M D

CRASH COURSEN
,
C I A
BASIC ECG & BASIC I ARRYTHMIA
FendraW
R A Wician, MD

N D
Internal
UKRIDA
Medicine Department
Faculty of Medicine
FE
 Learning Objectives
M D
1. Memahami tiap komponen dalam EKG
N
2. Memahami sistematika interpretasi
, EKG
secara singkat I A
C takiaritmia &
I
3. Mengetahui prinsip identifikasi
bradiaritmia
A W
D
takiaritmia
R
4. Mengetahui prinsip manajemen awal
& bradiaritmia
E N
F
 Elektrokardiografi
• pemeriksaan rekaman aktifitas listrik M
D
N , jantung
yang dikonduksikan melalui ion dalam tubuh
ke permukaan I A
IC
A W
D R
E N
F
 M D
N ,
I A
IC
A W
DR
E N
F
 1mV = 10mm
M D
N ,
I A
IC
A W 25 mm/s

25 mm ~ 1 s

DR 1mm ~ 1/25 s

E N
F
 M D
N ,
I A
IC
A W
DR
E N
F
 M D
N ,
I A
IC
A W
DR
E N
F
 Sistematika interpretasi EKG
M D
•
•
Rythm
Rate N ,
I A
IC
• Axis
•
•
A W
Chamber enlargement
Ischemia or infarct
• AV-Block
DR
•
N
Bundle branch block
E
F
 Sistematika interpretasi EKG
M D
,
1. Rhytm Normal sinus rhytm ? or NOT ?
2. Rate
3. Axis
I A N
1. P positif di II & negatif di aVR
2. Tiap P selalu diikuti QRS & T

IC
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. QRS complex
A W
6. Frekuensi Jantung (HR): 60 –100 /menit

7. ST segment
DR
N
8. QT interval

FE
9. T wave
10.U wave
 M D
N ,
I A
IC
A W
DR
1. P positif di II & negatif di aVR

E N2. Tiap P selalu diikuti QRS & T

F
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
M D
1. Rhytm
2. Rate N ,
1500 / RR (kotak kecil)
A
300 / RR (kotak sedang)

I
3. Axis
IC
“Rule of 300”

RR interval
Heart rate
1
300

A
2
W
150
3
100
4
75
5
60
6
50

“Rule
300/
1500/
of
6 (k.sdg)
300”
30 (k.kcl)
D
R
=650x/mnt
= 50x/mnt
50x/mnt

E N
F
 Sistematika interpretasi EKG
M D
1. Rhytm
2. Rate
N ,
3. Axis
I A
4. P wave IC
5. PR interval
6. QRS complex
A W
7. ST segment
DR
N
8. QT interval

FE
9. T wave
10.U wave
 Sistematika interpretasi EKG
M D
1. Rhytm
2. Rate
N ,
3. Axis
I A
4. P wave IC
5. PR interval
6. QRS complex
A W
7. ST segment
DR
N
8. QT interval

FE
9. T wave
10.U wave
 Sistematika interpretasi EKG
M D
1. Rhytm
2. Rate
N ,
3. Axis
I A
4. P wave IC
5. PR interval
6. QRS complex
A W
7. ST segment
DR
N
8. QT interval

FE
9. T wave
10.U wave
 M D
I
N ,
I A
IC
II
A W III

DR
E N
F
 M D
N ,
I A
IC
A W
DR
E N
F
 M D
N ,
I A
IC
A W
DR
E N
F
 Sistematika interpretasi EKG
M D
1. Rhytm
2. Rate
Atrium abnormality

N ,
3. Axis

C I A RA abn LA abn
4. P wave
I
5. PR interval
6. QRS complex
A W
DR
7. ST segment
8. QT interval

E
9. T waveN
F
10.U wave
 Sistematika interpretasi EKG
M D
1. Rhytm
2. Rate 1’ AV block  PR-I ↑
N ,
Konduksi dr SA ke AV & setelahnya

3. Axis
I A
2’ AVB tp I  PR-I ↑ prog + drop
4. P wave
IC
2’ AVB tp II  PR-I ttp + drop
5. PR interval
6. QRS complex
A W
3’ AVB  complete / disosiasi A&V

PR-I ↓  Preeksitasi. Co: WPW

DR
7. ST segment
8. QT interval

E
9. T waveN
F
10.U wave
 Sistematika interpretasi EKG
Ventricle abnormality

M D
1. Rhytm
2. Rate
N ,
Amplitude ↑  hipertrofi Vent LVH RVH

3. Axis
Interval ↑  BBB

I A LBBB RBBB

4. P wave
IC
5. PR interval
6. QRS complex
A W
DR
7. ST segment
8. QT interval

E N
9. T wave

F
10.U wave
 Sistematika interpretasi EKG
M D
1.
2.
Rhytm
Rate
Ischemia & infark

ST depresi
N , T inversi
3. Axis
I
ST elevasi

C A Q patologis
4.
5.
P wave
PR interval I Ciri Q patologis:

6. QRS complex
A W 1. Lebarnya >0,04 detik (1 mm)
2. Dalamnya >25% amplitudo
gelombang R
7.
8.
DR
ST segment
QT interval
Normal bila di aVR

