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Rinelia Minaswary
Pengenalan Elektro kardiograf
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Principles of Electrocardiograph
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Electrocardiogram (ECG)
• The ECG is a graphic recording of the electrical
activity of the heart, at a specific moment in time.
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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
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SISTEM HANTARAN JANTUNG dan GELOMBANG EKG
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Excitation of the Heart
Excitation of the Heart
JANTUNG DAN POSISINYA DALAM
RONGGA TORAKS
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ELECTRODE PLACEMENT
• LIMB LEADS
• CHEST LEAD
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LIMB LEADS
• Bipolar leads
I II III
• Augment leads
Avr Avl Avf
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CHEST LEADS
• 6 UNIPOLAR LEADS
• V1
• V2
• V3
• V4
• V5
• V6
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Hubungan arah impuls – defleksi
elektrokardiogram
Arah impuls Arah defleksi Gambar
depolarisasi
Menuju - Bifasik
meninggalkan
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12-LEAD ECG LAY-OUT
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RULING OUT LIMB LEAD REVERSAL
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BASIC CRITICAL VALUES
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ECG Graph Paper
Voltage
0.04 s
(millivolts; mV)
y
(1 1) mm2 0.1 mV
x’ x
Time (seconds; s)
First
FirstR-
R-
wave
wave
Next
NextR-
R-
wave
wave
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Example:
What is the heart rate ?
QRS-
complex
P-wave (qRs)
T-wave
U-wave
Q (q)
S (s)
The P-wave
P-wave
PR-interval
P T
U P
Q S
Gel. P = defleksi akibat depolarisasi atrium Gel. R’(r’) = defleksi negatif awal akibat
Gel. Q(q) = defleksi negatif awal akibat de depolarisasi ventrikel yg mengi-
polarisasi ventrikel yg mendahului kuti gel. (R)
gel. (R) Gel.T = defleksi akibat repolarisasi ventrikel
Gel. R(r) = defleksi positif awal akibat de Gel. U = defleksi (biasanya positif) sete-
polarisasi ventrikel lah gel T dan mendahului gel P
Gel. S(s) = defleksi negatif awal akibat de -------- = depolarisasi atrium
polarisasi ventrikel yg mengikuti -------- = depolarisasi dan repolarisasi
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gel. (R) ventrikel
NOMENKLATUR KOMPLEKS QRS
Transitional zone
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LOOKING AT THE RHYTHM
• Is the rhythm
Evaluate the rhythm
regularstrip
or irregular?
at the bottom of the
• 12-lead
Is there for
a P the
wavefollowing
before every QRS complex
• Are they any abnormal beats.
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Irama Sinus
• Irama jantung yang normal adalah irama sinus, yaitu
suatu pola penjalaran impuls listrik yang teratur dan
berasal dari NSA
• Syarat-syarat suatu EKG dikatakan berirama sinus
adalah:
1. Setiap 1 gelombang P diikuti 1 kompleks QRS
2. Interval PR 0,12-0,20 detik (3-5 mm)
3. P di lead II positif, P di lead aVR negatif
4. FDJ antara 60-100x/menit, reguler
Cardiac Axis Determination
Complexes
Complexes
moving
moving
towards
towards one
one
another
another
‘Positive’
‘Positive’ Complexes
Complexes
complexes
complexes deflecting
deflecting
away
away from
from
one
one another
another
Normal
Normalaxis
axis
Left
Leftaxis
axis
Right
Rightaxis
axis deviation
deviation
deviation
deviation
ST-segment Abnormalities
OR
I aVR V1 V4
II aVL V2 V5
III aVF V3 V6
Limb Leads Chest Leads
Inferior Wall
I aVR V1 V4
II aVL V2 V5
III aVF V3 V6
Inferior Wall
I aVR V1 V4
II aVL V2 V5
III aVF V3 V6 Inferior Wall
Lateral Wall
• I and aVL
– Left Arm
I aVR V1 V4
II aVL V2 V5
III aVF V3 V6
Lateral Wall
• V5 and V6
– Left lateral chest
I aVR V1 V4
II aVL V2 V5
III aVF V3 V6
Lateral
• I, aVL, V5, V6
Lateral Wall
I aVR V1 V4
II aVL V2 V5
III aVF V3 V6
Anterior Wall
• V3, V4
– Left anterior chest
I aVR V1 V4
II aVL V2 V5
III aVF V3 V6
Anterior Wall
• V3, V4
I aVR V1 V4
II aVL V2 V5
III aVF V3 V6
SeptalWALL
SEPTAL Wall
• V1, V2
• Along sternal borders
I aVR V1 V4
II aVL V2 V5
III aVF V3 V6
Septal
• V1,V2
I aVR V1 V4
II aVL V2 V5
III aVF V3 V6
The 10 Rules for a Normal ECG
1. PR interval should be 120 to 200 milliseconds or 3 to 5 little squares
2. The width of the QRS complex should not exceed 110 ms, less than 3 little squares
3. The QRS complex should be dominantly upright in leads I and II
4. QRS and T waves tend to have the same general direction in the limb leads
5. All waves are negative in lead aVR
6. The R wave in the precordial leads must grow from V1 to at least V4 and The S wave
in the precordial leads must grow from V1 to at least V3 and disappear in V6.
7. The ST segment should start isoelectric except in V1 and V2 where it may be elevated
8. The P waves should be upright in I, II, and V2 to V6
9. There should be no Q wave or only a small q less than 0.04 seconds in width in I, II, V2
to V6
10. The T wave must be upright in I, II, V2 to V6
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LETS SUMMARIZE
How do we produce an excellent 12-lead ECG?
Proper skin prep
Correct electrode placement
Recognize and know how to correct problems
Recognize basic critical values
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Thank You