Download - INTERPRETASI ELEKTROKARDIOGRAFI
INTERPRETASI ELEKTROKARDIOGRAFI
dr. Erlina Marfianti, MSc, SpPD Departemen Ilmu Penyakit Dalam
Fakultas Kedokteran UII
Definisi EKG adalah grafik hasil catatan potensial
listrik yang dihasilkan oleh denyut jantung
EKG merupakan alat pembantu diagnostik. Penderita dengan kelainan jantung organik bisa menunjukkan gambaran EKG normal
EKG bisa menunjukkan kelainan non spesifik pada orang sehat
Kegunaan EKG
Beberapa kelainan jantung yang dapat diketahui dari EKG Hipertrofi Infark miokard Aritmia Gangguan elektrolit Efek obat-obatan: misal digitalis dll
Physiologic Properties of Myocardial Cells
• Automaticity : Ability to initiate an impulse• Excitability : Ability to respond to an impulse• Conducticity : Ability to transmit an impulse• Contractility : Ability to respond with pumping action
LEAD
Components of a NSR
Rekaman EKG baku telah ditetapkan bahwa:
a. Kecepatan rekaman : 25 mm/detik
b. Kekuatan voltage : 1 mv = 10 mm
Bearti ukuran di kertas EKG:
a. Pada garis horosontal
- Tiap 1mm = 1 kotak kecil = 1/25 detik = 0,04 detik
- Tiap 5mm = 1 kotak sedang = 5/25 detik = 0,20 detik
- Tiap 25 mm = 1,00 detik
Components of a NSR: P wave
1. Describe the sequence of right and left atrial2. Normal positif in lead I, II, aVF, and V4 – V63. Normal negative in lead aVR4. Duration < 0,12 sec5. Amplitudo < 2,5 mm
Components of a NSR : PR interval
1. Time needed to transmit impuls from SA node to AV node2. Normal 0,12 – 0,22 sec ( 3-5,5 small box)3. Short PR interval preeksitasion syndrome 4. Prolonged PR interval think about A-V block.
Components of a NSR :QRS complex
1. Describe activation of left and right ventrikel2. Duration 0,05 – 0,10 sec (<2,5 small box). 3. Measure usually in limbs lead4. If the amplitudo less than 10 mm in all leads low voltage. 5. Abnormal complex QRS seen in conduction defect
Components of a NSR :QRS complex
Nomenclature of complex QRS
• first negative deflection named Q wave• first positive deflection named R wave• negative deflection after R wave called S wave• R wave always above the baseline• Q`and S wave always below the baseline
Components of a NSR :QRS complex
Q wave
1. Normal Q wave seen in lead I, aVL, and V5-6. describe activation of septum left to right2. Q wave in V1-2 is abnormal3. Pathologic Q : duration > 0,04 sec and/ or height > dari 1/3 complex QRS
Components of a NSR:ST segment
Normal ST segment
1. Usually isoelectric, elevation < 1 mm in extremity still normal2. Depression < 0,5 mm3. Point at the end of QRS complex named J point
Components of a NSR:T wave
T wave criteria
1. Describe repolarization of ventricel 2. Normal positif in leads I,II and V3-V63. Normal negative in lead III
Components of a NSR:QT duration
QT duration
1. Describe total sistolic time2. variation according to heart rate, gender and age3. QT interval must be < ½ R-R interval in HR 65-90/mnt4. Normal QT correction 0,44 + 0,02 sec5. Prolonged QTc predispose R on T VT
How to report
Rhythm : - Heart rate :
- Axis :
- Transisional Zone :
- Interval
- PR :
- QRS :
- QT :
- Sign : Hipertrophi, iskemia, infark
CONCLUSION :
Rate
Rhytm(Irama)
Irama Sinus Normal
Irama jantung yang normal ialah irama yang ditentukan oleh simpul SA dan disebut irama sinus:
- Frekuensi antara 60-100 x/menit- Teratur- Gelombang P negatif di aVR dan
positif di II- Tiap gelombang P diikuti oleh
kelompok QRS TPenyimpangan - ARITMIA
AXISSetiap vektor jantung mempunyai:
-Polaritas
-Arah
-Ukuran/Intensitas
Axis Deviation
-300
1800
-900
900
Normal
Left Axis
Right Axis
ExtremeRight Axis
Penentuan Sumbu QRS di Bidang Frontal
1. Secara praktis tentukan di sandapan I dan AVF
2. Tentukan di sandapan manakah terdapat keadaan ekuipotensial (nol)
Amplitudo di Ekuipotensial di
Sumbu
I AVF
Positif positif III +30
aVL +60
I +90
aVF 0
Positif Negatif II - 30
aVR - 60
I -90
Negatif Positif aVR +120
II +150
aVF +180
Negatif Negatif aVL -120
III - 150
AKSIS Posisi Jantung-30 s/d -15-15 s/d +15+ 15 s/d +45+ 45 s/d +75+ 75 s/d +110+110 s/d + 180-30 s/d -90-90 s/d ± 180
HorizontalSemi horizontalIntermediateSemi VertikalVertikalDeviasi Sumbu ke kananDeviasi sumbu ke kiriDeviasi ke kanan hebat
PATHOLOGY
CORRELATION BETWEEN LOCATION OF ISCHAEMIC, ECG AND CORONARY ARTERY ANATOMY
LOCATION OF INFARCT/ ECG CORONARY ARTERY INVOLVED
ISCHAEMIC
ANTERIOR EKSTENSIVE I, aVL, V1-V6 LAD, LCX
ANTEROSEPTAL V1- V3 LAD
ANTEROLATERAL I, aVL, V4- V6 LCX
INFERIOR II, III, aVF RCA, PDA
POSTERIOR V7- V9 PL (POSTEROLATERAL)
RV V3R – V5R RCA/ RV BRANCH
LAD Left Anterio Descenden.LCX circumflex.RCA Righ Cor.Art.
MYOCARDIAL INFARCTION Myocardial infarction is characterized by the
necrosis of a portion of the myocard resulting from a lack of sufficient blood suply to keep the muscle viable.
The most common cause is complete occlusion of coronary artery by atherosclerotic coronary trombosis.
Terminology of infarct Acute infarct : several hours untill days
ECG : ST elevation Recent infarct : several days- weeks.
ECG : evolution Old infarct : more than 6 months.
ECG : Q wave or QS complex or slow progression of R wave
CRITERIA LVH Chest lead (Sokolow, Lyon) :
S wave in V1 + R wave in V5 or V6 > 35 mm R in V5 or V6 > 26 mm.R plus S in any chest leads > 45 mm
Limb leads (Gubner, Ungerleider) :R in I + S in III > 25 mmR in aVF > 20 mmR in aVL > 11 mmR in aVR > 15 mm
LV Strain (Strain Pattern) = perubahan segmen ST dan gelombang T= depresi semen ST dan inversi T
Hipertrofi ventrikel kanan
Deviasi aksis ke kanan (>+110) R V1> S V1 Gelombang R yang tinggi di
sandapan aVR Rotasi searah jarum jam