MUST KNOW - ECG

(For UKMPPD)
@wisdakusuma
KARDIO / JANTUNG
1. Cardiac arrest -> algoritma syok/non syok -> VF, VT, AF,
AFlutter
2. Tachiaritmia HR>150
3. Bradiaritmia HR<50
4. Pembesaran ruang Jantung
1. Atrium kanan (p pulmonal)
2. Attrium kiri (p mitral, “McD”)
3. Ventrikel kanan (defleksi + di V1, RAD)
4. Ventrikel kiri (R di V5/V6 >27, atau kalua + S di V1 >35)
5. AV Block
6. RBBB dan LBBB -> QRS melebar, dan rSr (kayak huruf M) di
V1/v2( R) di V5/V6 (L)
7. ACS-> STEMI -> liat tabel
 HENTI JANTUNG

PINGSAN PIKIRKAN

TAK ADA NADI

HENTI
TAK SADAR JANTUNG

Tidak bernafas
normal
 Basic Life Support (BLS)
SRS-CAB
• Safety -> pindahkan korban ke tempat aman
• Response -> cek respon / nyeri
• Shout for Help -> panggil bantuan / ambulans
• Circulation -> Cek Nadi!
• Airway -> obstruction?
• Breathing –> Look Listen Feel
Sampai datang monitor / defibrilator,
kemudian ikuti algoritma ACLS
Setelah alat defibrilator datang…
Hanya ada 2 macam irama
• Shockable (bisa di-”setrum”)

VENTRIKULAR TAKIKARDIA
TANPA NADI
(pulseless VT)

VENTRIKULAR FIBRILASI
Hanya ada 2 macam irama
• Unshockable (tidak bisa di-”setrum”)

PULSELESS ELECTRICAL
ACTIVITY (PEA)
EKG yang bukan VT, bukan
VF, bukan asistol tapi pasien
henti jantung

ASISTOL (“FLAT”)
 Harus diapakan pertama kali?

VENTRIKEL FIBRILASI
( VF )
DEFIBRILASI+RJP
VENTRIKEL TAKIKARDI
( VT TANPA NADI )
HENTI
JANTUNG

PEA
RJP

ASYSTOLE
 Irama EKG lain (tidak henti jantung)

SUPRAVENTRIKULAR
QRS SEMPIT

VENTRIKULAR
QRS LEBAR
VENTRIKEL FIBRILASI

TX : DEFIB
VENTRIKEL TAKIKARDI
TANPA NADI

TX : DEFIB
 VENTRIKEL TAKIKARDI
DENGAN NADI

DILIHAT STABIL ATAU TIDAK

PULSELESS ELECTRICAL ACTIVITY
( PEA )
 ASYSTOLE

IS IT TRUE ASYSTOLE?
ATRIAL FIBRILASI
ATRIAL FLUTTER
SUPRA VENTRICULAR TAKIKARDI

TX : VAGAL MANUVER, ADENOSIN

What is the heart rate?

www.uptodate.com

(300 / 6) = 50 bpm
What is the heart rate?

www.uptodate.com

(300 / 4) = ~ 75 bpm
What is the heart rate?

(300 / 1.5) = 200 bpm

AXIS

Defleksi positif Defleksi negatif

Sindroma Koroner Akut
• Dapat (tidak selalu) ditandai dengan perubahan
pada segmen ST (baik elevasi maupun depresi)
 Elevasi segmen ST (ST elevation)
www.cvphysiology.com
STEMI
1. ST Elevation with ‘evolution’
- ≥ 1 kotak pada lebih dari LEAD II,III,aVF dan I - aVL
- ≥ 2 kotak in V1-V6
2. New LBBB

NON STEMI
ST depression ≥ 1 kotak
T inverted > 2 kotak
Depresi segmen ST (ST
depression)
 LOKASI ELEVASI/DEPRESI ARTERI KORONER YANG
LOKASI INFARK SEGMEN ST TERLIBAT (TERSERING)
MIOKARD AKUT

