the basic of ecg

48
Wisnoe Pribadi SpJP

Upload: pinanoe

Post on 16-Jan-2016

42 views

Category:

Documents


1 download

DESCRIPTION

ekg

TRANSCRIPT

Page 1: The Basic of Ecg

Wisnoe Pribadi SpJP

Page 2: The Basic of Ecg
Page 3: The Basic of Ecg

Conduction System

SA Node Internodal branch AV Node Hiss Bundle Purkinje Fiber Contraction

Page 4: The Basic of Ecg
Page 5: The Basic of Ecg
Page 6: The Basic of Ecg

The Electrocardiogram ( ECG )The Electrocardiogram ( ECG )

P wave : atrial P wave : atrial depolarisationdepolarisation

QRS complex : QRS complex : ventricular ventricular depolarisationdepolarisation

T wave : T wave : ventricular ventricular repolarisationrepolarisation

Atrial repolarisation Atrial repolarisation hidden by QRShidden by QRS

P

Q

R

S

T

Page 7: The Basic of Ecg
Page 8: The Basic of Ecg

v9

Page 9: The Basic of Ecg
Page 10: The Basic of Ecg

P Wave

Page 11: The Basic of Ecg

P Pulmonale

Page 12: The Basic of Ecg

P Mitrale

Page 13: The Basic of Ecg

PR Interval

Page 14: The Basic of Ecg

QRS Complex

Page 15: The Basic of Ecg

ST Segment

Page 16: The Basic of Ecg

T Wave

Page 17: The Basic of Ecg
Page 18: The Basic of Ecg

INTERPRETATION ECGINTERPRETATION ECG

P waveP wave

PR intervalPR interval

Q waveQ wave

R waveR wave

S waveS wave

ST segmentST segment

T waveT wave

Page 19: The Basic of Ecg

Normal Sinus Rhythm

Rhythm : RegularRate : 60 – 100P wave : Normal in configuration; precede each QRSPR : Normal ( 0. 12 – 0.20 seconds )QRS : Normal ( less than 0.12 seconds )

SINUS ARRYTMIA SINUS BRADYCARDIA

SINUS TACHYCARDIA

Page 20: The Basic of Ecg

First-degree AV block

Rhythm : RegularRate : Usually normalP wave : Sinus P wave present; one P wave to each QRSPR : Prolonged ( greater than 0.20 seconds )QRS : Normal

Page 21: The Basic of Ecg

Second -degree AV block, Mobitz I

Rhythm : IrregularRate : Usually slow but can be normalP wave : Sinus P wave present; some not followed by QRS complexesPR : Progressively lengthensQRS : Normal

Page 22: The Basic of Ecg

Second-degree AV block, Mobitz II

Rhythm : Regular usually; can be irreguler if conduction ratios varyRate : Usually slowP wave : Two, three, or four P waves before each QRSPR : PR interval of beat with QRS is constant; PR interval may be normal or prolongedQRS : Normal if block in His bundle; wide if block involves bundle branches

Page 23: The Basic of Ecg

Third-degree AV block

Rhythm : RegularRate : 40 – 60 if block in His bundle; 30 – 40 if block involves bundle branchesP wave : Sinus P wave present; bear no relationship to QRS; can be found hidden in QRS complexes and T wavesPR : Varies greatlyQRS : Normal if block in His bundle; wide if block involves bundle branches

Page 24: The Basic of Ecg
Page 25: The Basic of Ecg
Page 26: The Basic of Ecg
Page 27: The Basic of Ecg
Page 28: The Basic of Ecg
Page 29: The Basic of Ecg
Page 30: The Basic of Ecg

Wolff-Parkinson-White syndrome

Page 31: The Basic of Ecg
Page 32: The Basic of Ecg

ST depresi dan perubahan gelombang T

• ST depresi dianggap bermakna bila > 1 mm di bawah garis dasar PT di titik J• Titik J didefinisikan sebagai akhir kompleks QRS dan permulaan segmen ST

Bentuk segmen ST :

• up-sloping ( tidak spesifik )• horizontal ( lebih spesifik untuk iskemia )• down-sloping ( paling terpercaya untuk iskemia )

Perubahan gelombang T pada iskemia kurang begitu spesifik Gelombang T hiperakut kadang2 merupakan satu-satunyaperubahan EKG yang terlihat

Page 33: The Basic of Ecg

HYPERACUTE T WAVE

Page 34: The Basic of Ecg

ST DEPRESSION

HORIZONTAL

DOWN SLOOPING

UP SLOOPING

Page 35: The Basic of Ecg

Anatomi Koroner dan EKG 12 sandapan ( LEAD )

• Sandapan V1 dan V2 menghadap septal area ventrikel kiri

• Sandapan V3 dan V4 menghadap dinding anterior ventrikel kiri

• Sandapan V5 dan V6 ( ditambah I dan avL ) menghadap dinding lateral ventrikel kiri

• Sandapan II, III dan avF menghadap dinding inferior ventrikel kiri

Page 36: The Basic of Ecg

Unstable angina

Page 37: The Basic of Ecg

Acute anteroseptal myocardial infarction. Hyperacute T-wave changes are noted

Page 38: The Basic of Ecg

Acute anterolateral myocardial infarction

Page 39: The Basic of Ecg

High lateral infarction

Page 40: The Basic of Ecg

Inferior myocardial infarction

Page 41: The Basic of Ecg

Acute inferoposterior myocardial infarction

Page 42: The Basic of Ecg
Page 43: The Basic of Ecg

L V H

Page 44: The Basic of Ecg

L V H

Page 45: The Basic of Ecg

L V H

Page 46: The Basic of Ecg

R V H

Page 47: The Basic of Ecg

R V H

Page 48: The Basic of Ecg

R V H