Download - ECG (elektro Cardio graf)
![Page 1: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/1.jpg)
ECG 12 leads
Dr. Bambang Budiono, SpJP, FIHACardiac Center, RS Dr. Wahidin Sudirohusodo
Bagian Kardiologi dan Kedokteran VaskularFK-UNHAS
![Page 2: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/2.jpg)
Dasar Dasar Elektrofisiologi
![Page 3: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/3.jpg)
The Prime TM ECG electrocardiac mapping system
(Source: Meridien Medical Technologies, Inc)
![Page 4: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/4.jpg)
Penempatan Leads
![Page 5: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/5.jpg)
Lead/sandapan = Kamera
• Lead/ sandapan berfungsi seperti kamera yang “meneropong” aktivitas listrik jantung dari berbagai sudut.
![Page 6: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/6.jpg)
Segitiga Einthovent
I
IIIII
aVR
aVF
aVL
Sandapan ekstrimitas Bipolar dan Unipolar
Vektor Listrik Jantung
![Page 7: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/7.jpg)
Chest Leads
![Page 8: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/8.jpg)
Defleksi Positif atau Negatif ECG tergantung dari :
- Posisi sandapan
- Arah aliran listrik/ vektor
Morfologi gelombang ECG dan posisi Sandapan
Aliran listrik
![Page 9: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/9.jpg)
![Page 10: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/10.jpg)
MEKANISME PEMBENTUKAN GELOMBANG EKG
Mekanisme terbentuknya gelombang P, Segmen P-R kompleks QRS, dan gelombang T
![Page 11: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/11.jpg)
Contoh : Rekaman ECG di sandapan II
![Page 12: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/12.jpg)
Contoh : Rekaman ECG di sandapan II
![Page 13: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/13.jpg)
Contoh : Rekaman ECG di sandapan II
![Page 14: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/14.jpg)
Eksitasi Ventrikel
![Page 15: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/15.jpg)
Contoh : Rekaman ECG di sandapan V6
V6
![Page 16: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/16.jpg)
Contoh : Rekaman ECG di sandapan V6
Arah Defleksi gelombang T = Kompleks QRS
V6
Sel yang mengalami Depolarisasi lebih awalAkan mengalami repolarisasi lebih awal
![Page 17: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/17.jpg)
Vektor listrik & Morfologi ECG
V5
![Page 18: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/18.jpg)
Sandapan ekstrimitas dan thoraks
![Page 19: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/19.jpg)
Bagaimana membaca ECG secara sistematis
• Standarisasi• Irama (Sinus atau lainnya)• Aksis QRS• Kecepatan• Morfologi gelombang P &
durasi• Interval PR• Morfologi QRS & durasi• Segmen ST-T • Morfologi gelombang T • Gelombang U • Interval QT
![Page 20: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/20.jpg)
• Lihat gelombang P di lead II, dan aVR.
Irama Sinus, jika : P diikuti kompleks QRS• Lead II : QRS defleksi positif.• Lead aVR : QRS defleksi negatif.
Fibrilasi Atrial (coarse/kasar, fine/halus)Atrial Flutter (Sawtooth appearance)
Menentukan Irama
![Page 21: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/21.jpg)
Mengenali IramaMengenali Irama
• Langkah 1: Adakah gelombang P ?
• Langkah 2: Adakah kompleks QRS ?
• Langkah 3: Apakah gelombang P dan kompleks QRS ‘berhubungan’ ?
![Page 22: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/22.jpg)
Contoh 1
• Langkah 1.
–Adakah gelombang P ?
![Page 23: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/23.jpg)
Contoh 1 (lanjutan)
•Adakah gelombang P ?– Ya, P teridentifikasi dengan mudah
dan teratur.
![Page 24: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/24.jpg)
Contoh 1 (Lanjutan)
• Langkah 2.
– Adakah kompleks QRS ?
![Page 25: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/25.jpg)
Contoh 1 (lanjutan)
• Langkah 2.
– Ya, kompleks QRA tampak normal, dan sempit.
![Page 26: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/26.jpg)
Contoh 1 (lanjutan)
• Langkah 3
– Apakah berhubungan , 1:1?
![Page 27: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/27.jpg)
Contoh 1 (lanjutan)
• Langkah 3– Apakah berhubungan, 1:1?
• Ya, terlihat setiap 1 gelombang P diikuti 1 kompleks QRS.
