copy of ecg normal n arrythmiaaaaaaaaaaaaaaaaa.ppt
TRANSCRIPT
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Electrocardiography
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OVERVIEWOVERVIEW
Cardiac Physiology
Electrocardiography
Diagnosing Heart Conditions
Electrocardiography
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Cardiac Physiology Electrocardiography Diagnosis
ARTERIESdistributes blood from
heart
VEINSbrings blood back to heart
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Cardiac Physiology Electrocardiography Diagnosis
Atria
Ventricles
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Cardiac Physiology Electrocardiography Diagnosis
Sinoatrial Node
Atrioventricular Node
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Electrocardiography (EKG)
• Prinsip Dasar EKG
• EKG Leads
• Interpretasi Basic EKG
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Apex
Base
EKG
+
-
Directions of Ventricular Depolarization and Repolarization Waves
Depolarization
Repolarization
Depolarization Wave
Repolarization Wave
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Base
Apex(+)
(-)
Major Electrical Axis of the Heart
Major Electrical Axis
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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
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Leads
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Precordial leads
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Right Arm
Left LegRight Leg(Ground)
Left Arm
Lead I +-
+
-
Major Electrical Axis
Lead II +
-
Lead III
+
-
VII = VI + VIII
Bipolar Leads
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Left ArmRight Arm
Left Leg
aVR
+
-
Unipolar Lead (aVR)
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Unipolar Lead (aVL)
Left ArmRight Arm
Left Leg
aVL
+
-
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Left ArmRight Arm
Left LegaVF+
-
Unipolar Lead (aVF)
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Left ArmRight Arm
Left Leg
-
+ V1
V2+V3+V4+V5+V6+
Precordial Leads (V1 to V6)
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aVF
Lead I
Lead IIILead II
aVRaVL
Directionality of Bipolar and Unipolar Leads
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Heart
Body Cross-section at Heart Level
V1V2
V3
V4
V5
V6
Directionality of Precordial Leads
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Basic EKG Interpretation
• EKG Waves (P, QRS, and T waves)
• EKG Intervals (P-R, Q-T intervals)
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Cardiac Physiology Electrocardiography Diagnosis
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Timing of ECG
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P wave(AtrialDepolarization)
QRS Complex (Ventricular Depolarization)
T wave(Ventricular
Repolarization) P wave
One Cardiac Cycle
EKG Waves
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P wave
QRS Complex
T wave P wave
P-RInterval
Q-TInterval
P-R Interval = A-V Conduction TimeQ-T Interval = Ventricular Contraction TimeR-R Interval = Cardiac Cycle TimeHeart Rate = 1/R-R Interval
EKG Intervals
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Cardiac Physiology Electrocardiography Diagnosis
P
Q
R
S
T
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Cardiac Physiology Electrocardiography Diagnosis
P
Q
R
S
T
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Cardiac Physiology Electrocardiography Diagnosis
P
Q
R
S
T
0.5 Sec
1 sec
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Graphic ECG
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ECG Graphic
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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
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Menghitung Heart Rate
300/6 =50 bpm
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Menghitung Heart Rate
300/? =……..bpm
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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’
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Cardiac Physiology Electrocardiography Diagnosis
P
Q
R
S
T
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Cardiac Physiology Electrocardiography Diagnosis
P
Q
R
S
T
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Cardiac Physiology Electrocardiography Diagnosis
P
Q
R
S
T
0.5 Sec
1 sec
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ECG Normal
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Rhythm (Irama)
• Sinus
• Arrythmia
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Frequency
• Normal
• Tachycardia
• Bradycardia
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SK
Arrythmia
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Arrhytmia
Tachyarrhythmia (rate >100 x/min)
Bradyarrhytmia(rate < 60 X/min)
• QRS sempit (<0.12 ms)• QRS lebar (>0.12 ms)
• AV blok derajat 1, 2 & 3• RBBB & LBBB
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Approach to electrocardiographic diagnosis
• Duration of QRS
• Regularity of QRS
P wave ??
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QRS complex Regular / irregular ?
QRS complexNormal-looking QRS complex?
Wide / narrow ?
P wave ?
Relationship between P and QRS ?
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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”
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Atrial Flutter
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PSVT :
-due to re-entry mechanism-narrow QRS complex-regular-retrograde atrial depolarization-P wave ?
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PSVT (Paroxysmal SupraVentricular Tachyradia)
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SVT
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SVT
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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
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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
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Rapid AF
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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
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Cardiac Physiology Electrocardiography Diagnosis
Preventricular Contractions
• Coffee
• Cigarettes
• Sleep deprivation
• Pathology
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Cardiac Physiology Electrocardiography Diagnosis
ECG with Preventricular Contractions
Normal ECG
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VES
SR
VENTRIKEL EXTRA SYSTOLE
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SR SR SR SRSR SR
VES VES
Sinus rhythm with Multifocal VES
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Ventricular Tachycardia
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V T
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Ventricular Fibrillation
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Cardiac Physiology Electrocardiography Diagnosis
ECG during Ventricular Fibrillation
Normal ECG
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Cardiac Physiology Electrocardiography Diagnosis
Ventricular Fibrilation
• Ischemia
• Electric Shock
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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)
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Sick Sinus Syndrome
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LBBB
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The Deadly
Rhythms
VT VF
PEA(Pulse less ElectricalActivity)
A systole
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Cardiac Physiology Electrocardiography Diagnosis
ECG with Atrioventricular Block
Normal ECG
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SUMMARYSUMMARY
Cardiac Physiology
Electrocardiography
Diagnosing Heart Conditions
• Atria• Ventricles• Nodes• Electrical
Propagation
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SUMMARYSUMMARY
Cardiac Physiology
Electrocardiography
Diagnosing Heart Conditions
• ECG Measurement
• P-Wave• QRS-Complex• T-Wave
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SUMMARYSUMMARY
Cardiac Physiology
Electrocardiography
Diagnosing Heart Conditions
• AV Block• PVCs• V-Fib
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SummaryCardiac 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
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Dr.MARNA SURYA ISMY, Sp.PD