The document provides information on interpreting electrocardiograms (EKGs), including:
1. It describes the components of the EKG and what each component represents, such as the P wave representing atrial activation and the QRS complex representing ventricular activation.
2. It provides guidelines for systematically interpreting an EKG, such as checking the rate, rhythm, intervals, and looking for patterns that may indicate conditions like atrial fibrillation.
3. It explains how to determine aspects like the heart rate from the number of boxes between R waves and how to determine the electrical axis by which leads are positive or negative.
The document provides information on interpreting electrocardiograms (EKGs), including:
1. It describes the components of the EKG and what each component represents, such as the P wave representing atrial activation and the QRS complex representing ventricular activation.
2. It provides guidelines for systematically interpreting an EKG, such as checking the rate, rhythm, intervals, and looking for patterns that may indicate conditions like atrial fibrillation.
3. It explains how to determine aspects like the heart rate from the number of boxes between R waves and how to determine the electrical axis by which leads are positive or negative.
The document provides information on interpreting electrocardiograms (EKGs), including:
1. It describes the components of the EKG and what each component represents, such as the P wave representing atrial activation and the QRS complex representing ventricular activation.
2. It provides guidelines for systematically interpreting an EKG, such as checking the rate, rhythm, intervals, and looking for patterns that may indicate conditions like atrial fibrillation.
3. It explains how to determine aspects like the heart rate from the number of boxes between R waves and how to determine the electrical axis by which leads are positive or negative.
The document provides information on interpreting electrocardiograms (EKGs), including:
1. It describes the components of the EKG and what each component represents, such as the P wave representing atrial activation and the QRS complex representing ventricular activation.
2. It provides guidelines for systematically interpreting an EKG, such as checking the rate, rhythm, intervals, and looking for patterns that may indicate conditions like atrial fibrillation.
3. It explains how to determine aspects like the heart rate from the number of boxes between R waves and how to determine the electrical axis by which leads are positive or negative.
ELEKTROKARDIOGRAM SN = SA node A-V NODE = A-V Node HIS = Bundle of his BB = Bundle branch P = Purkinje fibers
SISTEM HANTARAN JANTUNG dan GELOMBANG EKG Horizontal menyatakan kecepatan kertas dalam waktu 1 mm = 0,04 detik 5 mm = 0,2 detik Vertikal menyatakan voltage elektris jantung dalam millivolt 10 mm = 1 mV Pada pemeriksaan rutin kecepatan rekaman kertas EKG 25 mm/detik
1 mm = 0,1 mV 1 mm = 0,04 detik
10 mm = 1 mV 5 mm = 0,2 detik The P wave represents atrial activation The PR interval is the time from onset of atrial activation to onset of ventricular activation. The QRS complex represents ventricular activation; The QRS duration is the duration of ventricular activation. The ST-T wave represents ventricular repolarization. The QT interval is the duration of ventricular activation and recovery. The U wave probably represents "afterdepolarizations" in the ventricles. Hasil pembacaan EKG
No Aspek yang mau dinilai
1 Irama 2 Rate gelombang P 3 Rate gelombang QRS 4 Gelombang P 5 Durasi interval PR 6 Durasi QRS kompleks 7 Aksis gelombang P 8 Aksis gelombang QRS 9 Konfigurasi QRS kompleks 10 Segmen ST 11 Durasi QT / Durasi QoTc 12 Gelombang T 13 Gelombang U 14 Kesimpulan SYSTEMATIC INTERPRETATION GUIDELINES for Electrocardiograms RATE Rate calculation Common method: 300-150-100-75-60-50 Mathematical method: 300/# large boxes between R waves Six-second method: # R-R intervals x10 RHYTHM Rhythm Guidelines: 1. Check the bottom rhythm strip for regularity, i.e. - regular, regularly irregular, and irregularly irregular. 2. Check for a P wave before each QRS, QRS after each P. 3. Check PR interval (for AV blocks) and QRS (for bundle branch blocks). Check for prolonged QT. 4. Recognize "patterns" such as atrial fibrillation, PVC's, PAC's, escape beats, ventricular tachycardia, paroxysmal atrial tachycardia, AV blocks and bundle branch blocks. Determining Heart Rate from the Electrocardiogram
