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ELEKTROKARDIOGRAM

ELEKTROKARDIOGRAM. EKG NORMAL. Kegunaan Pemeriksaan EKG. rekaman EKG 12 lead: Dalam batas normal Kelainan irama jantung Kelainan sistem konduksi Pembesaran atrium atau ventrikel Inflamasi, iskemia atau infark miokard Kelainan atau penyakit yang mempengaruhi kinerja otot jantung.

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ELEKTROKARDIOGRAM

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  1. ELEKTROKARDIOGRAM

  2. EKG NORMAL Kegunaan Pemeriksaan EKG rekaman EKG 12 lead: • Dalam batas normal • Kelainan irama jantung • Kelainan sistem konduksi • Pembesaran atrium atau ventrikel • Inflamasi, iskemia atau infark miokard • Kelainan atau penyakit yang mempengaruhi kinerja otot jantung

  3. EKG: MEMOTRET JANTUNG DARI SISI FRONTAL DAN HORIZONTAL

  4. Standard limb leads (Sandapan Ekstremitas)

  5. Augmented Leads

  6. EKG NORMAL Gambar 1.1 Sandapan baku bipolarlead I, II dan III dan Sandapan ekstrimitas diperkuat lead aVR, aVL dan aVF  potongan jantung secara vertikal

  7. Precordial Leads (Sandapan Dada)

  8. Sandapan Dada Kanan

  9. EKG NORMAL Gambar 1.3 Sandapan dada unipolar(prekordial)Lead V1, V2, V3, V4, V5 dan V6  potongan jantung secara horizontal

  10. EKG NORMAL Quality check (Q.C) setiap Elektrokardiogram ! 1. Kecepatan rekaman EKG 25 mm/detik (atau 50 mm/detik bila perlu) 2.Standardisasi EKG. Harus ada tanda 1 mV = 10 mm pada permulaan lead 3. Gelombang P “upright” (defleksi keatas, positif) di lead I 4. Gelombang P “downward” (negatif) di lead aVR 5. “R wave progression” 6. Lead I + lead III = Lead II 7.aVR + aVL + aVF = 0

  11. EKG NORMAL Gambar 1.4 Definisi dan ukuran PQRST

  12. EKG: rekaman aktivitas listrik jantung pada permukaan tubuh

  13. EKG NORMAL Standardisasi EKG Gambar 1.5 Tanda 1 mV atau 1/2 mV

  14. EKG NORMAL Gambar 1.7 Progresi gelombang R dan regresi gelombang S dari V1- V6

  15. EKG NORMAL Tabel 1.1 QRS kompleks : QRS interval normal 0,07 –0,11 detik, rata-rata 0,08 detik (2 mm=2 kotak kecil (KK)) amplitudo lebih dari 5 mm (0,05 mv)lead prekordial 10 mm (1,0 mv) Gelombang R tertinggi 30 mm (dewasa) Gelombang Q 0,03 detik, defleksi kebawah kurang dari 1 mm

  16. EKG NORMAL Tabel 2.1 QRS Axis Normal : - 30º sampai + 110º LAD patologis: - 30º sampai – 90º RAD patologis: > + 110º sampai + 180º EAD patologis: - 90º sampai – 180º

  17. EKG NORMAL Gambar 2.2 Mean QRS vektor

  18. EKG NORMAL Gambar 1.2 Sistem HEXAXIAL

  19. AXIS

  20. EKG NORMAL Gambar 2.1 QRS axis berdasarkan lead I dan aVF

  21. Langkah Interpretasi: • Rhythm • Rate • Axis • Hypertrophy • Ischemia • Infacrt

  22. EKG NORMAL Analisis / pembacaan rekaman EKG 1. Irama (cepat, lambat, reguler, irreguler) Heart rate atau kecepatan denyut jantung 2. Kelainan gelombang P, PR interval adakah extrasystole atrial 3. QRS axis, QRS interval Kelainan gelombang Q, R dan S Adakah extrasystole (PVC, PJC) 4. ST segment (Isoelektrik, depresi, elevasi) ST junction (normal, naik) Kelainan gelombang T QT atau QTC interval QRST angle Kesimpulan : interpretasi EKG

  23. Standar Penulisan hasil analisa EKG • Irama: sinus • HR: • Axis: • Gel P: • Interval PR: ….dtk • QRS kompleks: ….dtk • Gel Q patologis • Progresi R • Segmen ST: isoelektris, elevasi, depresi • Gel T: upright, flat, inverted • S V1/ SV2 + RV5/RV6 < 35

  24. Sinus tachycardia

  25. Supraven-tricular extrasystole

  26. Review of cardiac arrhythmias (1) : Arrhythmias with extopic impulse formationSUPREVENTRICULAR ARRHYTHMIAS

  27. EKG NORMAL Gambar 1.3 Sandapan dada unipolar(prekordial)Lead V1, V2, V3, V4, V5 dan V6

  28. HIPERTROFI

  29. Electrolytes & ECG • Most important being Potassium(K+), Calcium(Ca2+) Hyperkalemia • Renal Failure • Drugs eg. Slow K, ACE inhibitor, Spironolactone 19/2/2000

  30. Hyperkalaemia • Tall, symmetrical, ‘tented’ T wave - hallmark • widened QRS • PR interval prolonged • P wave flattened, eventually disappear • rarely, ST elevation in praecordial leads • Arrhythmias - VF 19/2/2000

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