ANTERIOR LEAD V3, V4 LAD CABANG DIAGONAL

LAD CABANG SEPTAL,

ANTEROSEPTAL LEAD V1, V2, V3, V4
CABANG DIAGONAL

ANTERIOR
LEAD I, aVL, V2-V6 LAD PROXIMAL
EKTENSIF

INFERIOR LEAD II, III, aVF RCA

LAD CABANG DIAGONAL

LATERAL LEAD I, aVL, V5 DAN V6 DAN ATAU CABANG
SIRKUMFLEKS
POSTERIOR LEAD V7, V8, DAN V9 RCA
Atrial Hypertrophy
 Right atrial enlargement
 Tall, peaked p wave
 Left atrial enlargement
 Widening p wave, M-shape, notched
 Deep, negative component p wave in V1
RAH LAH
Ventricular Hypertrophy
 LVH (Sokolow, Lyon)
 S in V1 + R in (V5 or V6) > 35 mm
 R in V5 or V6 > 27 mm
 R + S in precordial leads > 45 mm
 RVH
• Right axis deviation of +110° or more.
• Dominant R wave in V1 (> 7mm tall or R/S ratio > 1).
• Dominant S wave in V5 or V6 (> 7mm deep or R/S ratio < 1).
• QRS duration < 120ms (i.e. changes not due to RBBB).
LVH
RVH
SUPRAVENTRICULAR TACHYCARDIA
Atrial Flutter :
-The result of a re-entry circuit within
the atria
-Irregular / regular QRS rate
-Narrow QRS complex
-Rapid P waves (300x/min), “sawtooth”
Atrial Fibrillation :

-from multiple area of re-entry within atria

-or from multiple ectopic foci
-irregular, narrow QRS complex
-very rapid atrial electrical activity
(400-700 x/min).
-no uniform atrial depolarization
ATRIAL FIBRILATION
Junctional rhythm:
-AV junction can function as a pace maker
(40-60 x/min).
-due to the failure of sinus node to initiate
time impulse or conduction problem.
-normal-looking QRS.
-retrograde P wave.
-P wave may preceede, coincide with, or
follow the QRS
JUNCTIONAL RHYTM
 VES (Ventricular Extra Sistole)

SR

VES
VES
Ventricular Tachycardia
Ventricular Fibrillation
PULSELESS ELECTRICAL ACTIVITY
(PEA)
First-degree AV block

Rhythm : Regular
Rate : Usually normal
P wave : Sinus P wave present; one P wave to each QRS
PR : Prolonged ( greater than 0.20 seconds )
QRS : Normal
 1st degree AV block

Prolonged PR interval
Second -degree AV block, Mobitz I

Rhythm : Irregular
Rate : Usually slow but can be normal
P wave : Sinus P wave present;
some not followed by QRS complexes
PR : Progressively lengthens
QRS : Normal
PR memanjang , konstan
 2nd degree AV block, type 1

Missing QRS Missing QRS

PR memanjang progresif, lalu QRS hilang
Second-degree AV block, Mobitz II

Rhythm : Regular usually;

can be irreguler if conduction ratios vary
Rate : Usually slow
P wave : Two, three, or four P waves before each QRS
PR : PR interval of beat with QRS is constant;
PR interval may be normal or prolonged
QRS : Normal if block in His bundle;
wide if block involves bundle branches
2nd degree AV block, type 2

Missing QRS
PR normal atau memanjang,
Namun QRS tiba-tiba hilang
Third-degree AV block

Rhythm : Regular
Rate : 40 – 60 if block in His bundle;
30 – 40 if block involves bundle branches
P wave : Sinus P wave present; bear no relationship to QRS;
can be found hidden in QRS complexes and T waves
PR : Varies greatly
QRS : Normal if block in His bundle;
wide if block involves bundle branches
 Total AV Block /3rd degree AV block

QRS QRS QRS

P P P P P P P
P dan QRS jalan sendiri-sendiri
 1st degree

2nd degree, Mobitz 1

2nd degree, Mobitz 2

3st degree
 Right Bundle Branch Block
QRS melebar dengan gel. rSR atau RSR’ di V1/V2/V3, Gel. S lebar dan slurred di I, aVL, V5-V6
RBBB
Left Bundle Branch Block
QRS melebar (>120ms) dengan gel R bentuk “M” di I/V5/V6, dominan gel. S di V1
LBBB