Electrocardiography Diagnosis
Sinoatrial Node
Atrioventricular Node
Electrocardiography (EKG)
• Prinsip Dasar EKG
• EKG Leads
• Interpretasi Basic EKG
Apex
Base
EKG
+
-
Directions of Ventricular Depolarization and Repolarization Waves
Depolarization
Repolarization
Depolarization Wave
Repolarization Wave
Base
Apex(+)
(-)
Major Electrical Axis of the Heart
Major Electrical Axis
EKG Leads
• The 12 EKG leads measure the electrical activity of the heart from 12 different directions
• Bipolar Leads: Lead I, Lead II, Lead III
• Unipolar Leads: aVR, aVL, aVF
• Precordial Leads: V1, V2, V3, V4, V5, V6
Leads
Precordial leads
Right Arm
Left LegRight Leg(Ground)
Left Arm
Lead I +-
+
-
Major Electrical Axis
Lead II +
-
Lead III
+
-
VII = VI + VIII
Bipolar Leads
Left ArmRight Arm
Left Leg
aVR
+
-
Unipolar Lead (aVR)
Unipolar Lead (aVL)
Left ArmRight Arm
Left Leg
aVL
+
-
Left ArmRight Arm
Left LegaVF+
-
Unipolar Lead (aVF)
Left ArmRight Arm
Left Leg
-
+ V1
V2+V3+V4+V5+V6+
Precordial Leads (V1 to V6)
aVF
Lead I
Lead IIILead II
aVRaVL
Directionality of Bipolar and Unipolar Leads
Heart
Body Cross-section at Heart Level
V1V2
V3
V4
V5
V6
Directionality of Precordial Leads
Basic EKG Interpretation
• EKG Waves (P, QRS, and T waves)
• EKG Intervals (P-R, Q-T intervals)
Cardiac Physiology Electrocardiography Diagnosis
Timing of ECG
P wave(AtrialDepolarization)
QRS Complex (Ventricular Depolarization)
T wave(Ventricular
Repolarization) P wave
One Cardiac Cycle
EKG Waves
P wave
QRS Complex
T wave P wave
P-RInterval
Q-TInterval
P-R Interval = A-V Conduction TimeQ-T Interval = Ventricular Contraction TimeR-R Interval = Cardiac Cycle TimeHeart Rate = 1/R-R Interval
EKG Intervals
Cardiac Physiology Electrocardiography Diagnosis
P
Q
R
S
T
Cardiac Physiology Electrocardiography Diagnosis
P
Q
R
S
T
Cardiac Physiology Electrocardiography Diagnosis
P
Q
R
S
T
0.5 Sec
1 sec
Graphic ECG
ECG Graphic
Menghitung Heart Rate
• Kecepatan standard =25 mm/sec
• 1 menit : 25x60 =1500/menit
• Kotak besar = 5mm
• 1500/5 =300
• Kotak kecil = 1mm
• 1500/1 =1500
Menghitung Heart Rate
300/6 =50 bpm
Menghitung Heart Rate
300/? =……..bpm
Mean Electricle Axis
• Cari lead yang paling ‘nol’• Axisnya adalah yg tegak lurus terhadap ‘nol’• Garis tegak ini ada + dan -• Lihat kembali lead ‘nol’
– Bila benar-benar nol = axis– Bila lebih positif axis 15 derjat dekat ‘nol’– Bila lebih negatif axis 15 derhat jauh dari ‘nol’
Cardiac Physiology Electrocardiography Diagnosis
P
Q
R
S
T
Cardiac Physiology Electrocardiography Diagnosis
P
Q
R
S
T
Cardiac Physiology Electrocardiography Diagnosis
P
Q
R
S
T
0.5 Sec
1 sec
ECG Normal
Rhythm (Irama)
• Sinus
• Arrythmia
Frequency
• Normal
• Tachycardia
• Bradycardia
SK
Arrythmia
Arrhytmia
Tachyarrhythmia (rate >100 x/min)
Bradyarrhytmia(rate < 60 X/min)
• QRS sempit (<0.12 ms)• QRS lebar (>0.12 ms)
• AV blok derajat 1, 2 & 3• RBBB & LBBB
Approach to electrocardiographic diagnosis
• Duration of QRS
• Regularity of QRS
P wave ??
QRS complex Regular / irregular ?
QRS complexNormal-looking QRS complex?
Wide / narrow ?
P wave ?
Relationship between P and QRS ?
Atrial Flutter :
-The result of a re-entry circuit within the atria-Irregular / regular QRS rate-Narrow QRS complex-Rapid P waves (300x/min), “sawtooth”
Atrial Flutter
PSVT :
-due to re-entry mechanism-narrow QRS complex-regular-retrograde atrial depolarization-P wave ?
PSVT (Paroxysmal SupraVentricular Tachyradia)
SVT
SVT
Atrial Fibrillation :
-from multiple area of re-entry within atria-or from multiple ectopic foci-irregular, narrow QRS complex-very rapid atrial electrical activity (400-700 x/min).-no uniform atrial depolarization
Atrial Fibrillation :
-from multiple area of re-entry within atria-or from multiple ectopic foci-irregular, narrow QRS complex-very rapid atrial electrical activity (400-700 x/min).-no uniform atrial depolarization
Rapid AF
Junctional rhythm:
-AV junction can function as a pace maker (40-60 x/min).-due to the failure of sinus node to initiate time impulse or conduction problem.-normal-looking QRS.-retrograde P wave.-P wave may preceede, coincide with, or follow the QRS
Cardiac Physiology Electrocardiography Diagnosis
Preventricular Contractions
• Coffee
• Cigarettes
• Sleep deprivation
• Pathology
Cardiac Physiology Electrocardiography Diagnosis
ECG with Preventricular Contractions
Normal ECG
VES
SR
VENTRIKEL EXTRA SYSTOLE
SR SR SR SRSR SR
VES VES
Sinus rhythm with Multifocal VES
Ventricular Tachycardia
V T
Ventricular Fibrillation
Cardiac Physiology Electrocardiography Diagnosis
ECG during Ventricular Fibrillation
Normal ECG
Cardiac Physiology Electrocardiography Diagnosis
Ventricular Fibrilation
• Ischemia
• Electric Shock
Bradyarrhytmia(rate < 60 x/min)
Failure of impulse formation
• Sinus Bradycardia• Sick Sinus Syndrome
AV conduction abnormalities
• 1st and 2nd AV Block• Total AV Block• BBB (Bundle Branch
Block)
Sick Sinus Syndrome
LBBB
The Deadly
Rhythms
VT VF
PEA(Pulse less ElectricalActivity)
A systole
Cardiac Physiology Electrocardiography Diagnosis
ECG with Atrioventricular Block
Normal ECG
SUMMARYSUMMARY
Cardiac Physiology
Electrocardiography
Diagnosing Heart Conditions
• Atria• Ventricles• Nodes• Electrical
Propagation
SUMMARYSUMMARY
Cardiac Physiology
Electrocardiography
Diagnosing Heart Conditions
• ECG Measurement
• P-Wave• QRS-Complex• T-Wave
SUMMARYSUMMARY
Cardiac Physiology
Electrocardiography
Diagnosing Heart Conditions
• AV Block• PVCs• V-Fib
SummaryCardiac Arrthythmias
• Tachycardia: abnormally fast heart rate
• Bradycardia: Abnormally slow heart rate
• Incomplete Atrioventricular Block: Prolonged P-R interval
• Complete Atrioventricular Block: P waves and QRS complexes become dissociated
• Fibrillation: Complete lack of coordination
Dr.MARNA SURYA ISMY, Sp.PD