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ECG is easy
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![Page 1: ECG is easy](https://reader035.fdokumen.com/reader035/viewer/2022062216/55cf932f550346f57b9c8004/html5/thumbnails/1.jpg)
ECG is easy
Teguh winarso
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ECG What’s up ?
Rekaman denyut jantung yang diproyeksikan bidang berpotensial
elektrik di permukaan tubuh.
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LISTRIK DAN JANTUNG
POLARISASI Istirahat (luar positive &
dalam negative)DEPOLARISASI
Aktive (luar negative & dalam positive)
REPOLARISASINgaso neeh…
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What is Ahli Elektrokardiografi Say ?
Look like Electrics Pump ?
1. Sel Pace maker PL
2. Sel Konduksi kabel
3. Sel Miokard pompa
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The Pace Maker Cell
Sel kecil 5-10 mmDepolarisasi spontan & terus menerus
Nodus SA
(60-100)Nodus AV
(40-60)
Sel Ventrikel
(20-40)
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Sel Konduksi
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SEL MIOKARDIUM
P: 50-100 mmProtein kontraktil AKTIN
& MIOSINKunci Ca (kopling
eksitasi-kontraksi)
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WAKTU & VOLTAGE
BAGAIMANA SIFAT UTAMA GELOMBANG EKG ?
HOW abaut EKG paper ?
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Tiga Sifat Utama Gelombang EKG
DURASI detikAMPLITUDO
mVKONFIGURASI
lbh subjective
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ECG PAPER
Kotak kecil: 1x1mm; besar: 5x5 mmHorisontal Kecil: 0,04 dtk; Besar: 0,2 dtkVertikal Kecil: 0,1 mV; Besar: 0,5 mV 1 dtk = 5 ktk besar
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Do U Know Guys?
Depolarisasi Atrium
Depolarisasi Ventrikel
Repolarisasi Ventrikel
Interval
Segmen
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DEPOLARISASI ATRIUM
Menimbulkan gel PLaksana kerikil jatuh
dalam kolam yang tenang
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MASA JEDA
Timbul garis ISOELEKTRIS antara gel P dg kompleks QRS
N AV pintu tol Ventrikel terisi penuh
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DEPOLARISASI VENTRIKEL
Timbul kompleks QRS
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Bagian-bagian kompleks QRS
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REPOLARISASI VENTRIKEL
SESAAT PASCA DEPOLARISASI VENTRIKEL
PERIODE REFRAKTERKEBAL TERHADAP RANGSANG
PEMULIHAN
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REPOLARISASI ATRIUM
ADA ENGGAK OM..KOK AA’ NGGAK
LIHAT GELOMBANGNYA…?
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GARIS LURUS siapa sih Loe ?
Segmen grs lurus pengbng 2 glmb
Interval 1 glmb + grs lurus
Interval PRSegmen STInterval QT
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Are U TIRED Guys ?
OM…TANTE..KALO DAH PUCIING..RELAKSASI DULU YAH..
SIAPTARIK NAFAS DALAM-DALAM
TAHANKELUARKAN DARI MULUT
FUUUUHHHH….
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GELOMBANG EKG
Om Tante BAB ini kita akan Belajar
BAGAIMANA TERBENTUKNYA GELOMBANG EKG….yang seperti
SANDI RUMPUT itu lho..
Time for thinking OM..Tante…CIAAAP…
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THE SECRET…!!!
Electrode/ Sandapan KAMERA
DEPOLARISASI
REPOLARISASI
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DEPOLARISASI
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REPOLARISASI
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12 KAMERA EKG
JANTUNG BENDA 3 DIMENSI
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JENIS KAMERA (sandapan)
EKSTRIMITASStandar (Bipolar)Augmented (Unipolar)
PRECORDIAL (Unipolar)V1-V6
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Sandapan EKSTRIMITAS
Jantung dipandang dari bidang vertikal (frontal)
Look like
a Giant Cyrcle
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Segi Tiga Enthoven
I
IIIII
aVLaVR
aVF
+
++
-
- -
Standar (Bipolar) I II III
Augmented (Unipolar) aVL aVF aVR
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My GIANT CYRCLE
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Sandapan PRECORDIAL
V1V2V3
V4V5V6
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The meaning of ME
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VEKTOR (AKSIS)
Arah rata-rata gelombang listrik
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AKSIS, LEAD, & BENTUK GELOMBANG
Remember about the secret OK..
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EKG NORMAL
Hayo…DAH pada NGANTUK YAH…
Oke OM..TANTE..Sekarang kita
SENAM MATA Yuk…
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GELOMBANG P
Amplitudo: < 0,2 mV Paling positive : lead
II
EKTRIMITAS
PRECORDIAL
NORMAL kahSaya..?
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INTERVAL PR
Mulai Depolarisasi atrium s.d awal Depolarisasi
Normal: 0,12-0,2 detik
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KOMPLEKS QRS
Merangsang Septum Interventrikuler
Arah: Kiri ke Kanan Tidak selalu tampak N: < 1/3 tinggi gel R Depleksi negative pd:
I, aVL, V5 dan V6WHY ????