•Ini yang disebut irama sinus
![Page 28: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/28.jpg)
Contoh 2
• Ikuti langkah 1-3 seperti contoh 1.• Apakah iramanya ?
![Page 29: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/29.jpg)
Contoh 3
• Ikuti langkah yang sama. Apakah EKG ini irama sinus ?
![Page 30: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/30.jpg)
Contoh 3 (lanjutan)Contoh 3 (lanjutan)• Langkah 1
– Adakah gelombang P ?• Ya,
– Catatan : Tanda panah yang patah patah memperlihatkan lokasi gelombang P, termasuk yang terbenam dalam gelombang kompleks QRS.
![Page 31: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/31.jpg)
Contoh 3 (lanjutan)Contoh 3 (lanjutan)
• Langkah 2– Adakah kompleks QRS ?
•Ya, kompleks QRS tampak normal, dan sempit.
![Page 32: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/32.jpg)
Contoh 3 Lanjutan• STEP 3.
– Apakah gelombang P dan kompleks QRS berhubungan?• Tidak, keduanya teratur dalam bentuk dan frekuensinya, tetapi saling
tidak berhubungan.
– EKG ini sesuai blok AV derajat 3. – Bila atrium dan ventrikel tidak sinkron, jantung tidak dapat memompa
secara efektif.
![Page 33: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/33.jpg)
Normal Adolescent ECG
II
aVR
![Page 34: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/34.jpg)
Lead II
![Page 35: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/35.jpg)
![Page 36: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/36.jpg)
‘Coarse’ Atrial Fibrilation
Iregular R-R
![Page 37: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/37.jpg)
Atrial Flutter
![Page 38: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/38.jpg)
Bagaimana menentukan aksis QRS (I)
Frontal Plane
• Ukur R-S di lead I
• Ukur R-S di lead aVF
aVF
I
Normal : -30 - + 120LAD : < -30RAD : > 120 Superior Axis : >180
Left Axis
Right AxisNormal Axis
Superior Axis
0
90
180
![Page 39: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/39.jpg)
Horizontal Plane
Bagaimana menentukan aksis QRS (II)
Transition Zone
Progression of R wave
Counter Clockwise Clockwise
V1
V5V4V3
V2
V6
![Page 40: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/40.jpg)
Formula = 300 : medium block
![Page 41: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/41.jpg)
Morfologi gel.P & durasi
Normal : - Positif di lead I, II, aVF, V3-V6
- Tinggi < 2.5-3 kotak kecil
- Durasi < 12 ms
P mitral : Lebar (>12ms) & ‘notch’ di lead II
‘Terminal Negative deflection’ di lead V1
P pulmonal : Tinggi (>3mm) di lead II
durasi : normal
![Page 42: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/42.jpg)
![Page 43: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/43.jpg)
Dilatasi atrium kiri : P ‘mitral’
![Page 44: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/44.jpg)
Dilatasi atrium kanan = P ‘pulmonal’
![Page 45: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/45.jpg)
Hipertrofi Ventrikel kiri
• Voltage Criteria PointR or S in Limb leads ≥ 20mm 3S in V1 or V2 ≥ 30 mmR in V5 or V6 ≥ 30 mm• Negative ST-wave w/out Digitalis. 3• Negative terminal P in V1 ≥ 0.04 sec 3• LAD ; ≥ 30• QRS ≥ 0.09 sec 3• Intrinsicoid deflection > 0.05 sec in V5 or V6 3 Repolarization abnormality with Digitalis 3
Definite LVH = 5 pointsProbable LVH = 4 points
![Page 46: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/46.jpg)
Right Ventricular Hypertrophy•RAD ≥ 110•R wave or R’ in lead V1 of ≥5mm•R:S Ratio in V1 > 1 and V6 < 1 •QRS complex may be slightly Prolonged but < 0.12 sec.*ST Segment depression, upward convexity, and inverted T wave in lead V1 and V2.*Delayed intrinsicoid deflection in lead V1 (0.034-0.055 sec)*Prominent P wave in lead II
![Page 47: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/47.jpg)
Bundle Branch Block
RSR pattern at V6 RSR pattern at V1
LBBB RBBB
![Page 48: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/48.jpg)
Right Bundle Branch Block
![Page 49: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/49.jpg)
IRAMA-IRAMA JANTUNG YANG MEMBAHAYAKAN JIWA
Irama Cepat- Supra Ventrikular Takikardia- Ventrikular Takikardia/ Fibrilasi- Torsade de Pointes
Irama Lambat- AV blok Derajat 2- AB blok total
