Download - ECG Praktis-Sesi 1
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Dr Andika SitepuDepartemen Kardiologi dan Vaskuler FKUI
National Cardiac Center Harapan KitaJakarta
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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
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OutlineOutline1. Review of the conduction system2. EKG waveforms and intervals3. EKG leads4. Determining heart rate5. Determining QRS axis
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What is an ECG?What is an ECG?
The electrocardiogram (ECG) is a representation of the electrical events of the cardiac cycle
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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)
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Conduction System
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SA Node Internodal branch AV Node Hiss Bundle Purkinje Fiber Contraction
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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
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PR Interval
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QRS Complex
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ST Segment
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T Wave
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EKG LEADSEKG LEADS
• STANDARD LIMB LEADS • I, II, III
• AUGMENTED LIMB LEADS • aVR, aVL, aVF
• PRECORDIAL LEADS• V1, V2, V3, V4, V5, V6
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Standard Limb LeadsStandard Limb Leads
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Standard Limb LeadsStandard Limb Leads
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Augmented Limb LeadsAugmented Limb Leads
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All Limb LeadsAll Limb Leads
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Precordial LeadsPrecordial Leads
Adapted from: www.numed.co.uk/electrodepl.html
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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
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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
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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
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What is the heart rate?What is the heart rate?
(300 / 6) = 50 bpm
www.uptodate.com
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What is the heart rate?What is the heart rate?
(300 / ~ 4) = ~ 75 bpm
www.uptodate.com
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What is the heart rate?What is the heart rate?
(300 / 1.5) = 200 bpm
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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
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What is the heart rate?What is the heart rate?
22 x 10 = 220 bpm
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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)
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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.
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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/
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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/
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– Tentukan jenis ritme– Hitung frekwensi-nya – Hitung axis– Hitung interval PR, QRS– Analisa gelombang P, QRS, ST dan T
Sistematika membaca EKGSistematika membaca EKG
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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 )
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PEMASANGAN ELEKTRODAPEMASANGAN ELEKTRODA• STANDART• RIGHT VENTRICLE• POSTERIOR• DEXTROCARDIA
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SOAL 1SOAL 1
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SOAL 2SOAL 2
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SOAL 3SOAL 3