ekg patologis
TRANSCRIPT
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EKG PATOLOGISARTERIO 2012
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GAMBARAN EKG
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KERTAS EKG
Kertas EKG merupakan kertas grafik yang merupakan garis horizontal dan vertikal dengan jarak 1mm (kotak kecil). Garis yang lebih tebal terdapat pada setiap 5mm disebut (kotak sedang). Garis horizontal Menunjukan waktu, dimana 1mm = 0,04 dtk, sedangkan 5mm = 0,20 dtk. Garis vertical Menggambarkan voltage, dimana 1mm = 0,1 mv sedangkan setiap 5 mm = 0,5 mv.
0,04 dt
0, 20 dt
0,1 mv 0,5 mv
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Ada 10 elektroda/kabel yang dipasang pada tubuh
RA : tangan kananLA : tangan kiriRL : kaki kananLL : kaki kiri
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V1 : ICS 4 linea sternalis dextra
V2 : ICS 4 linea sternalis sinistra
V3 : antara V2 dan V4
V4 : ICS 5 linea midclavicula sinistra
V5 : ICS 5 linea axillaris anterior sinistra
V6 : ICS 5 linea midaxillaris sinistra
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Sadapan (lead) EKG
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Hal-hal yang perlu diperhatikan
1. Irama / Rythm2. Regularitas3. Frekuensi / Rate4. Axis Frontal5. Axis Horizontal (Zona Transisi)6. Gel P, Kompleks QRS, Gel T, Gel U7. Interval PR, Interval QRS, Interval QT8. Tanda Hipertrofi9. Tanda Iskemik dan Infark
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1. IRAMA / RYTHM
Normalnya irama jantung berasal dari nodus SA irama sinus ; ciri : Irama teratur HR 60 – 100 x/menit Gelombang P selalu diikuti gelombang QRS dan T
Cara lain :
Lihat gel. P di Lead I dan Lead aVFJika, Lead I = + ; Lead aVF = +Maka, irama berasal dari nodus sinoatrial / Irama Sinus
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Lead I
Lead aVF
+
+
Sinus
Junctional
Ventrikular
Atrial
-
-
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2. REGULARITAS Regular : Jarak R-R sama Irregular : Jarak R-R tidak sama
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6 kotak 6 kotak
Contoh : REGULAR
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3. FREKUENSI / RATE
Atrium : Puncak P – P Ventrikel : Puncak R – R
Cara Menghitung :
1. 300/ banyaknya KOTAK SEDANG
2. 1500/ banyaknya KOTAK KECIL
3. Dipakai jika IRREGULAR
6 DETIK (Hitung Kompleks QRS) X 10
12 DETIK (Hitung Kompleks QRS) X 5
6 detik = 30 kotak sedang
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Jawab : 300 / 4 kotak sedang = 75 x / menit
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Frekuensi Normal : 60 – 100 x/ menit< 60 x / menit = bradikardi> 60 x / menit = takikardi
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4. AXIS FRONTAL Axis / sumbu normal = (-3oo) – (+90o) / (-3oo) – (+110o)
Cara sederhana :
Lihat gel. R Lead I dan Lead aVF
Lead I Lead aVF Axis
+ + Normal (Normo Axis Deviation)
+ - Deviasi kiri (Left Axis Deviation)
- + Deviasi kanan (Right Axis Deviation)
- - Deviasi kanan ekstrim (Superior Axis Deviation)
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5. ZONA TRANSISI Zona transisi adalah dimana tinggi gel. R
hampir sama dengan kedalaman gel. S
Normalnya zona transisi terdapat di lead V3 / V4
Jika zona transisi berada pada V1/ V2 = counter clock wise
Jika zona transisi berada pada V5/V6 = clock wise
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6. GEL P,KOMPLEKS QRS, GEL T, GEL U Gel P
Amplitudo : < 3mm Interval : < 3mm Selalu + di lead II dan - di aVR
Gel Q interval : < 1mm amplitudo : 1/3 gel R
Gel R positif disemua sadapan kecuali aVR V1V6 Berangsur membesar
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Gel S V1V6 berangsur menghilang
Gel TAmplitudo normal :- < 10 mm di sandapan dada- < 5 mm di sandapan ekstremitas- Min. 1 mmBentuk patologis Indikator iskemik /infark
Gel U Jarang terlihat Merupakan depleksi positif setelah gelombang T
sebelum gelombang P U inverted iskemi, hipertrofi
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7. INTERVAL PR, INTERVAL QRS, INTERVAL QT
Interval PR Dari awal P sampai awal kompleks QRS Interval : 0,12 sampai 0,20 detik
Interval QRS Dari awal kompleks QRS sampai akhir QRS Interval : 0,06 – 0,12 detik
Interval QT Merupakan depolarisasi Repolarisasi ventrikel Nilai normal 0,42 detik (cowok) dan 0,43 (cewek)
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8. TANDA HIPERTROFI
Abnormalitas Atrium Kanan P pulmonal Tinggi dan lancip di II, III, aVF (amplitudo > 2,5
mm; interval > 0,11 detik V1 amplitudo > 1,5 mm
Abnormalitas Atrium Kiri P mitral Di lead II punya 2 puncak interval > 0,12 detik Defleksi terminal di V1 negatif dengan lebar 0,04
dan dalam > 1mm kriteria moris
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Hipertrofi Ventrikel Kanan Rasio R/S terbalik S menetap di V5 dan V6 Depresi segmen ST dan T inverted di V1-V3
Hipertrofi Ventrikel Kiri Lihat S di V1 > 27 mm R di V5 atau V6 > 27 mm Jumlah S di V1 dan R di V5 > 35 mm
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Hipertrofi Ventrikel Kiri
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Hipertrofi Ventrikel Kanan
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9. Tanda iskemia/infark
Iskemia Depresi segmen ST Gelombang T inverted
Infark ST elevasi Gelombang Q abnormal Fase
Akut : ST elevasi + T inverted Subakut : ST elevasi + T inverted + gelombang Q
abnormal Kronik : gelombang Q abnormal
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ISKEMIK
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FASE INFARK
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INFARK
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TELAH ADA Q PATOLOGIS
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Lokasi terjadinya abnormalitas Anterior : V2 – V4 Anteroseptal : V1 - V3 Anterolateral : I, aVL, V5-V6 Ekstensiv anterior : I, aVF, V1-V6 Inferior : II, III, aVF Posterior : V1-V2
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GAMBAR APAKAH INII ??
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S persisten
T inverted
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THANK YOU..
Selamat belajar