ekg rspad
DESCRIPTION
EKG RSPADTRANSCRIPT
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PROSES REKAM dan
BACA EKG
Prof. DR.dr. Zainal Musthafa, SpJP, FIHA, MSi
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EKG NORMAL
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ELEKTRO KARDIOGRAFIPENGERTIANElektrokardiografi adalah ilmu yg mempelajari
aktivitas listrik jantung. Elektrokardigram ( EKG ) adalah suatu grafik yg
menggambarkan rekaman listrik jantung.
FUNGSI EKGEKG mempunyai fungsi diagnostik diantaranya :Aritmia jantungHipertrofi atrium dan ventrikelIskemik dan infark miokardEfek obat-obatan seperti ( digitalis, anti aritmia dll )Gangguan keseimbangan elektrolit khususnya kaliumPenilaian fungsi pacu jantung
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ANATOMI JANTUNG
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PEMBULUH DARAH KORONER
RCA
LM
LCX
LAD
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SISTEM KONDUKSI
S A
A V
SA NODE 60-100 x/mntSA NODE 60-100 x/mnt
AV NODE 40-60 x/mntAV NODE 40-60 x/mnt
SRABUT PURKINJE 20-40 SRABUT PURKINJE 20-40 x/mntx/mnt
SP
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KERTAS EKGKertas 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 besar ).
• Garis horizontal Menunjukan waktu, dimana 1mm = 0,04 dtk, sedangkan 5mm = 0,20 dtk.
• Garis vertikal menggambarkan voltage, dimana 1 mm = 0,1 mv. Sedangkan 5 mm = 0,5 mv
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GAMBAR EKG
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Atrial Depolarization
GELOMBANG PGELOMBANG Pa. Lebar kurang dari 0,12 a. Lebar kurang dari 0,12
detikdetik
b.Tinggi kurang dari 0,3 mvb.Tinggi kurang dari 0,3 mv
c. Selalu Positif di lead IIc. Selalu Positif di lead II
d. Selalu negative di lead d. Selalu negative di lead AVRAVR
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PR Interval
P – R Interval :Diukur dari permulaan
gelombang P sampai permulaan gelombang
QRS
Normal : 0,12 – 0,20 detik
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VentricleDepolarization
Gelombang QRS :
Normal : lebar tidak melebihi 0,12 “
Tinggi tergantung lead
Gelombang QRS terdiri dari gel Q, Gel R dan gelombang S
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Gelombang R dan S di lead Perikordial
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Segmen STDiukur dari akhir QRS s/d awal gel T
• Normal : Isoelektris• Kepentingan : Elevasi Pada
injuri/infark akut Depresi Pada iskemia
NON STEMI STEMI
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SANDAPAN ECG
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SANDAPAN EKG
• Terdapat 2 jenis sandapan ( lead ) pada EKG.
1. Sandapan Bipolar Yaitu merekam perbedaan potensial dari dua elektroda Sandapan ini ditandai dengan angka romawa ( Lead I, II,dan III )
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SANDAPAN EKG
Sandapan Unipolar Sandapan Unipolar EktremitasMerekam besar potensial listrik pada satu ektremitas, elektroda ekplorasi diletakan pada ektremitas yg akan diukur. Gabungan elektroda-elektroda pada ektremitas yg lain membentuk elektroda indiferen ( potensial 0 ) ( aVR, aVL, aVF )
SandapanUnipolar PrekordialMerekam besar potensial listrik jantung dengan bantuan elektroda eksplorasi yg ditempatkan di beberapa dingding dada. Elektroda indiferen diperoleh dengan menggabungkan ketiga elektroda ektremitas.
( V1 s/d V9 dan V3R, V4R )
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LEAD I
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LEAD II
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LEAD III
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A V R
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A V L
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A V F
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SANDAPAN ECG
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CARA MENENTUKAN IRAMA JANTUNG
1. Tentukan apakah Iramanya teratur atau tidak
2. Tentukan frekuensi heartratenya
3. Tentukan gelombang P normal atau tidak, bagaimana hubungannya dengan QRS komlek
4. Tentukan Interval PRnya normal atau tidak
5. Tentukan gelombang QRSnya, normal atau tidak
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CARA MENGHITUNG NADI
Menentukan frekuensi jantungA. 300 = ( jml kotak besar dlm 60 detik ) Jml kotak besar antara R – R
B. 1500 = (jml kotak kecil dlm 60 detik ) Jml kotak kecil antara R – R
C. Ambil EKG strip sepanjang 6 detik, hitung jumlah QRS dan kalikan 10.
CAT : RUMUS A/B UNTUK EKG YANG TERATUR. RUMUS C UNTUK YANG TIDAK TERATUR.
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4
GAMBARAN PJK / INFARK
Ada 3 tingkatan kerusakan myocard
1) Ischemia = Sifatnya reversible
2) Injury = Sifatnya reversible
3) Necrosis = Infark = Irreversible
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1. ISCHEMIC : ST depresi : Up sloping Down sloping // isoelektris
T inverted
2. INJURY : ST elevasi
3. NECROSIS : Q patologi atau QS
DD. Kardiomiopathy, LVH, WPW
Phase : awal / hiperakut akut (hari 1-7)
recent (hari 7- 1 bln) lama / Old
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GAMBARAN ISCHEMIA PADA EKG
T inversi, biasanya simetreis
ST depresi yang spesifik Horizontal
Sagging (downsloping)/menurun
ST depresi kurang spesifik (upsloping=naik)
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ST elevasi tidak spesifik (cekung ke atas)
ST elevasi, yg spesifik (konvex ke atas/ cembung ke atas)
GAMBARAN INJURY PADA EKG
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GAMBARAN NECROSIS PADA EKG
Disebut necrosis pattern apabila :Gambaran Q wave yg lebar dan dalam
Q wave dianggap patologis apabila dalamnya > 1/3 dari tinggi R Dalamnya Q menunjukkan tebalnya jaringan necrosis
Tingginya R menunjukkan sisa jaringan myocard yg sehat Adanya QS menunjukkan necrosis seluruh myocard
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R R
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CAUSE OF CARDIAC ARRHYTHMIAS :
• Disturbances in automaticity : bertambah cepat atau bertambah lambatnya
suatu daerah otomatisitas. Misal di sinus node, AV node, abnormal beats/ depolarisasi
atrium, AV junction, ventrikel, VT, dll.
• Disturbances in conduction : konduksi terlalu cepat (WPW) atau
terlalu lambat (blok AV).
• Combinations of altered automaticity and conduction.
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How to identify arrhythmias ?
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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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NORMAL SINUS RHYTHM
R RR
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PSVT :
-due to re-entry mechanism-narrow QRS complex
-regular-retrograde atrial depolarization
-P wave ?
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PSVT
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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
R R R
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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”
P P
R R
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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
QRSR R
PP
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VES
SR
VENTRIKEL EXTRA SYSTOLE(VES)
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SR SR SR SRSR SR
VES VES
Sinus rhythm with
Multifocal VES
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Sinus rhythm with VES couplet
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Sinus Rhythm with VES, R on T
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Ventricular Tachycardia
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Torsade de Pointes
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Ventricular Fibrillation
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Prolonged PR interval
1st degree AV block
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Missing QRS Missing QRS
2nd degree AV block, type 1
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2nd degree AV block, type 2
Missing QRS
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P P P P P P P
QRS QRS QRS
Total AV Block / 3rd degree AV
block
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Treat the patient, not the
monitor . . . . .!!!
SELESAI
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EKG & ARITMIA