Electrocardiography

OVERVIEW
Cardiac Physiology
Electrocardiography Diagnosing Heart Conditions

Cardiac Physiology

Electrocardiography Diagnosis

ARTERIES
distributes blood from heart

VEINS
brings blood back to heart

Cardiac Physiology

Electrocardiography Diagnosis

Atria

Ventricles

Cardiac Physiology

Electrocardiography Diagnosis

Sinoatrial Node Atrioventricular Node

Electrocardiography (EKG)
Prinsip Dasar EKG EKG Leads Interpretasi Basic EKG

Directions of Ventricular Depolarization and Repolarization Waves

Depolarization Wave Repolarization Wave

Base
EKG + Depolarization Repolarization

Apex

Major Electrical Axis of the Heart

(-)

Base
Major Electrical Axis

Apex
(+)

EKG Leads
The 12 EKG leads measure the electrical activity of the heart from 12 different directions Bipolar Leads: Lead I, Lead II, Lead III Unipolar Leads: aVR, aVL, aVF Precordial Leads: V1, V2, V3, V4, V5, V6

Leads

Precordial leads

Bipolar Leads -

Lead I

VII = VI + VIII

Right Arm -

Left Arm Major Electrical Axis +

Lead III +

Lead II +

Right Leg (Ground)

Left Leg

Unipolar Lead (aVR)

aVR
+ Right Arm Left Arm -

Left Leg

Unipolar Lead (aVL)

+

aVL -

Right Arm

Left Arm

Left Leg

Unipolar Lead (aVF)

Right Arm Left Arm

aVF

Left Leg

Precordial Leads (V1 to V6)

Right Arm
+ + + + + + V1 V2 V3 V4 V5 Left Arm

V6 Left Leg

Directionality of Bipolar and Unipolar Leads

aVR aVL

Lead I

Lead III aVF

Lead II

Directionality of Precordial Leads

Body Cross-section at Heart Level Heart

V6
V4 V5

V1

V2

V3

Basic EKG Interpretation

EKG Waves (P, QRS, and T waves) EKG Intervals (P-R, Q-T intervals)

Cardiac Physiology

Electrocardiography Diagnosis

Timing of ECG

EKG Waves
QRS Complex (Ventricular Depolarization)

P wave (Atrial Depolarization)

T wave (Ventricular Repolarization)

P wave

One Cardiac Cycle

EKG Intervals

P-R Interval = A-V Conduction Time Q-T Interval = Ventricular Contraction Time R-R Interval = Cardiac Cycle Time Heart Rate = 1/R-R Interval

QRS Complex

P wave

T wave

P wave

P-R Interval

Q-T Interval

Cardiac Physiology

Electrocardiography Diagnosis

R
P Q S T

Cardiac Physiology

Electrocardiography Diagnosis

R
P Q S T

Cardiac Physiology

Electrocardiography Diagnosis

R
P Q S T

1 sec

0.5 Sec

Graphic ECG

ECG Graphic

Menghitung Heart Rate

Kecepatan standard =25 mm/sec 1 menit : 25x60 =1500/menit Kotak besar = 5mm 1500/5 =300 Kotak kecil = 1mm 1500/1 =1500

Menghitung Heart Rate

300/6 =50 bpm

Menghitung Heart Rate

300/? =..bpm

Mean Electricle Axis

Cari lead yang paling nol Axisnya adalah yg tegak lurus terhadap nol Garis tegak ini ada + dan Lihat kembali lead nol
Bila benar-benar nol = axis Bila lebih positif axis 15 derjat dekat nol Bila lebih negatif axis 15 derhat jauh dari nol

Cardiac Physiology

Electrocardiography Diagnosis

R
P Q S T

Cardiac Physiology

Electrocardiography Diagnosis

R
P Q S T

Cardiac Physiology

Electrocardiography Diagnosis

R
P Q S T

1 sec

0.5 Sec

ECG Normal

Rhythm (Irama)

Sinus Arrythmia

Frequency
Normal Tachycardia Bradycardia

Arrythmia

SK

Arrhytmia
Tachyarrhythmia (rate >100 x/min)
QRS sempit (<0.12 ms) QRS lebar (>0.12 ms)

Bradyarrhytmia (rate < 60 X/min)

AV blok derajat 1, 2 & 3 RBBB & LBBB

Approach to electrocardiographic diagnosis

Duration of QRS
Regularity of QRS

P wave ??

QRS complex Regular / irregular ?

QRS complex Normal-looking QRS complex? Wide / narrow ?

P wave ?

Relationship between P and QRS ?

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

Atrial Flutter

PSVT :
-due to re-entry mechanism -narrow QRS complex -regular -retrograde atrial depolarization -P wave ?

PSVT (Paroxysmal SupraVentricular Tachyradia)

SVT

SVT

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

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

Rapid AF

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

Cardiac Physiology

Electrocardiography Diagnosis

Preventricular Contractions
Coffee Cigarettes Sleep deprivation

Pathology

Cardiac Physiology

Electrocardiography Diagnosis

Normal ECG

ECG with Preventricular Contractions

VENTRIKEL EXTRA SYSTOLE

SR

VES

Sinus rhythm with Multifocal VES

VES

VES

SR

SR

SR

SR

SR

SR

Ventricular Tachycardia

VT

Ventricular Fibrillation

Cardiac Physiology

Electrocardiography Diagnosis

Normal ECG

ECG during Ventricular Fibrillation

Cardiac Physiology

Electrocardiography Diagnosis

Ventricular Fibrilation
Ischemia Electric Shock

Bradyarrhytmia (rate < 60 x/min)

Failure of impulse formation Sinus Bradycardia Sick Sinus Syndrome

AV conduction abnormalities 1st and 2nd AV Block Total AV Block BBB (Bundle Branch Block)

Sick Sinus Syndrome

LBBB

The Deadly Rhythms

VT

VF

PEA (Pulse less Electrical Activity)

A systole

Cardiac Physiology

Electrocardiography Diagnosis

Normal ECG

ECG with Atrioventricular Block

SUMMARY
Atria Ventricles Nodes Electrical Propagation

Cardiac Physiology Electrocardiography

Diagnosing Heart Conditions

SUMMARY
ECG Measurement P-Wave QRS-Complex T-Wave

Cardiac Physiology Electrocardiography

Diagnosing Heart Conditions

SUMMARY
AV Block PVCs V-Fib

Cardiac Physiology Electrocardiography

Diagnosing Heart Conditions

Summary Cardiac Arrthythmias

Tachycardia: abnormally fast heart rate Bradycardia: Abnormally slow heart rate Incomplete Atrioventricular Block: Prolonged P-R interval Complete Atrioventricular Block: P waves and QRS complexes become dissociated Fibrillation: Complete lack of coordination

Dr.MARNA SURYA ISMY, Sp.PD