ecg kursus fkusu dr a.majid 05 juni 2007

7/17/2019 ECG Kursus FKUSU Dr a.majid 05 Juni 2007

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(ECG=(ECG=EKGEKG))

Penilaian

Electrocardiogram

Abdul Majid Bagian Fisiologi FK USU Medan

5 Juni2007



• Anelectrocardiogram

is a test thatmeasures the

electrical activityof the heart. Thisincludes the rateand regularity of

beats as well asthe size and position of thechambers, anydamage to the

heart, and effectsof drugs or

devices to regulatethe heart.



Cardiac Anatomy

Atrial muscle

Sinoatrial (SA)A node Left atrium

Descending aortaInferior

vena cava

Ventricluar

Pulmonary

veins

Superior

vena cava

Tricuspid valve

Mitral valve

Atrioventricular (AV) node

Purkine

fi!ers

muscle

Internodalconducting

tissue



Action Potentials in the Heart

AV

Purkinje

Ventricle

Aortic artery

Left atrium

Descending aortaInferior vena cava

Ventricluar

Atrial muscle

Pulmonary

veins

Superior vena cava

Pulmonary artery

Tricuspid valve

Mitral valve

Interventricular

septum

AV node

SA node

ECG

!P"

0#$2%0#2 s a&&ro'# 0#(( s

)A

Atria

Purkine

fi!ers

muscle

Speciali"edconductingtissue



Cardiac Physiology Electrocardiography Diagnosis

PP

##

$$

SS

TT




P

#

$

S

T



!his dia*ram illustrates ECG +a,es and inter,als as +ell

as standard time and ,olta*e measures on the ECG &a&er#

• 1. ECG Waves and Intervals:

• -hat do they mean.• +a,e/ the sequential acti,ation

de&olari1ation o3 the ri*ht and le3t atria

") com&le'/ ri*ht and le3t ,entricularde&olari1ation normally the ,entricles areacti,ated simultaneously

S!"! #ave/ ,entricular re&olari1ation

U #ave/ ori*in 3or this +a,e is not clear % 4ut &ro4a4ly re&resents a3terde&olari1ations inthe ,entricles

$ interval/ time inter,al 3rom onset o3 atrialde&olari1ation P +a,e to onset o3 ,entricularde&olari1ation ") com&le'

%$S duration/ duration o3 ,entricular musclede&olari1ation

%! interval/ duration o3 ,entricular

de&olari1ation and re&olari1ation

$$ interval/ duration o3 ,entricular cardiaccycle an indicator o3 ,entricular rate

interval/ duration o3 atrial cycle anindicator o3 atrial rate

•



Heart rate state atrial and

,entricular6 i3 di33erent

P" inter,al 3rom 4e*innin* o3

P to 4e*innin* o3 ")

") duration +idth o3 most

re&resentati,e ")

! inter,al 3rom 4e*innin* o3") to end o3 !

") a'is in 3rontal &lane

%& Measurements (usually made in frontal plane leads)'



Kwantitatif

•Gel.P: panjang ± 0.06 s tinggi : 0.20 mV

•QRS: lebar : 0.06 –

0.10 s•PR inter!al: 0.12 –0.20 s.

•Q – " inter!al: 0.#2 –0.$0 s.




P

#

$

S

T

0.5 Sec

1 sec



Ho+ to calculate Heart "ate



Behold: Einthovens Triangle! Each of the " frontal plane

leads has a negative and positive orientation #as

indicated by the $ and % signs&. 't is important torecognize that (ead ' #and to a

lesser e)tent (eads a*+ anda*(& are right left in

orientation. Also, (ead a*-#and to a lesser e)tent (eads ''

and '''& are superior inferiorin orientation. The diagrambelow further illustrates the

frontal plane hooup.



E'am&les o3 ") A'is

A&is in t'e le(t a&is deviation )*A+,

range/

ead aV" is the smallest and

isoelectric lead#

!he t+o &er&endiculars are %80 o and

9$20 o#

eads :: and ::: are mostly ne*ati,e

i#e#6 mo,in* a+ay 3rom the 9 le3t le*

!he a'is6 there3ore6 is %80 o#

A&is in t'e nor-al range

ead aV; is the isoelectric lead#

!he t+o &er&endiculars to aV; are

0 o and $<0 o#

ead : is &ositi,e i#e#6 oriented to

the le3t#

!here3ore6 the a'is has to 4e 0 o#

A&is in t'e rig't a&is deviation

)$A+, range:

ead aV" is closest to 4ein*

isoelectric sli*htly more &ositi,e

than ne*ati,e

!he t+o &er&endiculars are %80 oand 9$20 o#

ead : is mostly ne*ati,e= lead :::

is mostly &ositi,e#

!here3ore the a'is is close to 9$20

o# >ecause aV" is sli*htly more

&ositi,e6 the a'is is sli*htly 4eyond

9$20 o i#e#6 closer to the &ositi,e

ri*ht arm 3or aV"



