8/22/2019 ECG Made Easy Martin

1/51

ECG made easyMartin Winardi

8/22/2019 ECG Made Easy Martin

2/51

8/22/2019 ECG Made Easy Martin

3/51

12 Standard Leads

3 sandapan bipolar: I, II dan III

3 sandapan unipolar ekstremitas:aVR, aVL dan aVF 6 sandapan unipolar prekordial: V1 - V6

8/22/2019 ECG Made Easy Martin

4/51

8/22/2019 ECG Made Easy Martin

5/51

8/22/2019 ECG Made Easy Martin

6/51

8/22/2019 ECG Made Easy Martin

7/51

I, aVL: High lateral wall

II, III, aVF: Inferior wall

8/22/2019 ECG Made Easy Martin

8/51

V1-V2: Septal wallV3-V4: Anterior wall

V5-V6: Lateral wall

8/22/2019 ECG Made Easy Martin

9/51

Lokasi dinding ventrikel pada EKG

8/22/2019 ECG Made Easy Martin

10/51

Membaca EKG

- - 1 s e c o n d - -

0,2 s

0,04 s

8/22/2019 ECG Made Easy Martin

11/51

ST segment

PR interval : awal P - awal Q (N = 0,12 - 0,20 s)

QRS duration : awal Q - akhir S (N < 0,12 s)

QT interval : awal Q - akhir T (QTc: 0,35 - 0,45 s)

8/22/2019 ECG Made Easy Martin

12/51

Membaca EKG

1. Irama (Rhytm)

2. Frekuensi (Rate)

3. Sumbu (Axis)

4. P wave5. PR interval

6. QRS complex

7. ST segment

8. T wave

9. QT interval

10. U wave

ST segment

8/22/2019 ECG Made Easy Martin

13/51

Rhytm

Cardinal features of sinus rhythm:

The P wave is upright in leads I and II

Each P wave is followed by a QRS complex

The heart rate is 60-99 beats/min

8/22/2019 ECG Made Easy Martin

14/51

Rate

Heart rate = 1500 / RR(mm) = 300 / jml kotak sedang (5mm)

Jarak 1 kotak sedang : 300 x/menit

Jarak 2 kotak sedang : 150 x/menit Jarak 3 kotak sedang : 100 x/menit

Jarak 4 kotak sedang : 75 x/menit

Jarak 5 kotak sedang : 60 x/menit

Jarak 6 kotak sedang : 50 x/menit

8/22/2019 ECG Made Easy Martin

15/51

Sinus rhytm (sinus takikardi)

13mm

HR = 1500/13 = 115 beat/mnt

8/22/2019 ECG Made Easy Martin

16/51

Rhytm?

Sinus aritmia

The SA node discharges irregularly

Rate = 5 x 10 = 50 bpm

1 second

1 2 3 4 5

2 s 3 s 4 s 5 s 6 s

8/22/2019 ECG Made Easy Martin

17/51

Axis

Bidang frontal

Bidang horizontal

8/22/2019 ECG Made Easy Martin

18/51

8/22/2019 ECG Made Easy Martin

19/51N

LAD

RAD

8/22/2019 ECG Made Easy Martin

20/51

Perhitungan Axis (Bidang Frontal)

aVF

N

LAD

aVFI

RAD

8/22/2019 ECG Made Easy Martin

21/51

Axis? Normo axis

8/22/2019 ECG Made Easy Martin

22/51

Axis? RAD

8/22/2019 ECG Made Easy Martin

23/51

Axis

LAD:

Left ventricular

hypertrophy

LBBB Infark miokard inferior

RAD:

Right ventricular

hypertrophy

Emboli paru PPOK

Infark miokard lateral

8/22/2019 ECG Made Easy Martin

24/51

Axis bidang horizontal

8/22/2019 ECG Made Easy Martin

25/51

Axis bidang horizontal

(dilihat dari kaki)

8/22/2019 ECG Made Easy Martin

26/51

P wave

P wave = depolarisasi atrium

P wave normal:

Lead II: +

aVR: -

V1: bifasik

Durasi < 3 kotak kecil (

8/22/2019 ECG Made Easy Martin

27/51

P wave abnormalities

Right atrial enlargement:

- Pulmonary hypertension

- PPOK, Cor pulmonale

Left atrial enlargement:

- Mitral valve disease

8/22/2019 ECG Made Easy Martin

28/51

PR interval

Normal: 0,12 - 0,20 s (3 - 5 kotak kecil)

< 0,12s : Wolff Parkinson White (WPW) syndrome

> 0,12s: AV blok

8/22/2019 ECG Made Easy Martin

29/51

QRS interval

Normal < 0,12 s (< 3 kotak kecil)

Abnormal:

Bundle branch block

RBBB: V1 = RSR

LBBB: V6 = M

New LBBB = STEMI

8/22/2019 ECG Made Easy Martin

30/51

BBB?

