ekg normal btcls.ppt
TRANSCRIPT
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PROSES REKAM &
BACA EKG
Prof. DR.dr. Zainal Musthafa, SpJP(K), FIHA, FS, MSi
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EKG NORMAL
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ELEKTRO KARDIOGRAFIPENGERTIAN Elektrokardiografi adalah ilmu yg mempelajari aktivitas listrik jantung. Elektrokardigram ( EKG ) adalah suatu grafik yg menggambarkan rekaman listrik
jantung.
FUNGSI EKG EKG mempunyai fungsi diagnostik diantaranya : Aritmia jantung Hipertrofi atrium dan ventrikel Iskemik dan infark miokard Efek obat-obatan seperti ( digitalis, anti aritmia dll ) Gangguan keseimbangan elektrolit khususnya kalium Penilaian fungsi pacu jantung
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KERTAS EKGKertas EKG (merupakan kertas grafik) yang
bergaris horizontal dan vertikal dengan jarak 1mm ( kotak kecil ). Garis yang lebih tebal terdapat pada setiap 5mm disebut ( kotak besar ).
• Garis horizontal Menunjukan waktu, Dimana 1mm = 0,04 dtk, sedangkan 5mm = 0,20 dtk.
• Garis vertikal menggambarkan voltage, dimana 1 mm = 0,1 mv.
• Sedangkan 5 mm = 0,5 mv
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Lokasi infark miokard
Elektroda/Sandapan Lokasi Infark Miokard
V1-V4 Anteroseptal
V1,V2 Septal
V3-V4 Anterior
I,aVL High Lateral
V5-V6, I, aVL Lateral
V3-V6, I, aVL Anterolateral
V1-V6, I, aVL Extensive anterior
II, III, aVF Inferior
V3R, V4R Right ventricular
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ANATOMI JANTUNG
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PEMBULUH DARAH KORONER
RCA
LM
LCX
LAD
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SISTEM KONDUKSI
S A
A V
SA NODE 60-100 x/mntSA NODE 60-100 x/mnt
AV NODE 40-60 x/mntAV NODE 40-60 x/mnt
SRABUT PURKINJE 20-40 SRABUT PURKINJE 20-40 x/mntx/mnt
SP
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GAMBAR EKG
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Atrial Depolarization
GELOMBANG PGELOMBANG P
a. Lebar kurang dari 0,12 a. Lebar kurang dari 0,12 detikdetik
b.Tinggi kurang dari 0,3 mvb.Tinggi kurang dari 0,3 mvc. Selalu Positif di lead IIc. Selalu Positif di lead IId. Selalu negative di lead d. Selalu negative di lead
AVRAVR
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PR Interval
P – R Interval :Diukur dari permulaan
gelombang P sampai permulaan gelombang
QRS Normal : 0,12 – 0,20 detik
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Ventricle Depolarization
Gelombang QRS :
Normal : lebar tidak melebihi 0,12 “Tinggi tergantung leadGelombang QRS terdiri dari gel Q, Gel R dan gelombang S
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Segmen STDiukur dari akhir QRS s/d awal gel T
Normal : Isoelektris
Kepentingan : Elevasi pd injuri/infark akut
Depresi pd iskemia
NON STEMI STEMI
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SANDAPAN ECG
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SANDAPAN EKG
• Terdapat 2 jenis sandapan ( lead )
pada EKG.
1. Sandapan Bipolar
Yaitu merekam perbedaan
potensial dari dua elektroda
Sandapan ini ditandai dengan
angka romawi ( Lead I, II, III )
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SANDAPAN EKG
Sandapan Unipolar
Sandapan Unipolar EktremitasMerekam besar potensial listrik pada satu ektremitas, elektroda ekplorasi diletakan pada ektremitas yg akan diukur. Gabungan elektroda-elektroda pada ektremitas yg lain membentuk elektroda indiferen ( potensial 0 )
( aVR, aVL, aVF )
Sandapan Unipolar PrekordialMerekam besar potensial listrik jantung dengan bantuan elektroda eksplorasi yg ditempatkan di beberapa dingding dada. Elektroda indiferen diperoleh dengan menggabungkan ketiga elektroda ektremitas.
