Ekg Normal Dan Acs Sudin Timur

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ELECTROCARDIOGRAPHY
Dr. HERAWATI ISNANIJAH, SpJP, FIHA

Anatomy & Physiology
CARDIOVASCULAR SYSTEM
Anatomy of the Heart
 Heart chambers :
 Left & right atria
 Left & right ventricles
 Heart valves :
 Atrioventricular valves :
 Right : Tricuspid
 Left : Bicuspid/Mitral
 Semilunar valves
 Right : Pulmonary valve
 Left : Aortic valve

Anatomy of the Heart
Coronary circulation
 Aorta
 Coronary arteries
 Arterioles
 Capillaries
 Venules
 Coronary sinus
 Right atrium
Intrinsic Conducting System
 Sinoatrial node
 Electrical pace maker
 Atrioventricular node
 Receives impulses originating
from SA node
 Bundle of His
 Electrical link between atria
and ventricles
 Purkinje fibres
 Distribute impulses to
ventricles
The Electrocardiogram ( ECG )
 P wave : atrial
depolarisation R
 QRS complex :
ventricular T
depolarisation P
 T wave : ventricular Q
repolarisation S
 Atrial repolarisation
hidden by QRS
NORMAL
ECG INTERPRETATION
1. RATE
2. RHYTHM
3. GELOMBANG P
4. PR INTERVAL
5. QRS COMPLEX
6. AXIS
7. ST SEGMENT
8. HIPERTROPHIC SIGNS
9. ARRHYTHMIA
1. RATE
Normal heart rate : 60 – 100 x/minutes
• > 100 x/minutes : Sinus Tachycardia
• < 60 x/minutes : Sinus Bradicardia
Determination heart rate (normal paper speed 25 mm/s):

• 300
Count number of large square (bold boxes in one R – R’ interval)
• 1500
Count number of small square in one R – R’ intervals
• Number of QRS complex in 6 seconds, multiply by 10
2. RHYTHM
Normal cardiac rhythm : SINUS rhythm
Sinus rhythm characteristics :

• Rate 60-100 bpm
• Constant R – R interval
• Negative P wave in aVR and positive di II
• P wave is always followed by QRS complex
3. P Wave
GELOMBANG P
Gambaran yang ditimbulkan oleh depolarisasi atrium
Normal
Tinggi : < 0,3 mvolt
Lebar : < 0,12 detik
Selalu positif di L II
Selalu negatif di aVR
Kepentingan
Mengetahui kelainan di Atrium
“Gelombang P Mitral”
“ Gelombang P Pulmonal “
4. PR Interval
4. Interval PR
Diukur dari permulaan P s/d permulaan QRS
Normal : 0,12 - 0,20 detik

5. QRS Complex
5. GELOMBANG QRS
Gambaran yang ditimbulkan oleh depolarisasi ventrikel
Normal :
Lebar : 0,06 - 0,12 detik
Tinggi : Tergantung lead
Normal gelombang Q
Lebar : < 0,04 detik
Dalam : < 1/3 tinggi R
6. AXIS
RAD /Right Axis Deviation
LAD /Left Axis Deviation
LAD
RAD
7. ST Segment
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-satunya
perubahan EKG yang terlihat
T Wave
EVOLUSI EKG
PADA
STEMI
Proximal large RCA occlusion
ST elevation in leads II, III, aVF, V5, and V6

with precordial ST depression
ECG, large Anterior Infarction
Occlusion of diagonal
branch ( arrow )
ST elevation in I and aVL

Mid LAD occlusion
after the first septal
perforator ( arrow )
ECG :
Anterior MI
Occlusion of diagonal
branch ( arrow )
ST elevation in I and aVL

ECG, large Anterior Infarction
Proximal large RCA occlusion
ST elevation in leads II, III, aVF, V5, and V6

with precordial ST depression
Small inferior distal RCA occlusion
ECG changes in leads II, III, and aVF

Unstable Angina Pectoris
Unstable Angina Pectoris
Acute Anterior Myocardial Infarction
Acute Anterolateral Myocardial Infarction
Acute Lateral Myocardial Infarction
Acute Inferoposterior Myocardial Infarction
Right Bundle Branch Block
RBBB + Anterior Infarction
LBBB
Klasifikasi Takikardia
 Dengan QRS sempit
 Reguler
 Ireguler
 Dengan QRS lebar
 Reguler
 Ireguler
Supraventricular Tachycardia
 Rate : 150–250 bpm

 Rhythm : Regular
 P Waves : Frequently buried in preceding QRS/T waves and difficult to see
 PR Interval: Usually not possible to measure
 QRS : Normal (0.06–0.10 sec) but may be wide if abn. conducted
through ventricles
Atrial flutter
 Rate : Atrial: 250–350 bpm; ventricular: slow or fast

 Rhythm : Usually regular but may be variable
 P Waves : Flutter waves have a saw-toothed appearance
 PR Interval : Variable
 QRS : Usually normal (0.06–0.10 sec), but may appear widened if
flutter waves are buried in QRS
Atrial Fibrilation
 Rate : Atrial: 350 bpm or greater; ventricular: slow or fast

 Rhythm : Irregular
 P Waves : No true P waves; chaotic atrial activity
 PR Interval: None
 QRS : Normal (0.06–0.10 sec)
Ventricular Tachycardia
 Rate: 100–250 bpm

 Rhythm: Regular
 P Waves: None or not associated with the QRS
 PR Interval: None
 QRS: Wide ( 0.10 sec), bizarre appearance

Ekg Normal Dan Acs Sudin Timur

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HOW TO READ

Dr. HERAWATI ISNANIJAH, SpJP, FIHA

 Left : Aortic valve

Determination heart rate (normal paper speed 25 mm/s):

Normal cardiac rhythm : SINUS rhythm

Sinus rhythm characteristics :

Normal : 0,12 - 0,20 detik

LAD /Left Axis Deviation

• ST depresi dianggap bermakna bila > 1 mm di bawah garis dasar PT di titik J

• up-sloping ( tidak spesifik )

Perubahan gelombang T pada

ST elevation in leads II, III, aVF, V5, and V6

ST elevation in I and aVL

ST elevation in I and aVL

ST elevation in leads II, III, aVF, V5, and V6

ECG changes in leads II, III, and aVF

 Rate : 150–250 bpm

 Rate : Atrial: 250–350 bpm; ventricular: slow or fast

 Rate : Atrial: 350 bpm or greater; ventricular: slow or fast

 Rate: 100–250 bpm

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