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Outline

1. Review of the conduction system

2. EKG waveforms and intervals

3. EKG leads4. Determining heart rate

5. Determining QRS axis

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What is an ECG?

The electrocardiogram (ECG) is a

representation of the electrical events

of the cardiac cycle

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What types of pathology can weidentify and study from EKGs?

Arrhythmias

Myocardial ischemia and infarction

Pericarditis Chamber hypertrophy

Electrolyte disturbances (i.e.

hyperkalemia, hypokalemia) Drug toxicity (i.e. digoxin and drugs

which prolong the QT interval)

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Conduction System

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SA Node

Internodal branchAV NodeHiss BundlePurkinje Fiber

Contraction

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EKG waveforms and intervals

P wave : atrialdepolarisation

QRS complex :ventriculardepolarisation

T wave : ventricularrepolarisation

Atrial repolarisation

hidden by QRS

P

Q

R

S

T

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PR Interval

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ST Segment

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T Wave

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ECG LEADS

STANDARD LIMB LEADS I, II, III

AUGMENTED LIMB LEADS

aVR, aVL, aVF

PRECORDIAL LEADS

V1, V2, V3, V4, V5, V6

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Standard Limb Leads

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Standard Limb Leads

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Augmented Limb Leads

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All Limb Leads

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Precordial Leads

Adapted from: www.numed.co.uk/electrodepl.html

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PEMASANGAN

ELEKTRODE

PEMASANGAN ELEKTRODE EXTREMITAS Lengan kanan dan lengan kiri

Kaki kanan dan kaki kiri

PEMASANGAN ELEKTRODE DADA V1 = Parasternal kanan di ICS-4

V2 = Parasternal kiri di ICS-4

V4 = MCL kiri di ICS-5

V3 = Median antara V2 dgn V4 V5 = Para Axillair Line kiri di ICS-5

V6 = Median Axillair kiri di ICS-5

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Arrangement of Leads on the EKG

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Anatomic Groups(Septum)

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Anatomic Groups(Anterior Wall)

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Anatomic Groups(Lateral Wall)

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Anatomic Groups(Inferior Wall)

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MENGHITUNG DETAK JANTUNG

Menggunakan Mistar EKG

300 dibagi jumlah kotak besar antara

interval R-R 1500 dibagi jumlah kolom horizontal

antara interval R-R

Hitung banyaknya voltage R dalam6 sec dan dikalikan 10

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What is the heart rate?

(300 / 6) = 50 bpm

www.uptodate.com

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What is the heart rate?

(300 / ~ 4) = ~ 75 bpm

www.uptodate.com

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What is the heart rate?

(300 / 1.5) = 200 bpm

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The Rule of 300

It may be easiest to memorize the followingtable:

# of big

boxes

Rate

1 300

2 150

3 100

4 75

5 60

6 50

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What is the heart rate?

22 x 10 = 220 bpm

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The QRS Axis

By near-consensus, the

normal QRS axis is defined

as ranging from -30to +90.

-30to -90is referred to as a

left axis deviation (LAD)

+90to +180is referred to as

a right axis deviation (RAD)

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The Quadrant ApproachExamine the QRS complex in leads I and aVF todetermine if they are predominantly positive orpredominantly negative. The combination shouldplace the axis into one of the 4 quadrants below.

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Quadrant Approach: Example 1

Negative in I, positive in aVFRAD

The Alan E. Lindsay

ECG Learning Center

http://medstat.med.utah.

edu/kw/ecg/

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Quadrant Approach: Example 2

Positive in I, negative in aVF LAD

The Alan E. LindsayECG Learning Center

http://medstat.med.utah.

edu/kw/ecg/

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Tentukan jenis ritme

Hitung frekwensi-nya

Hitung axis

Hitung interval PR, QRS

Analisa gelombang P, QRS, ST dan T

Sistematika membaca EKG

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Normal Sinus Rhythm

Rhythm : RegularRate : 60 100P wave : Normal in configuration; precede each QRSPR : Normal ( 0. 12 0.20 seconds )QRS : Normal ( less than 0.12 seconds )

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SOAL 1

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SOAL 2

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SOAL 3

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