INTERPRETASI ELEKTROKARDIOGRAFI

dr. Erlina Marfianti, MSc, SpPD

Departemen Ilmu Penyakit Dalam

Fakultas Kedokteran UII

Definisi

• EKG adalah grafik hasil catatan potensial listrik yang dihasilkan oleh denyut jantung

• EKG merupakan alat pembantu diagnostik. Penderita dengan kelainan jantung organik bisa menunjukkan gambaran EKG normal

• EKG bisa menunjukkan kelainan non spesifik pada orang sehat

Kegunaan EKG

• Beberapa kelainan jantung yang dapat diketahui dari EKG– Hipertrofi– Infark miokard– Aritmia– Gangguan elektrolit– Efek obat-obatan: misal digitalis– dll

Physiologic Properties of Myocardial Cells

• Automaticity : Ability to initiate an impulse• Excitability : Ability to respond to an impulse• Conducticity : Ability to transmit an impulse• Contractility : Ability to respond with pumping action

LEAD

Components of a NSR

Rekaman EKG baku telah ditetapkan bahwa:

a. Kecepatan rekaman : 25 mm/detik

b. Kekuatan voltage : 1 mv = 10 mm

Bearti ukuran di kertas EKG:

a. Pada garis horosontal

- Tiap 1mm = 1 kotak kecil = 1/25 detik = 0,04 detik

- Tiap 5mm = 1 kotak sedang = 5/25 detik = 0,20 detik

- Tiap 25 mm = 1,00 detik

Components of a NSR: P wave

1. Describe the sequence of right and left atrial2. Normal positif in lead I, II, aVF, and V4 – V63. Normal negative in lead aVR4. Duration < 0,12 sec5. Amplitudo < 2,5 mm

Components of a NSR : PR interval

1. Time needed to transmit impuls from SA node to AV node2. Normal 0,12 – 0,22 sec ( 3-5,5 small box)3. Short PR interval preeksitasion syndrome 4. Prolonged PR interval think about A-V block.

Components of a NSR :QRS complex

1. Describe activation of left and right ventrikel2. Duration 0,05 – 0,10 sec (<2,5 small box). 3. Measure usually in limbs lead4. If the amplitudo less than 10 mm in all leads low voltage. 5. Abnormal complex QRS seen in conduction defect

Components of a NSR :QRS complex

Nomenclature of complex QRS

• first negative deflection named Q wave• first positive deflection named R wave• negative deflection after R wave called S wave• R wave always above the baseline• Q`and S wave always below the baseline

Components of a NSR :QRS complex

Q wave

1. Normal Q wave seen in lead I, aVL, and V5-6. describe activation of septum left to right2. Q wave in V1-2 is abnormal3. Pathologic Q : duration > 0,04 sec and/ or height > dari 1/3 complex QRS

Components of a NSR:ST segment

Normal ST segment

1. Usually isoelectric, elevation < 1 mm in extremity still normal2. Depression < 0,5 mm3. Point at the end of QRS complex named J point

Components of a NSR:T wave

T wave criteria

1. Describe repolarization of ventricel 2. Normal positif in leads I,II and V3-V63. Normal negative in lead III

Components of a NSR:QT duration

QT duration

1. Describe total sistolic time2. variation according to heart rate, gender and age3. QT interval must be < ½ R-R interval in HR 65-90/mnt4. Normal QT correction 0,44 + 0,02 sec5. Prolonged QTc predispose R on T VT

How to report

Rhythm : - Heart rate :

- Axis :

- Transisional Zone :

- Interval

- PR :

- QRS :

- QT :

- Sign : Hipertrophi, iskemia, infark

CONCLUSION :

Rate

Rhytm(Irama)

Irama Sinus Normal

Irama jantung yang normal ialah irama yang ditentukan oleh simpul SA dan disebut irama sinus:

- Frekuensi antara 60-100 x/menit- Teratur- Gelombang P negatif di aVR dan positif di

II- Tiap gelombang P diikuti oleh kelompok

QRS T

Penyimpangan - ARITMIA

AXISSetiap vektor jantung mempunyai:

-Polaritas

-Arah

-Ukuran/Intensitas

Axis Deviation

-300

1800

-900

900

Normal

Left Axis

Right Axis

ExtremeRight Axis

Penentuan Sumbu QRS di Bidang Frontal

1. Secara praktis tentukan di sandapan I dan AVF

2. Tentukan di sandapan manakah terdapat keadaan ekuipotensial (nol)

Amplitudo di Ekuipotensial di

Sumbu

I AVF

Positif positif III +30

aVL +60

I +90

aVF 0

Positif Negatif II - 30

aVR - 60

I -90

Negatif Positif aVR +120

II +150

aVF +180

Negatif Negatif aVL -120

III - 150

AKSIS Posisi Jantung

-30 s/d -15-15 s/d +15

+ 15 s/d +45

+ 45 s/d +75

+ 75 s/d +110

+110 s/d + 180-30 s/d -90-90 s/d ± 180

Horizontal

Semi horizontal

Intermediate

Semi Vertikal

Vertikal

Deviasi Sumbu ke kanan

Deviasi sumbu ke kiri

Deviasi ke kanan hebat

PATHOLOGY

CORRELATION BETWEEN LOCATION OF ISCHAEMIC, ECG AND CORONARY ARTERY

ANATOMYLOCATION OF INFARCT/ ECG CORONARY ARTERY INVOLVEDISCHAEMIC

ANTERIOR EKSTENSIVE I, aVL, V1-V6 LAD, LCX

ANTEROSEPTAL V1- V3 LAD

ANTEROLATERAL I, aVL, V4- V6 LCX

INFERIOR II, III, aVF RCA, PDA

POSTERIOR V7- V9 PL (POSTEROLATERAL)

RV V3R – V5R RCA/ RV BRANCH

LAD Left Anterio Descenden.LCX circumflex.RCA Righ Cor.Art.

MYOCARDIAL INFARCTION

• Myocardial infarction is characterized by the necrosis of a portion of the myocard resulting from a lack of sufficient blood suply to keep the muscle viable.

• The most common cause is complete occlusion of coronary artery by atherosclerotic coronary trombosis.

Terminology of infarct

• Acute infarct : several hours untill days ECG : ST elevation

• Recent infarct : several days- weeks. ECG : evolution

• Old infarct : more than 6 months. ECG : Q wave or QS

complex or slow progression of R wave

CRITERIA LVH Chest lead (Sokolow, Lyon) :

S wave in V1 + R wave in V5 or V6 > 35 mm R in V5 or V6 > 26 mm.R plus S in any chest leads > 45 mm

Limb leads (Gubner, Ungerleider) :R in I + S in III > 25 mmR in aVF > 20 mmR in aVL > 11 mmR in aVR > 15 mm

LV Strain (Strain Pattern) = perubahan segmen ST dan gelombang T= depresi semen ST dan inversi T

Hipertrofi ventrikel kanan

• Deviasi aksis ke kanan (>+110)

• R V1> S V1

• Gelombang R yang tinggi di sandapan aVR

• Rotasi searah jarum jam