9.
N
T wave
E
10.
F
U wave
 Sistematika interpretasi EKG
M D
1. Rhytm
2. Rate
N ,
3. Axis
I A
4. P wave
IC
5. PR interval
6. QRS complex
A W
DR
7. ST segment
8. QT interval

E
9. T waveN
F
10.U wave
 Sistematika interpretasi EKG
M D
1. Rhytm
2. Rate
N ,
3. Axis
I A
4. P wave
IC
5. PR interval
6. QRS complex
A W
DR
7. ST segment
8. QT interval

E
9. T waveN
F
10.U wave
 Sistematika interpretasi EKG
M D
1. Rhytm
2. Rate
N ,
3. Axis
I A
4. P wave
IC
5. PR interval
6. QRS complex
A W
DR
7. ST segment
8. QT interval

E
9. T waveN
F
10.U wave
 Sistematika interpretasi EKG
M D
,
1. Rhytm Normal sinus rhytm ? or NOT ?
2. Rate
3. Axis
I A N
4. P wave IC
5. PR interval
6. QRS complex
A W
7. ST segment
DR
N
8. QT interval

FE
9. T wave
10.U wave
 ARRYTHMIA
Normal sinus rhytm
M D
N ,
I A
IC
W
Sinus aritmia
A
DR
E N
F
 Takikardia Sinus

M D
N ,
I A
IC
W
Bradikardia Sinus
A
DR
E N
F
 M D
N ,
I A
IC
A W
DR
E N
F
 M D
N ,
I A
IC
A W
DR
E N
F
 Ekstrasistol Atrial

M D
N ,
I A
IC
W
Ekstrasistol Ventrikel

A
DR
E N
F
 CARDIAC ARRYTHMIA
M D
,
Tachyarrythmia
Arrythmia
Narrow QRS

I A N
Wide QRS

IC
A W
DR
E N Bradyarrythmia

F
 Tachyarrythmia
w/ pulse

M D
,
• Stable or Unstable?
• Narrow or Wide complex?
•

I A N
Regular or Irregular?

C
• Unstable  electrical

I cardioversion

A W Narrow stable
• Vagal man  adenos  rate
control

DR • Rate control

E N Wide stable
• Pharmaco cardioversion

F • Rate control?
• Trial adenos?
 M D
N ,
I A
IC
A W
DR
E N
F
 M D
N ,
I A
IC
A W
DR
E N
F
 M D
,
SUPRAVENTRICULAR TACHYCARDIA

N
I A
IC
A W
DR
E N
F
 Takikardia Ventrikel dan Torsade de Pointes

M D
N ,
I A
IC
W
Fibrilasi Ventrikel

A
DR
E N
F
 M D
N ,
I A
IC
A W
R
• Unstable or Stable?
D
N
• Unstable  intervention
E
F
SINUS ARREST & SA EXIT BLOCK

M D
N ,
I A
IC
A W
DR
E N
F
 M D
TERIMA KASIH N ,
I A
IC
A W
DR
E N
F
 M D
ECG QUIZN ,
I A
IC
A W
DR
E N
F
 CERDAS CERMAT EKG
M D
N ,
I A
IC
A W
DR
E N
F
 CERDAS CERMAT EKG
M D
N ,
I A
IC
A W
DR
E N
F
 CERDAS CERMAT EKG
M D
N ,
I A
IC
A W
DR
E N
F
 CERDAS CERMAT EKG
M D
N ,
I A
IC
A W
DR
E N
F
 CERDAS CERMAT EKG
M D
N ,
I A
IC
A W
DR
E N
F
 M D
N ,
I A
IC
A W
DR
E N
F
 M D
N ,
I A
IC
A W
DR
E N
F
 CERDAS CERMAT EKG
M D
N ,
I A
IC
A W
DR
E N
F
 CERDAS CERMAT EKG
M D
N ,
I A
IC
A W
DR
E N
F
 CERDAS CERMAT EKG
M D
N ,
I A
IC
A W
DR
E N
F
 M D
N ,
I A
IC
A W
DR
E N
F
 Fibrilasi Atrial

M D
N ,
I A
IC
Fluter Atrial

A W
DR
E N
F
 M D
N ,
I A
IC
A W
DR
E N
F
 M D
N ,
I A
IC
A W
DR
E N
F
 M D
N ,
I A
IC
A W
DR
E N
F
 M D
N ,
I A
IC
A W
• AbnormalD
R
E N P wave

F
 M D
N ,
I A
IC
A W
DR
E N
F
 M D
ADDITIONAL NOTES N ,
I A
IC
A W
DR
E N
F
ATRIAL FIBRILATION & STROKE RISK
M D
N ,
I A
IC
A W
DR
E N
F
 Normal Intervals
M D
Heart rate
N ,
60 - 100 beats/min
bradycardia < 60
I A
tachycardia IC
> 100
PR interval
A W 0.12 – 0.20 sec
QRS
QRS axisDR < 0.12 sec
- 30º to + 110º
E
QTc N < 0.45 sec
F
 LVH
M D
,
R
• S

I A N
IC
A W
DR
E N S

F
 M D
N ,
I A
IC
A W
DR
E N
F
 M D
N ,
I A
IC
A W
DR
E N
F
 M D
N ,
I A
IC
A W
DR
E N
F