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KONSEP DASAR EKG

Rinelia Minaswary
Pengenalan Elektro kardiograf

1. Menerangkan kegunaan pemeriksaan EKG


2. Mengenalkan alat EKG
3. Menerangkan Elektrofisiologi jantung
4. Menjelaskan standard lead, chest lead dan
monitor lead.

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Principles of Electrocardiograph

• Electrocardiograph – is the instrument that


records the electrical activity of the heart

• Electrocardiogram (ECG) is the record of that


activity

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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.

• Note: ‘Electrical activity’ refers to the depolarisation


and repolarisation of the atria and ventricles.

• Note: The ECG cannot tell us anything about the


‘mechanical activity’ (i.e. contraction and relaxation)
of the myocardium.
Anatomi
dan
Fisiologi
SISTEM
KARDIO
VASKU
LER

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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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16
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Hubungan arah impuls – defleksi
elektrokardiogram
Arah impuls Arah defleksi Gambar
depolarisasi

Menuju Positif (ke atas)


elektroda +

Menuju - Bifasik
meninggalkan

Meninggalkan Negatif (ke


elektroda + bawah)
The Standard 12-lead ECG
This space should contain the following
You have each received a copy of
What is missing in this blank space?
information:
this ECG…
•Patient identifiers (e.g. name, hospital number,
treating physician, etc.)
•Date and time that the ECG was obtained
•Vital signs, including BP and HR
•Comment on any relevant symptoms (e.g. chest
pain), cardiovascular drugs and special lead
placements…
WHAT YOU NEED TO LOOK FOR

• Are the limb leads hooked up correctly?


• Are the chest leads hooked up correctly?
• Is the ECG free of artifact.
• Is this ECG a Critical Value

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12-LEAD ECG LAY-OUT

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RULING OUT LIMB LEAD REVERSAL

• Avr is always negative

• Lead I is always positive

• Lead II and III positive for the P wave and


usually the QRS complex

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BASIC CRITICAL VALUES

• Bradycardia – HR < 40bpm


• Tachycardia HR > 120bpm
• PVC’s - 4 or more in a row
• ST Elevation

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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)

Question: What would the bigger


square, i.e. the (5  5) mm2, represent?

y’ Answer: 0.2 s on the x-axis; 0.5 mV on


the y-axis.
Rate Determination:

First
FirstR-
R-
wave
wave

Next
NextR-
R-
wave
wave

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Example:
What is the heart rate ?

•Are the RR-intervals constant?


•RR-intervals are approximately 3 ‘big’
Count the number of squares between
squares apart.
two consecutive R-waves…
•Thus, the heart rate is: 300 ÷ 3 = 100
beats per minute.
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Learning 12 Lead ECG Interpretation
Common Paramedic responses prior to learning 12
Lead ECG Interpretation:
• I can’t interpret a 12 Lead ECG like a Cardiologist!
• Are you kidding me?
Common Paramedic responses after learning 12 Lead
ECG Interpretation:
• Hey – that wasn’t as hard as I thought it would be!
Deflections on the ECG
R

QRS-
complex
P-wave (qRs)
T-wave
U-wave

Q (q)
S (s)
The P-wave
P-wave
PR-interval

 Conduction through the Right Atrium (RA)


 Conduction through the Left Atrium (LA)
 Conduction through the His-Purkinje network

PR-interval: Represents the depolarisation of the atria and the


time it takes for the impulse to spread from the SA-node,
through the AV-junction, the bundle of His, and to the bundle
branches.
Q Wave
R Wave
S Wave
J-Point
ST Segment
The J Point

• J point - end of QRS complex &


beginning of ST segment
R DEFINISI KONFIGURASI EKG

-------- = depolarisasi ventrikel

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

Source: Bing Images, at http://www.bing.com/images


Contiguous Leads

• Limb leads that “look” at the same area of


the heart

OR

• Numerically consecutive chest leads


Contiguous Leads
• Inferior wall: II, III, avF
• Lateral wall: I, aVL, V5, V6
• Septum: V1 and V2
• Anterior wall: V3 and V4

• Posterior wall: V7, V8, V9


(leads placed on the patient’s back 5th
intercostal space creating a 15 lead EKG)
Lead Groups

I aVR V1 V4
II aVL V2 V5
III aVF V3 V6
Limb Leads Chest Leads
Inferior Wall

• II, III, aVF


– Left Leg

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

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