Gelombang Q
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KOMPLEKS QRS (Cont.)
Durasi: 0,06-0,1 dtkAplitudo besar
kelistrikan tinggi
EKSTRIMITAS
PRECORDIAL
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SEGMEN ST
Waktu antara akhir depolarisasi dan awal repolarisasi Ventrikel
N: Landai / sedikit menanjak
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GELOMBANG T
Gambaran Repolarisasi Ventrikel
Rentan terhadap Gangguan
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INTERVAL QT
Awal Depolarisasi – Akhir Repolarisasi40% dari siklus jantung
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EKG ABNORMAL
Nah Om-Tante…kita akan bahas Sandi Rumput Eh…EKG yang ga Normal, kaya:
Hipertropi VentrikelAMI
Ok..siap
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HIPERTROPI & PEMBESARAN JANTUNG
HIPERTROFI
Pembesaran massa otot tebal dan Kuat
Akibat Kelebihan Beban Tekanan
DILATASI/PEMBESARAN
Ruang jantung membesar tapi tipis
Akibat Beban Volume Berlebih
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BAGAIMANA EKG BERUBAH ?
Depolarisasi > lama durasi gel EKG lebih panjang
Aliran Listrik > besar amplitudo gel membesar
Dilewati kebanyakan aliran listrik Pergeseran Aksis
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AKSIS
Normal: +90-0 drjt atau +90 – (-30)
> + 90 RAD <0/-30 LAD +180- (-90) UAD
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Cara Menentukan Aksis
Cari Lead I dan aVFTentukan defleksi (+/-)(+) arsir ke arah lead(-) arsir berlawananAksis Irisan arsiran
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Untuk hasil lebih tepat
Cari kompleks QRS y paling bifasik
Arahkan tegak lurus thd sadapan ini elektroda y tegak lurus terhadap aksis akan bifasik
Contoh:
Kompleks QRS (+120) pd Lead III bifasik, maka ia mengarah tegak lurus thd (+30) dan (-150). Karena daerah aksisnya sudah diketahui normal maka Aksis letaknya pada (+30)
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DEVIASI AKSIS
RAD
LAD
UAD
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HIPERTROPI VENTRIKEL
KIRI Aksis cenderung
LAD Amp R pd V6/V5 +
V1/V2 > 35 mm Ampl gl R pd V5 >
26 mm Ampl R pd V6 > 18
mm Amplt R pd V6 >
amp V5
KANANAksis cenderung
RAD > + 100Perubahan pola
gambaran Sandapan Precordial
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STRAIN
Gambaran iskemi (depresi segmen ST dan T inverted) pada Hipertropi
Ventrikel.
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LATIHAN Yukk………..!!!!!
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AKSIS nye normal ga seeh..!?
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AMI
Let’s Joint with Me….!!!
EKG MANIAK
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Perkembangan AMI
Gel T Runcing (peak) T inverted
ISKEMI
INJURI
INFARK
ST Elevasi
Q Patologis
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AMI (Gel T)
T peak / Gl T hiperakutMenunjukan kondisi ISKEMIReversibelBukan diagnostik u Infark
T InvertedTidak spesifik iskemi : Blok
Cabang Berkas, STRAINKhas Iskemik: bentuk simetrisPseudoinversi ????
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AMI (ST elevasi)
Menunjukan adanya cedera (injury)
Kembali normal dalam beberapa jam
MENETAP Aneurisme Ventrikel Elevasi titik J (repolarisasi awal)
orang muda sehat & kembali normal saat latihan fisik.
Beda Elevasi titik J dg ST elevasi ?????
Elevasi Titik J
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AMI (Q Patologis)
Durasi glg Q > 0,04 det (A)Kedlmn gl Q > 1/3 tinggi gl
R (B)
A
B
Habis ini latihan..Ya..Ya..
Ya..
ARRRGH….!
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Q patologis Where are U..?
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Lokasi AMI
INFERIOR
LATERAL
ANTERIOR
ANTERIORSEPTAL
POSTERIOR
II, III, aVF
I, aVL, V5, V6
V1-V6
V1,V2,V3, aVF
Resiprokal anterior
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Practice make Perfect
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Berapa frekuensi jantungnya..???
300 / jml kotak besar antar 2 glb R
1500/ jml kotak kecil antar 2 glb R
Jumlah R-R dalam 30 kotak besar x 10
Ingat 1 kotak besar = 0,2 detik so
1 detik ada 5 ktk besar.
30 kotak besar = 6 detik
Latihan lagi Yuuuk…..
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Latihan lageeeeeeeeeee….!!!
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How do U think about Me..!!!
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The end of Journeys
Please Remember EKG is Easy…Nothing is imposible if we tryNEVER GIVE UPU CAN DO IT