There are different short-cut methods that can be used to calculate rate, all of which assume a recording speed of 25 mm/sec. One method is to divide 1500 by the number of small squares between two R waves. For example, the rate between beats 1 and 2 in the above tracing is 1500/22, which equals 68 beats/min. Alternatively, one can divide 300 by the number of large squares (red boxes in this diagram), which is 300/4.4 (68 beats/min). Another method, which gives a rough approximation, is the "count off" method. Simply count the number of large squares between R waves with the following rates: 300 - 150 - 100 - 75 - 60. For example, if there are three large boxes between R waves, then the rate is 100 beats/min. Determining the Mean Electrical Axis (QRS axis)
Axis nomenclature Lead I Lead aVF
1. Normal axis (0 to +90 degrees) Positive Positive 2. Left axis deviation (-30 to -90) Also check lead II. To be true left axis deviation, it should also be down in Positive Negative lead II. If the QRS is upright in II, the axis is still normal (0 to -30). 3. Right axis deviation (+90 to +180) Negative Positive 4. Indeterminate axis (-90 to -180) Negative Negative Differential Diagnosis LVH, left anterior fascicular block, inferior wall Left axis deviation MI RVH, left posterior fascicular block, lateral Right axis deviation wall MI The chest leads overlie the following ventricular regions: Leads Ventricular Region V1-V2 Anteroseptal V3-V4 Anteroapical V5-V6 Anterolateral Infarct , injury and ischaemic Infarct
Accurate ECG interpretation in a patient with chest pain is critical. Basically,
there can be three types of problems - ischemia is a relative lack of blood supply (not yet an infarct), injury is acute damage occurring right now, and finally, infarct is an area of dead myocardium. It is important to realize that certain leads represent certain areas of the left ventricle; by noting which leads are involved, you can localize the process. The prognosis often varies depending on which area of the left ventricle is involved (i.e. anterior wall myocardial infarct generally has a worse prognosis than an inferior wall infarct).
V1-V2 anteroseptal wall
V3-V4 anterior wall V5-V6 anterolateral wall II, III, aVF inferior wall I, aVL lateral wall posterior wall V1-V2 (reciprocal) Infarct Represented by symmetrical T wave inversion (upside 1. Ischemia down). The definitive leads for ischemia are: I, II, V2 - V6. Acute damage - look for elevated ST segments. 2. Injury (Pericarditis and cardiac aneurysm can also cause ST elevation; remember to correlate it with the patient. Look for significant "patholgic" Q waves. To be significant, a Q wave must be at least one small box wide or one-third the entire QRS height. Remember, to 3. Infarct be a Q wave, the initial deflection must be down; even a tiny initial upward deflection makes the apparent Q wave an R wave. depresion
elevation Hypertrophy • Hypertrophy criteria are fairly straightforward; we will be looking for enlargement of any of the four chambers. • 1. LVH: (Left ventricular hypertrophy). Add the larger S wave of V1 or V2 (not both), measure in mm, to the larger R wave of V5 or V6. If the sum is > 35mm, it meets "voltage criteria" for LVH. Also consider if R wave is > 12mm in aVL. LVH is more likely with a "strain pattern" which is asymmetric T wave inversion in those leads showing LVH. • 2. RVH: (Right ventricular hypertrophy). R wave > S wave in V1 and R wave decreases from V1 to V6. • 3. Atrial hypertrophy: (leads II and V1). Right atrial hypertrophy - Peaked P wave in lead II > 2.5mm amplitude. V1 has increase in the initial positive deflection. Left atrial hypertrophy - Notched wide (> 3mm) P wave in lead II. V1 has increase in the terminal negative deflection. Ischemia: Note symmetric T wave inversions in leads I, V2-V5. Injury: Note ST segment elevation in leads V2-V3 (anteroseptal/anterior wall). Infarct: Note Q waves in leads II, III, and aVF (inferior wall). Posterior wall infarct. Notice tall R wave in V1. Posterior wall infarcts are often associated with inferior wall infarcts (Q waves in II, III and aVF). Atrial tachycardia multiple LVH RVH Acute MCI postero-inferior
