Wisnoe Pribadi SpJP

Conduction System

SA Node
Internodal branch
AV Node
Hiss Bundle
Purkinje Fiber
Contraction

The Electrocardiogram ( ECG )

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

v9

P Wave

P Pulmonale

P Mitrale

PR Interval

QRS Complex

ST Segment

T Wave

INTERPRETATION ECG
P wave
PR interval
Q wave
R wave
S wave
ST segment
T wave

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 )

SINUS BRADYCARDIA
SINUS TACHYCARDIA

SINUS ARRYTMIA

First-degree AV block

Rhythm : Regular
Rate : Usually normal
P wave : Sinus P wave present; one P wave to each QR
PR
: Prolonged ( greater than 0.20 seconds )
QRS
: Normal

Second -degree AV block, Mobitz I

Rhythm : Irregular
Rate : Usually slow but can be normal
P wave : Sinus P wave present;
some not followed by QRS complexes
PR
: Progressively lengthens
QRS
: Normal

Second-degree AV block, Mobitz II

Rhythm : Regular usually;
can be irreguler if conduction ratios vary
Rate : Usually slow
P wave : Two, three, or four P waves before each QRS
PR
: PR interval of beat with QRS is constant;
PR interval may be normal or prolonged
QRS
: Normal if block in His bundle;
wide if block involves bundle branches

Third-degree AV block

Rhythm : Regular
Rate : 40 60 if block in His bundle;
30 40 if block involves bundle branches
P wave : Sinus P wave present; bear no relationship to QRS
can be found hidden in QRS complexes and T wav
PR
: Varies greatly
QRS : Normal if block in His bundle;
wide if block involves bundle branches

Wolff-Parkinson-White syndrome

ST depresi dan perubahan gelombang T

ST depresi dianggap bermakna bila > 1 mm di bawah garis dasar PT di titik J
Titik J didefinisikan sebagai akhir kompleks QRS dan permulaan segmen ST
Bentuk segmen ST :
up-sloping ( tidak spesifik )
horizontal ( lebih spesifik untuk iskemia )
down-sloping ( paling terpercaya untuk iskemia )

Perubahan gelombang T pada

iskemia kurang begitu spesifik
Gelombang T hiperakut
kadang2 merupakan satu-satunya
perubahan EKG yang terlihat

HYPERACUTE T WAVE

ST DEPRESSION

HORIZONTAL

DOWN
SLOOPING

UP SLOOPING

Anatomi Koroner dan EKG 12 sandapan ( LEAD )

Sandapan V1 dan V2 menghadap septal area ventrikel kiri
Sandapan V3 dan V4 menghadap dinding anterior ventrikel kiri
Sandapan V5 dan V6 ( ditambah I dan avL ) menghadap
dinding lateral ventrikel kiri
Sandapan II, III dan avF menghadap dinding inferior ventrikel kiri

Unstable angina

Acute anteroseptal myocardial infarction.

Hyperacute T-wave changes are noted

Acute anterolateral myocardial infarction

High lateral infarction

Inferior myocardial infarction

Acute inferoposterior myocardial infarction

LVH

LVH

LVH

RVH

RVH

RVH