( V1 s/d V9 dan V3R, V4R )
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LEAD I
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LEAD II
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LEAD III
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A V R
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A V L
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A V F
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SANDAPAN EKG
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Urutan membaca EKG
• Identitas (usia, jenis), tgl/jam, kecepatan (25/50), tensi • Tentukan apakah Iramanya (sinus, av juntion, ventrikel, pace maker) dan teratur (reguler) atau tidak teratur (irreguler)• Tentukan frekuensi heart rate (HR) nya rumus (1500 : RR atau PP)• Tentukan gelombang P normal atau tidak, bagaimana hubungannya dengan QRS komplek• Tentukan Interval PRnya normal atau tidak• Tentukan gelombang QRSnya, normal atau tidak• Tentukan ST (isoelektrik, depresi, elevasi)• Tentukan gelombang T (normal, inverted)
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CARA MENGHITUNG HR
Menentukan frekuensi jantung
A. 300 = ( jml kotak besar dlm 60 detik ) Jml kotak besar antara R – R
B. 1500 = (jml kotak kecil dlm 60 detik ) Jml kotak kecil antara R – R
C. Ambil EKG strip sepanjang 6 detik, hitung jumlah QRS dan kalikan 10.
CAT : RUMUS A/B UNTUK EKG YANG TERATUR. RUMUS C UNTUK YANG TIDAK TERATUR.
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R R
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4
GAMBARAN PJK / INFARK
Ada 3 tingkatan kerusakan myocard
1) Ischemia = Sifatnya reversible
2)Injury = Sifatnya reversible
3)Necrosis = Infark = Irreversible
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1. ISCHEMIC ST depresi : Up sloping Down sloping // isoelektris T inverted
2. INJURY ST elevasi
3. NECROSIS Q patologi atau QS
DD. Kardiomiopathy, LVH, WPW
Phase : awal / hiperakut akut (hari 1-7) recent (hari 7- 1 bln) lama / Old
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Gambaran ISCHEMIA pd EKG
T inversi, biasanya simetreis
ST depresi yang spesifik Horizontal
Sagging (downsloping)/menurun
ST depresi kurang spesifik (upsloping=naik)
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ST elevasi tidak spesifik (cekung ke atas)
ST elevasi, yg spesifik (konvex ke atas/ cembung ke atas)
Gambaran INJURY pd EKG
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Gambaran NECROSIS pd EKG
Disebut necrosis pattern apabila :Gambaran Q wave yg lebar dan dalam
Q wave dianggap patologis apabila dalamnya > 1/3 dari tinggi R Dalamnya Q menunjukkan tebalnya jaringan necrosis
Tingginya R menunjukkan sisa jaringan myocard yg sehat Adanya QS menunjukkan necrosis seluruh myocard
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How to identify arrhythmias ?
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CAUSE OF CARDIAC ARRHYTHMIAS :
• Disturbances in automaticity : bertambah cepat atau bertambah lambatnya
suatu daerah otomatisitas. Misal di sinus node, AV node, abnormal beats/ depolarisasi
atrium, AV junction, ventrikel, VT, dll.
• Disturbances in conduction : konduksi terlalu cepat (WPW) atau
terlalu lambat (blok AV).
• Combinations of altered automaticity and conduction.
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QRS complex Regular / irregular ?
QRS complexNormal-looking QRS complex?
Wide / narrow ?
P wave ?
Relationship between P and QRS ?
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NORMAL SINUS RHYTHM
R RR
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PSVT :
-due to re-entry mechanism-narrow QRS complex
-regular-retrograde atrial depolarization
-P wave ?
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PSVT
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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
R R R
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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”
P P
R R
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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
R R
PP
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VES
SR
VENTRIKEL EXTRA SYSTOLE(VES)
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SR SR SR SRSR SR
VES VES
Sinus rhythm with
Multifocal VES
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Sinus rhythm with VES couplet
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Sinus Rhythm with VES, R on T
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Ventricular Tachycardia
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Ventricular Fibrillation
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Prolonged PR interval
1st degree AV block
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Missing QRS Missing QRS
2nd degree AV block, type 1
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2nd degree AV block, type 2
Missing QRS
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P P P P P P P
QRS QRS QRS
Total AV Block / 3rd degree AV
block
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Treat the patient, not the
monitor . . . . .!!!
SELESAI
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EKG & ARITMIA