8/22/2019 ECG Made Easy Martin

31/51

BBB?

8/22/2019 ECG Made Easy Martin

32/51

LVH

Left ventricle hypertrophy: Etiologi: Hipertensi, aorta stenosis & aorta

insufisiensi, kardiomiopati

Sokolow-Lyon:S V1 + R V5 atau V6 > 35 mm (7 kotak sedang)

8/22/2019 ECG Made Easy Martin

33/51

LVH

8/22/2019 ECG Made Easy Martin

34/51

RVH

Right ventricle hypertrophy: Etiologi: Cor pulmonal (PPOK), TR, ASD, VSD

Kriteria:

R > S di V1R di V1 > 7 mm

S di V5 atau V6 > 7

RAD

8/22/2019 ECG Made Easy Martin

35/51

RVH

8/22/2019 ECG Made Easy Martin

36/51

ST segment

Dinilai dari J point Normal: isoelektrik

Abnormal: ST elevasi / ST depresi

8/22/2019 ECG Made Easy Martin

37/51

ST elevasi

Etiologi: Infark miokard ST elevasi spesifik

Perikarditis

Aneurisma ventrikel Emboli paru

Perdarahan intrakranial

ST elevasi spesifik ST elevasi non spesifik

8/22/2019 ECG Made Easy Martin

38/51

ST elevasi

non spesifik

8/22/2019 ECG Made Easy Martin

39/51

ST Depresi

Etiologi: Myocardial ischemia

Left ventricular hypertrophy

Intraventricular conduction defects

Medication (e.g., digitalis)

Reciprocal changes in leads opposite the area of acute

injury

8/22/2019 ECG Made Easy Martin

40/51

ST Depresi

8/22/2019 ECG Made Easy Martin

41/51

ST depresi

non sepsifik

T inverted

LV strain pada LVH

8/22/2019 ECG Made Easy Martin

42/51

T wave

T wave = repolarisasi ventrikel

Defleksi normal = sesuai defleksi QRS

Positif di lead II

Amplitudo normal > 1 mm dan:

< 5 mm di lead eksremitas (I, II, III, aVR, aVL, aVF)

< 10 mm di lead prekordial (V1-6

)

Abnormal: iskemia, infark, strain pattern

(LVH,RVH), BBB, Hiperkalemia

8/22/2019 ECG Made Easy Martin

43/51

T wave inversion

Infark miokard: T inversi (bagian dari evolusi)

8/22/2019 ECG Made Easy Martin

44/51

Hiperkalemia

QRS melebar

P menurun/hilang

Tall T

8/22/2019 ECG Made Easy Martin

45/51

Hipokalemia

Prominent U wave

8/22/2019 ECG Made Easy Martin

46/51

QT interval

QT int = lamanya depolarisasi

repol. Ventrikel

Dipengaruhi oleh heart rate QT corrected (QTc)

Bazett formula: QTc = QT interval(s) / (R-R(s))

N = 0,35 - 0,45 s Prolonged QT:

Antiaritmia: amiodaron, procainamide

Obat psikiatri: haloperidol, phenothiazine, amitriptilin

Antimikroba: macrolide, quinolone, voriconazole, chloroquine

Congenital: Long QT syndrome

Elektrolit: Hypocalsemia, hipokalemia, hipomagnesemia

8/22/2019 ECG Made Easy Martin

47/51

QT interval

8/22/2019 ECG Made Easy Martin

48/51

QT interval

8/22/2019 ECG Made Easy Martin

49/51

Congenital Long QT syndrome

8/22/2019 ECG Made Easy Martin

50/51

Latihan

8/22/2019 ECG Made Easy Martin

51/51