CRASH COURSE

BASIC ECG & BASIC ARRYTHMIA

Fendra Wician, MD
Internal Medicine Department
UKRIDA Faculty of Medicine
 Learning Objectives
1. Memahami tiap komponen dalam EKG
2. Memahami sistematika interpretasi EKG
secara singkat
3. Mengetahui prinsip identifikasi takiaritmia &
bradiaritmia
4. Mengetahui prinsip manajemen awal
takiaritmia & bradiaritmia
 Elektrokardiografi
• pemeriksaan rekaman aktifitas listrik jantung
yang dikonduksikan melalui ion dalam tubuh
ke permukaan
1mV = 10mm

25 mm/s

25 mm ~ 1 s
1mm ~ 1/25 s
 Sistematika interpretasi EKG
• Rythm
• Rate
• Axis
• Chamber enlargement
• Ischemia or infarct
• AV-Block
• Bundle branch block
 Sistematika interpretasi EKG
1. Rhytm Normal sinus rhytm ? or NOT ?
2. Rate 1. P positif di II & negatif di aVR
3. Axis 2. Tiap P selalu diikuti QRS & T
3. Bentuk P pada satu lead sama & konstan
4. Interval P-P konstan
4. P wave
5. Interval PR normal : 0,12 –0,20 detik
5. PR interval 6. Frekuensi Jantung (HR): 60 –100 /menit
6. QRS complex
7. ST segment
8. QT interval
9. T wave
10. U wave
1. P positif di II & negatif di aVR
2. Tiap P selalu diikuti QRS & T
3. Bentuk P pada satu lead sama & konstan
4. Interval P-P konstan
5. Interval PR normal : 0,12 –0,20 detik
6. Frekuensi Jantung (HR): 60 –100 /menit
 Sistematika interpretasi EKG
1. Rhytm
2. Rate 1500 / RR (kotak kecil) 300 / RR (kotak sedang)

3. Axis “Rule of 300”

RR interval 1 2 3 4 5 6
Heart rate 300 150 100 75 60 50

300/
1500/
“Rule 6 (k.sdg)
of =650x/mnt
30 (k.kcl)
300” 
= 50x/mnt
50x/mnt
 Sistematika interpretasi EKG
1. Rhytm
2. Rate
3. Axis

4. P wave
5. PR interval
6. QRS complex
7. ST segment
8. QT interval
9. T wave
10. U wave
 Sistematika interpretasi EKG
1. Rhytm
2. Rate
3. Axis

4. P wave
5. PR interval
6. QRS complex
7. ST segment
8. QT interval
9. T wave
10. U wave
 Sistematika interpretasi EKG
1. Rhytm
2. Rate
3. Axis

4. P wave
5. PR interval
6. QRS complex
7. ST segment
8. QT interval
9. T wave
10. U wave
 I

II III
 Sistematika interpretasi EKG
1. Rhytm Atrium abnormality
2. Rate
3. Axis
4. P wave RA abn LA abn

5. PR interval
6. QRS complex
7. ST segment
8. QT interval
9. T wave
10. U wave
 Sistematika interpretasi EKG
1. Rhytm Konduksi dr SA ke AV & setelahnya
2. Rate
1’ AV block  PR-I ↑
3. Axis
2’ AVB tp I  PR-I ↑ prog + drop
4. P wave
2’ AVB tp II  PR-I ttp + drop
5. PR interval
3’ AVB  complete / disosiasi A&V
6. QRS complex
7. ST segment PR-I ↓  Preeksitasi. Co: WPW

8. QT interval
9. T wave
10. U wave
 Sistematika interpretasi EKG
Ventricle abnormality
1. Rhytm
Amplitude ↑  hipertrofi Vent LVH RVH
2. Rate
3. Axis Interval ↑  BBB LBBB RBBB

4. P wave
5. PR interval
6. QRS complex
7. ST segment
8. QT interval
9. T wave
10. U wave
 Sistematika interpretasi EKG
1. Rhytm Ischemia & infark
2. Rate ST depresi T inversi
3. Axis ST elevasi Q patologis
4. P wave
Ciri Q patologis:
5. PR interval 1. Lebarnya >0,04 detik (1 mm)
2. Dalamnya >25% amplitudo
6. QRS complex gelombang R
7. ST segment Normal bila di aVR
8. QT interval
9. T wave
10. U wave
 Sistematika interpretasi EKG
1. Rhytm
2. Rate
3. Axis
4. P wave
5. PR interval
6. QRS complex
7. ST segment
8. QT interval
9. T wave
10. U wave
 Sistematika interpretasi EKG
1. Rhytm
2. Rate
3. Axis
4. P wave
5. PR interval
6. QRS complex
7. ST segment
8. QT interval
9. T wave
10. U wave
 Sistematika interpretasi EKG
1. Rhytm
2. Rate
3. Axis
4. P wave
5. PR interval
6. QRS complex
7. ST segment
8. QT interval
9. T wave
10. U wave
 Sistematika interpretasi EKG
1. Rhytm Normal sinus rhytm ? or NOT ?
2. Rate
3. Axis

4. P wave
5. PR interval
6. QRS complex
7. ST segment
8. QT interval
9. T wave
10. U wave
ARRYTHMIA
Normal sinus rhytm

Sinus aritmia
 Takikardia Sinus

Bradikardia Sinus
 Ekstrasistol Atrial

Ekstrasistol Ventrikel
 CARDIAC ARRYTHMIA
Tachyarrythmia
Arrythmia
Narrow QRS Wide QRS

Bradyarrythmia
 Tachyarrythmia
w/ pulse
• Stable or Unstable?
• Narrow or Wide complex?
• Regular or Irregular?

• Unstable  electrical
cardioversion

Narrow stable
• Vagal man  adenos  rate
control
• Rate control

Wide stable
• Pharmaco cardioversion
• Rate control?
• Trial adenos?
SUPRAVENTRICULAR TACHYCARDIA
Takikardia Ventrikel dan Torsade de Pointes

Fibrilasi Ventrikel
• Unstable or Stable?
• Unstable  intervention
SINUS ARREST & SA EXIT BLOCK
TERIMA KASIH
ECG QUIZ
CERDAS CERMAT EKG
CERDAS CERMAT EKG
CERDAS CERMAT EKG
CERDAS CERMAT EKG
CERDAS CERMAT EKG
CERDAS CERMAT EKG
CERDAS CERMAT EKG
CERDAS CERMAT EKG
Fibrilasi Atrial

Fluter Atrial
• Abnormal P wave
ADDITIONAL NOTES
ATRIAL FIBRILATION & STROKE RISK
 Normal Intervals

Heart rate 60 - 100 beats/min

bradycardia < 60
tachycardia > 100
PR interval 0.12 – 0.20 sec
QRS < 0.12 sec
QRS axis - 30º to + 110º
QTc < 0.45 sec
 LVH
R
• S