![Page 50: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/50.jpg)
Supra Ventrikular Takikardia
Kriteria Diagnostik :
No P Wave SeenRegular R-RRate : 160-180 x/mnt
![Page 51: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/51.jpg)
Delta Wave & Short PR Interval
![Page 52: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/52.jpg)
Wolf Parkinson White
![Page 53: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/53.jpg)
Ventrikular Takikardia
Sustained VT QRS rate : 150-250x/mnt
Non-Sustained VT
Karakteristik : Rate QRS > 120 x/ menit QRS kompleks lebar VES > 3 berturutan
![Page 54: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/54.jpg)
Ventrikel Takikardia - Fibrilasi
Karakteristik : Gelombang QRS lebar > 190 x/mnt Diikuti Gelombang kacau (chaotic rhythm)
![Page 55: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/55.jpg)
![Page 56: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/56.jpg)
Torsade de Pointes
Karakteristik : Takikardia dengan QRS lebar Rate : >270 x/ menit Variasi aksis QRS
![Page 57: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/57.jpg)
VES berbahaya, jika :• SERING (> 30% kompleks QRS) atau terjadi peningkatan frekuensi• Dekat atau jatuh pada gelombang T (R on T)• VES yang terjadi ≥ 3 kali berturutan (run of V-tach)• VES pada infark miokard akut• VES multifocal
• Hal hal tersebut diatas mudah mencetuskan aritmia maligna, seperti :• Takikardi ventrikel • Fibrilasi ventrikel
sinus beatsUnconverted V-tach r V-fib
V-tach
“R on T phenomenon”
time
Makin cepat dilakukan kejut listrik, Makin besar kemungkinan untuk selamat !!
EKSTRA SISTOL VENTRIKEL
![Page 58: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/58.jpg)
V E SV E S
![Page 59: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/59.jpg)
Ventrikular Bigemini
![Page 60: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/60.jpg)
SR SR SR SRSR SR
VES VES
Sinus rhythm with multifocal VESSinus rhythm with multifocal VESDalam 1 lead tampak morfologi VES yang berbeda
![Page 61: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/61.jpg)
Sinus rhythm with VES coupletSinus rhythm with VES couplet
![Page 62: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/62.jpg)
AV blok derajat 2
• Mobitz Type 1
• Mobitz Type 2
![Page 63: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/63.jpg)
MOBITZ TYPE I
- Hampir selalu terjadi pada tingkatan AV node (jarang pada tingkatan berkas His atau berkas cabang di bawahnya), & sering terjadi karena peningkatan tonus parasimpatik atau efek obat (Dig, Prop, Verap.)
- Jarang diperlukan terapi khusus kecuali terjadi tanda dan gejala yang berat. Penyakit yang mendasari harus dicari.
![Page 64: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/64.jpg)
MOBITZ TYPE II
- Terjadi di bawah tingkatan AV Node , baik pada berkas His (uncommon), atau berkas cabang (common)
- Umumnya berkaitan dengan lesi organik di jalur konduksi,
- Jarang disebabkan oleh peningkatan tonus parasimpatik maupun efek obat.
Sebelum terjadi ‘drop beat’ tidak terjadi pemanjangan interval PR
![Page 65: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/65.jpg)
Mobitz Type 2 (2:1 block)
![Page 66: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/66.jpg)
AV Blok Total
• Menunjukkan blokade konduksi antara atrium dan ventrikel.
• ‘Atrial rate’ ≥ ‘ventricular rate’.
• Dapat terjadi pada level AV node,
![Page 67: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/67.jpg)
CARA MENDETEKSI LOKASI BLOK ATRIO-VENTRIKULAR
![Page 68: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/68.jpg)
![Page 69: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/69.jpg)
Basic Electrophysiology
![Page 70: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/70.jpg)
Left Anterior Fascicular Block
![Page 71: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/71.jpg)
![Page 72: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/72.jpg)
![Page 73: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/73.jpg)
![Page 74: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/74.jpg)
Sinus arrest
![Page 75: ECG (elektro Cardio graf)](https://reader036.vdocuments.us/reader036/viewer/2022081504/55880ae1d8b42afa288b4617/html5/thumbnails/75.jpg)