Dr Andika Sitepu Departemen Kardiologi dan Vaskuler FKUI National Cardiac Center Harapan Kita Jakarta

TOPIK
1. - BASIC ECG - SKILL STATION: PEMASANGAN EKG - QUIZ 2. - ARITMIA - SKILL STATION: DC SHOCK - QUIZ 3. - SINDROMA KORONER AKUT: EKG DAN TERAPI DINI - QUIZ

Outline
1. 2. 3. 4. 5. Review of the conduction system EKG waveforms and intervals EKG leads Determining heart rate Determining QRS axis

What is an ECG?
The electrocardiogram (ECG) is a representation of the electrical events of the cardiac cycle

What types of pathology can we identify and study from EKGs?

Arrhythmias Myocardial ischemia and infarction Pericarditis Chamber hypertrophy Electrolyte disturbances (i.e. hyperkalemia, hypokalemia) Drug toxicity (i.e. digoxin and drugs which prolong the QT interval)

Conduction System

SA Node Internodal branch AV Node Hiss Bundle Purkinje Fiber Contraction

EKG waveforms and intervals

P wave : atrial depolarisation
QRS complex : ventricular depolarisation T wave : ventricular repolarisation Atrial repolarisation hidden by QRS
R

PR Interval

QRS Complex

ST Segment

T Wave

EKG LEADS
STANDARD LIMB LEADS
I, II, III

AUGMENTED LIMB LEADS

aVR, aVL, aVF

PRECORDIAL LEADS
V1, V2, V3, V4, V5, V6

Standard Limb Leads

Standard Limb Leads

Augmented Limb Leads

All Limb Leads

Precordial Leads

Adapted from: www.numed.co.uk/electrodepl.html

PEMASANGAN ELEKTRODE
PEMASANGAN ELEKTRODE EXTREMITAS
Lengan kanan dan lengan kiri Kaki kanan dan kaki kiri

PEMASANGAN ELEKTRODE DADA

V1 V2 V4 V3 V5 V6 = = = = = = Parasternal kanan di ICS-4 Parasternal kiri di ICS-4 MCL kiri di ICS-5 Median antara V2 dgn V4 Para Axillair Line kiri di ICS-5 Median Axillair kiri di ICS-5

 Kecepatan kertas standard EKG

25 mm / s (10 25 50 mm / s)

STANDARISASI EKG

Setiap kolom horizontal = 0.04 sec Setiap kolom vertikal = 0,1 mV

MENGHITUNG DETAK JANTUNG

Menggunakan Mistar EKG 300 dibagi jumlah kotak besar antara interval R-R 1500 dibagi jumlah kolom horizontal antara interval R-R Hitung banyaknya voltage R dalam 6 sec dan dikalikan 10

What is the heart rate?

www.uptodate.com

(300 / 6) = 50 bpm

What is the heart rate?

www.uptodate.com

(300 / ~ 4) = ~ 75 bpm

What is the heart rate?

(300 / 1.5) = 200 bpm

The Rule of 300

It may be easiest to memorize the following table:
# of big boxes Rate

1
2 3

300
150 100

4
5 6

75
60 50

What is the heart rate?

22 x 10 = 220 bpm

The QRS Axis

By near-consensus, the normal QRS axis is defined as ranging from -30 to +90.

-30 to -90 is referred to as a left axis deviation (LAD) +90 to +180 is referred to as a right axis deviation (RAD)

The Quadrant Approach

Examine the QRS complex in leads I and aVF to determine if they are predominantly positive or predominantly negative. The combination should place the axis into one of the 4 quadrants below.

Quadrant Approach: Example 1

The Alan E. Lindsay ECG Learning Center http://medstat.med.utah. edu/kw/ecg/

Negative in I, positive in aVF RAD

Quadrant Approach: Example 2

The Alan E. Lindsay ECG Learning Center http://medstat.med.utah. edu/kw/ecg/

Positive in I, negative in aVF

LAD

Sistematika membaca EKG

Tentukan jenis ritme Hitung frekwensi-nya Hitung axis Hitung interval PR, QRS Analisa gelombang P, QRS, ST dan T

Normal Sinus Rhythm

Rhythm : Regular Rate : 60 100 P wave : Normal in configuration; precede each QRS PR : Normal ( 0. 12 0.20 seconds ) QRS : Normal ( less than 0.12 seconds )

PEMASANGAN ELEKTRODA
STANDART RIGHT VENTRICLE POSTERIOR DEXTROCARDIA

SOAL 1

SOAL 2

SOAL 3