Dr. Hilfan Ade Putra Lubis, Sp. JP (K)
Dr. Hilfan Ade Putra Lubis, Sp. JP (K)
Dr. Hilfan Ade Putra Lubis, Sp. JP (K)
JP (K)
SA node
Sumber impuls normal/
alamiah , 60 – 100
AV node
Bisa mengeluarkan
impuls 40-60x/menit
Berkas His
Serabut Purkinje
Ventrikel
Bisa mengeluarkan impuls
20-40 x/menit
+
-
positive
- +
negative
- +
Bifasik
Sandapan bipolar
Merekam perbedaan potensial dari 2 elektroda
I = lengan kanan (-) lengan kiri (+)
II = lengan kanan (-) tungkai kiri (+)
III = lengan kiri (-) tungkai kiri (+)
Sandapan unipolar
- Merekam potensial listrik pada satu elektroda
yang lain sebagai elektroda indiferen (0)
- Ada dua sandapan: ekstremitas & prekordial
Sandapan unipolar ekstremitas
avR, avL, avF -
Sandapan prekordial
V1,V2,V3,V4,V5,V6
Gelombang P
• Depolarisasi Atrium
R • Diikuti kontraksi atrium
• Sinus Ritme : + di II
• Sinus Ritme : - di avR
• N ; lebar < 0,12 dtk
• N : tinggi < 0,3 mV
P T
U
Q
S
Depolarisasi
atrium
Gelombang QRS
• Depolarisasi ventrikel
• Diikuti kontraksi ventrikel
• Lebar 0,06 - 0,12 dtk
Depolarisasi ventrikel
• Tinggi tergantung lead
R • Q patologis: tanda infark miokard
• Transisisonal zone untuk gel. R
Q
S
Gelombang T
• Repolarisasi ventrikel
• Diikuti relaksasi ventrikel
• + di lead : I,II,V3-V6
• - di lead avR
Repolarisasi ventrikel
1. Calibration
2. Rate and rhythm
3. QRS axis
4. P morphology
5. PR interval
6. QRS duration
7. QRS morphology
8. ST segment morphology
9. T morphology
10. Others: LVH, LV strain, BBB
11. Conclusion: normal/abnormal
1. RATE
Normal heart rate : 60 – 100 x/minutes
• > 100 x/minutes : Sinus Tachycardia
• < 60 x/minutes : Sinus Bradicardia
No ST Elevation ST Elevation
NSTEMI
Unstable Angina
STEMI Non STEMI
EKG PADA ISKEMIA MIOKARD
EKG PADA INJURI MIOKARD & EVOLUSINYA
CAUSE OF CARDIAC ARRHYTHMIAS :
P wave ??
QRS sempit
Irama
Irama Teratur
Tidak teratur
Supraventricular
Sinus Tachycardia Atrial Fibrillation
Tachycardia
Atrial Flutter
SVT :
-due to re-entry mechanism
-narrow QRS complex
-regular
-retrograde atrial depolarization
-P wave ?
Atrial Fibrillation :
Irama
Irama Teratur
tidak teratur
Ventricular Ventricular
Tachycardia Fibrillation
Ventricular Tachycardia
Torsade de Pointes
Ventricular Fibrillation
Failure of impulse AV conduction
formation abnormalities
Sinus Bradycardia 1st and 2nd AV Block
Sick Sinus Syndrome Total AV Block
BBB (Bundle Branch
Block)
First-degree AV block
Rhythm : Regular
Rate : Usually normal
P wave : Sinus P wave present; one P wave to each QRS
PR : Prolonged ( greater than 0.20 seconds )
QRS : Normal
Second -degree AV block, Mobitz I
Rhythm : Irregular
Rate : Usually slow but can be normal
P wave : Sinus P wave present;
some not followed by QRS complexes
PR : Progressively lengthens
QRS : Normal
Second-degree AV block, Mobitz II
Rhythm : Regular
Rate : 40 – 60 if block in His bundle;
30 – 40 if block involves bundle branches
P wave : Sinus P wave present; bear no relationship to QRS;
can be found hidden in QRS complexes and T waves
PR : Varies greatly
QRS : Normal if block in His bundle;
wide if block involves bundle branches
Treat the patient not the monitor