ekg bodoh
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kardioTRANSCRIPT
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CARA BODOH BACA EKG PADA PEDIATRI
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Indikasi pemeriksaan EKG
1. Sinkop/kejang2. Exertional symptoms3. Drug ingestion4. Takikardia/bradikardia5. Episode sianotik6. Gagal jantung7. Hipotermia
8. Gangguan elektrolit9. Penyakit Kawasaki10. Demam rematik11. Miokarditis12. Kontusi miokrad13. Pericarditis14. Post op jantung15. Defek bawaan
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ANATOMI JANTUNG
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ANATOMI JANTUNG
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Sadapan EKG
V1-6 : AnteriorV1-4 : AnteroseptalV3-5 : AnteroapikalV4-6 : AnteroapikalI,AVL,V5-6 : LateralII,III,AVF : InferiorV1,AVR : RV dan rongga ventrikel kiri
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GAMBARAN EKG
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GAMBARAN EKG
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Kertas EKG• Small box = 1 x 1 mm• Large box = 5 x 5 mm• Paper speed (horizontal boxes)
– Standard = 25 mm/sec
• Voltage calibration (vertical boxes)– Standard = 10 mm/mV (2 big boxes)– Half standard = 5 mm/mV (1 big box)– May have 10/5: standard for chest leads, half-
standard for precordial leads– NOTE THE CALIBRATION!!
Pediatric ECGs
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MEMBACA EKG
1. Irama2. Jenis Irama3. Rate/Frekuensi4. Zona Transisi (daerah equifasik)5. Menentukan arah aksis6. Mengenali pembesaran ruang jantung7. Mengenali morfologi gelombang
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1. MENGENALI IRAMA
1. SINUSa) Irama berasal dari NSAb) Gelombang 1 P selalu diikuti 1 QRS
2. NON-SINUSa) Atrialb) Junctionalc) Ventrikulerd) Pace maker
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IRAMA SINUS
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IRAMA ATRIAL
• Pemicu utama: impuls atrium
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IRAMA JUNCTIONAL
• Pemicu utamanya adalah NAV• Ciri: P hilang/inversi/mundur
(retrograde)
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IRAMA VENTRIKULER
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IRAMA PACE MAKER
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2. MENGENALI RITME
1. REGULARITAS2. INTERVAL PR3. INTERVAL QRS4. INTERVAL QT (memanjang/pendek)5. DROP BEATS6. GRUP QRS KOMPLEKS (bigemini/trigemini/quadrigemini/
triplet,couplet)7. PAUSED (terkompensasi/tidak)
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3. MENGHITUNG RATE/FREKUENSI
Measured in beats per minute1. 1500 / number of “little boxes” between consecutive QRS complexes2. 300 / number of “big boxes” between consecutive QRS complexes3. Beat in 6 seconds x 10 or Beat in 3 seconds x 20 or number QRS in “big
boxes” x 50
Pediatric ECGs
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Pediatric ECGs
Heart rate• Rate approximation
– Rate estimate: 300 - 150 - 75 - 60 - 50– Easy to memorize– No calculator needed
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Pediatric ECGs
Normal resting heart rates
• Newborn: 110 - 150 bpm• 2 years: 85 - 125 bpm• 4 years: 75 - 115 bpm• > 6 years: 60 - 100 bpm• Adult: 50 - 100 bpm
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4. MENENTUKAN ZONA TRANSISI
• Normalnya gelombang QRS mengalami progresi dari lead V1-V6
• Gelombang R sama nilainya dengan gelombang S (biasanya di zona V3/V4)
• Zona transisi menunjukkan septum interventrikulare• Pergeseran zona transisi ke kanan, menunjukkan rotasi jantung
searah jarum jam• Poor R wave progression
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5. MENENTUKAN AKSIS
1. Sadapan I dan AVF
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5. MENENTUKAN AKSIS
2. Menentukan sadapan yang equifasik. Aksis QRS tegak lurus dengan sadapan QRS yang equifasik
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5. MENENTUKAN AKSIS
3. Dengan metoda AVL dan AVF
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5. MENENTUKAN AKSIS
4. Dengan diagram
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5. MENENTUKAN AKSIS
4. Dengan diagram
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5. MENENTUKAN AKSIS
4. Dengan diagram
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5. MENENTUKAN AKSIS
4. Dengan diagram
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5. MENENTUKAN AKSIS
4. Dengan diagram
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Pediatric ECGs
Causes of left axis deviation• Normal variant• AV septal defect (including primum ASD)• Perimembranous inlet VSD• Tricuspid atresia• Single ventricle• Double outlet right ventricle• Noonan syndrome• Left anterior hemiblock after MI
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PEMBESARAN RUANG JANTUNG
1. Hipertrofi Atrium Kanan2. Hipertrofi Atrium Kiri3. Hipertrofi ventrikel Kanan4. Hipertrofi ventrikel Kiri
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PEMBESARAN RUANG JANTUNG
Hipertrofi Atrium Kanan Gelombang P berbentuk runcing dengan tinggi lebih dari 2.5 mm di
sadapan V1, II, III, V3R, dan V2 Gelombang ini berasal dari pembesaran atrium anterior kanan (P
pulmonale)
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PEMBESARAN RUANG JANTUNG
Hipertrofi Atrium Kiri Gelombang P inversi disadapan precordial dengan luas area lebih dari 1 mm Gelomabng P bifasik pada V1 Jika terdapat lekukan lebar pada pincak atau apabila puncak datar lebih panjang
dari 0.08 detik di sadapan V6 atau II, dapat juga pada I dan V3. Perubahan gelombang P ini disebut P mitral
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Pediatric ECGs
Atrial enlargement
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PEMBESARAN RUANG JANTUNG
Hipertrofi Ventrikel Kanan Aksis QRS ke kanan Kompleks QRS melebar dengan peningkatan voltase QRS
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