?CA!:?@ ?; CHE)! EEC!"?E) :@ (!H A@ 5!H :@!E"C?)!A

)PACE)/•

V$/ ri*ht (th intercostals&ace

• V2/ le3t (th intercostals&ace

• VB/ hal3+ay 4et+een V2

and V(• V(/ le3t 5th intercostal

s&ace6 mid%cla,icularline

• V5/ hori1ontal to V(6anterior a'illary line

• V8/ hori1ontal to V56mid%a'illary line



P%"&'('G)*%( *&%+G,S:

). P-%V,

QRS *'P(,/: R%")'+ 3'R. : (4445 R444 Q wa!e R wa!e

S wa!e S" S,G,+": ,(,V%")'+

,PR,SS)'+ R%")'+

" -%V,

::# "H!DE

:::# >?C / )A >?C

AV >?C

:V# EC!?P:C >EA!)



Soolo#"*/on Indi0es

electrocardio*ra&hic dia*nosis o3VH

There are two criteria with these widely usedindices:

• Su- o( S #ave in 1 and $ #ave in 2 or3 4 or 56.2 - )62 --, and7or

• $ #ave in a* 4 or 51.1 - )11 --,

AMMS$ AMMS$



E'am&le $/ im4%lead Volta*e Criteria= e#*#6 " in aV F$$ mm= note +ide

")! an*le



ample *' (STS +riteria' , points for voltage in V-. , points for ST/T c0anges

1ote also t0e left ais deviation of /23 degrees. and left atrial enlargement)



)! se*ment de&ression is o3ten characteri1ed

as hori1ontal6 u&slo&in*6 or

do+nslo&in*

@ote/ &slo&in* )! de&ression is not an

ischemic a4normality

Differential Diagnosis of ST Segment Depression

1ormal variants or artifacts' Pseudo/ST/depression

(4andering !aseline due to poor skin/electrode contact)

P0ysiologic 5/unctional depression 4it0 sinus

tac0ycardia (most likely due to atrial repolari"ation)

6yperventilation/induced ST segment depression

Isc0emic 0eart disease Su!endocardial isc0emia

(eercise induced or during angina attack / as

illustrated !elo4)



Nyeri dada (-

Nyeri dada (!

E"# pada $PTS



hyper ac%te T (0-1 hrs& ST ele'ation (ho%rs&

)a'e (*-+* hrs& T in'erted (1-, days

ECG changes in Acute Coronary Syndrome

ST depression )ith )itho%t T in'erted& )a'e (-

ST depression& deep T in'erted

)a'e

C/(STE/

Non C/

(NSTE/

$P



/ // /// a2 a3 a4

/$ gel ( Non / STE/Ele'asi ST

in'ersi T

gel (!



%Kalibrasi: apaa7 1 mV e89i!alent 10 mm

%Keepatan reaman: 2; mm<se ata9;0 mm<se.

% Getaran artefa: = filter ti>a >ipasang

= gr?9n>ing ti>a >i79b9ngan >enganeart7

= gangg9an >ari l?gam pa>a t9b97pasien

= jell@ 9rang ban@a.

% P?sisi eletr?>agel?mbang " pa>a sa>apan aVR

menja>i p?sitif @ang semestin@a negatif.

!eknik &em4uatan/

&erlu di&erhatikan/

:dentitas &asien

!an**al dan +aktu

&erekaman




EC# )ith Pre'entric%lar Contractions

Normal EC#



unifocal

1. re-ature

entri0ular

Co-8le&es)Cs,

-ulti(o0al

Multi(or-ed Cs are

0o--on in digitalis

into&i0ation.



7 PV+s may

occur as isolated

single events or

as couplets,

triplets. and

salvos (4-6

PVCs in a

ro!, also

called briefventricular

tachycardias&



7 PV+s

("-on-# p0enomenon).

dangerous in

an acute

isc0emic

situation.

ventricular

tac0ycardia

or fi!rillation&

late end%diastolic

PVCs are illustrated +ith

,aryin* de*rees o3

3usion# ;or 3usion to

occur the sinus P +a,e

must ha,e made it to the

,entricles to start the

acti,ation seIuence6 4ut

4e3ore ,entricular

acti,ation is com&leted

the late PVC occurs#

!he resultant ") looks

a 4it like the normal

")6 and a 4it like thePVC= i#e#6 a 3usion ")#




EC# )ith $trio'entric%lar 6loc7

Normal EC#




EC# d%ring entric%lar 4i8rillation

Normal EC#

ecg kursus fkusu dr a.majid 05 juni 2007

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