INTERPRETASI

EKG

SEJARAH (evolusi)

Willem
Einthoven

Mac 400

PENDAHULUAN

Kegunaan EKG :
1.
2.
3.
4.
5.
6.
7.
8.

Hipertropi atria dan ventrikel

Infark miokard
Aritmia .
Perikarditis
Efek obat obatan (digitalis, kina)
Gangguan elektrolit (K)
Beberapa penyakit sistemik (hipertiroid)
dsb
3

ANATOMI JANTUNG

SIRKULASI ARTERI
KORONARIA

A : Anterior View

B : Posterior View

Sandapan EKG (ECG Leads)

Bipolar Leads : Lead I, Lead II, Lead III

Unipolar Leads : aVR, aVL, aVF
Precordial Leads: V1, V2, V3, V4, V5, V6

Lea
d

Positiv
e
electro
de

Negativ
e
electro
de

View
of
Heart

LA

RA

Latera
l

II

LL

RA

Inferio
r

III

LL

LA

Inferio
r

Lead

Positive
electrode

View of
Heart

aVR

RA

None

aVL

LA

Lateral

aVF

LL

Inferior

Lead

Positive
electrode
Placement

View of
Heart

V1

4th Intercostal
space to right of
sternum

Septum

V2

4th Intercostal
space to left of
sternum

Septum

V3

Directly between
V2 and V4

Anterior

V4

5th Intercostal
space at left
midclavicular
line

Anterior

V5

Level with V4 at
left anterior
axillary line

Lateral

V6

Level with V5 at
left midaxillary
line

Lateral

10

Lead

Positive electrode
Placement

V1R

4th Intercostal space

to left of sternum

V2R

4th Intercostal space

to right of sternum

V3R

Directly between V2R

and V4R

V4R

5th Intercostal space

at right midclavicular
line

V5R

Level with V4R at

right anterior axillary
line

V6R

Level with V5R at

right midaxillary line

11

12

Electrocardiograp Diagnosi
s
hy

Cardiac
Physiology

SA
node

AV
node

Electrocardiograp Diagnosi
s
hy

Cardiac
Physiology

SA
node

AV
node

ECG Waves
QRS Complex
(Ventricular Depolarization)

P wave
(Atrial
Depolarization)

T wave
(Ventricular
Repolarization)

One Cardiac Cycle

P wave

Beberapa hal yang harus

diketahui
1.
2.
3.
4.

Ritme : Sinus / Aritmia

Ventrikular Rate / Atrial Rate
Aksis (Electrical Position)
Gelombang P : Interval dan
Amplitudo
5. PR interval
6. QRS compleks
7. Gelombang Q
8. Gelombang R
9. Gelombang S
10.Gelombang T
11.S-T segmen
12.Kesimpulan

16

17

TERMINOLOGI
qRs

QR

Rs

rS

Q/QS

RsR

rSr

RS

rSR

P
E
N
G
H
I
T
U
N
G
A
N
E
K
G
19

Menghitung Heart Rate

20

21

Frekuensi jantung normal : 60

100 x/I
> 100 x/i
(sinus) takikardi
< 60 x/i
(sinus) bradikardi
140 250 x/i takikardi
abnormal
250 350 x/i flutter
> 350 x/i
fibrillasi
22

26

CONTO
H
1

27

CONTO
H
3

28

29

Menentukan Axis (Electrical Position)

30

31

32

33

aVL

aVF

V3

V7

III

II

V1

V4

V8

V2

V6

V5

V9

V3R

V4R

35

36

Gelombang
P
Menggambarkan
aktivitas depolarisasi atria

Arah gelombang P normal selalu positif di II &

selalu negatif di aVR
Nilai Normal :
Tinggi < 3mm
Lebar < 3mm

37

Gelombang
Q
Menggambarkan awal fase depolarisasi ventrikel
Ciri ciri Q patologis :
1. Lebarnya sama atau lebih dari 1mm (0,04 detik)
2. Dalamnya lebih dari 25 % amplitudo gelombang R
Kepentingan : menentukan adanya nekrosis miokard
(infark miokard)

Gelombang
T repolarisasi ventrikel
Menggambarkan

Arah normal : sesuai arah gelombang QRS

Amplitudo normal
Kurang dari 10 mm di sandapan dada
Kurang dari 5mm di sandapan ekstremitas
Minimum 1 mm
Kepentingan :
1. menandakan infark atau iskemik
2. Menandakan kelainan elektrolit , dll

38

Extremely tall,
pointed T waves
seen in
hyperkalemia

39

T Inverted

Interval P-R
Batas normal : 0,12 0,20 detik
Kepentingan :
1. Interval P-R < 0,12 detik : terdapat pada hantaran
dipercepat (WPW syndrome)
2. Interval P-R > 0,20 detik : terdapat pada blok AV
3. Interval P-R berubah ubah : terdapat pada
wandering pacemaker

QRS interval = 0.06 0.10 sec

QT interval = 0.32 0.43 sec
41

Gelombang
R

42

V1

V6

RBB
B
LBB
B

43

44

45

S-T Segment

Need reference point

Compare to TP segment
DO NOT use PR segment as
reference!

ST

TP

Waveform
Components: Practice

Find J-points and ST

segments

Waveform
Components: Practice

Find J-points and ST

segments

Primary Causes of ST
Segment Elevation
Early repolarization
(normal variant in young
adults)
Pericarditis
Ventricular aneurysm
Pulmonary embolism
Intracranial

Primary Causes of ST
Segment Depression
Myocardial ischemia
Left ventricular hypertrophy
Intraventricular conduction
defects
Medication (e.g., digitalis)
Reciprocal changes in leads
opposite the area of acute49
injury

50

PROGRESIFITAS MYAKARD INFARK

AKUT

51

Tiga tanda infark

miokard akut :
Elevasi segment
ST
T Inversi
Q formasi

52

CONTO
H

56

CONTO
H

57

CONTO
H

58

CONTO
H

59

60

ST Depresi

Wassalamualaiku
m ww

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