Elektrokardiografi Dasar

Dr. Isman Firdaus

Departemen Kardiologi dan Kedokteran Vaskular FKUI/
Pusat Jantung Nasional Harapan Kita, Jakarta.

Anatomi Jantung Normal

Sel Autoritmik
Fase
Depolarisasi
Fase
Repolarisasi
Fase Istirahat

Sel Kontraktil
Fase
Depolarisasi
Fase Plateu
Fase
Repolarisasi
Fase Istirahat

Beberapa keadaan yang dapat dinilai

melalui rekaman EKG

Gelombang P

: depolarisasi kedua atrium

Gelombang QRS : Depolarisasi kedua Ventrikel

Gelombang T

: Repolarisasi Kedua Ventrikel

Pola Membaca EKG

Irama (Rhytme)
Rate QRS
Aksis QRS
Morfologi Gelombang P
Interval PR
Durasi QRS
Morfologi QRS
Deviasi Segmen ST
Morfologi Gelombang T
Morfologi Gelombang U
Lain-lain (LVH,LV Strain,BBB,
QT interval)
Kesimpulan EKG

Nilai Normal :
Interval PR

0,12 s/d 0,20

Durasi QRS

0,04 s/d 0,12

Aksis Normal

- 300

s/d + 1100

Irama
Sinus Ritme
SinusTakikardi
Sinus Bradikardi
Sinus Aritmia
Irama Jungtional
Irama Idioventrikular
Irama Ventrikular
Takiaritmia (SVT,Atrial
Fibrilasi, Atrial
Fluter,VT)
Bradiaritmia (blok
konduksi AV)
Sinus Aritmia

Pemasangan Lead Terbalik

Aksis QRS

Contoh Pembacaan EKG

Irama SR, QRS rate 70x/mnt, QRS Axis
+450, Gel P normal, Interval PR 0,18,
Durasi QRS 0,08, rSR di V1-V2, ST
Depresi 1-2mm di II,III,aVF, T inverted
simetris di II,III,aVF.
Kesan : RBBB inkomplet dengan ST depresi
dan T inverted pada sadapan inferior.

EKG Abnormal
Penyakit Jantung Koroner
Sindroma Koroner Akut
Takiaritmia
Bradiaritmia
Gangguan Elektrolit
Kelainan Struktur Jantung : Kelainan Katup,
Pembesaran Ruang Jantung, Efusi Perikard,
penyakit jantung bawaan.

ACUTE CORONARY SYNDROME

ST Elevation

No ST Elevation

NSTEMI

Unstable Angina
N Qw Myocardial
Infarction

Qw Myocardial
Infarction
AHA Guidelines, 2000

Atherosclerosis Timeline
Foam
cells

Fatty
streaks

Intermediate
lesion

Atheroma

Fibrous
plaque

Complicated
lesion rupture

Endothelial Dysfunction
From First Decade

From 3rd decade

From 3rd decade

Growth mainly by lipid accumulation

From 4th decade

From 4th decade
Smooth
muscle and
collagen

Thrombosis
hematoma

Infark
Transmural

Infark
Subendokard

Inferior myocardial infarction

Small inferior distal RCA occlusion

ECG changes in leads II, III, and aVF

Mid LAD occlusion

after the first septal
perforator (arrow)

ECG : large anterior MI

Occlusion of diagonal
branch ( arrow )

ST elevation in I and aVL

Proximal large RCA occlusion

ST elevation in leads II, III, aVF, V5, and V6

with precordial ST depression

Small inferior distal RCA occlusion

ECG changes in leads II, III, and aVF

Early repolarization

Unstable angina

Subendocardial ischemia.
Anterolateral ST-segment depression

Acute anteroseptal myocardial infarction.

Hyperacute T-wave changes are noted

Acute anterolateral myocardial infarction

High lateral infarction

Lateral myocardial infarction

Inferior myocardial infarction

Inferior myocardial infarction.

Inferior Q waves with T-wave inversions

Acute inferoposterior myocardial infarction

Left ventricular aneurysm

Right bundle branch block

Left bundle branch block

Takiaritmia
Sinus Tachycardia
Accelerated Atrial Tachycardia/Paroxysmal Atrial
Tachycardia
Atrial Flutter
Atrial Fibrillation
Reentrant Junctional Tachycardia (Nodal & Bypass)
Multifocal Atrial Tachycardia
Ventricular Tachycardia

Physiologic Basis of Pacemaker

Cells

Pacemaking &
Conduction System

Perbedaan lokal pola potensial aksi

mVolt

PACE MAKER ACTIVITY

Ca2+

influx

If
influx

K+
efflux

-20
-40

TP

-60

MDP
Phase 4 depolarization

Time
Leonardo S Lilly,Pathophysiology of heart disease, 1998

PACE MAKER ACTIVITY

mVolt
0
-20
-40

TP

-60

MDP

-90

Phase 4 depolarization

More negatuveMDP

Time

Leonardo S Lilly,Pathophysiology of heart disease, 1998

Macroreentry

Atrial Flutter

Microreentry

Atrial Fibrillation

Macroreentrant and Microreentrant

Tachycardias

A Fib/Flutter spectrum

Types of RJT

Junctional Tachycardia (RJT)

Reentry within the atrioventriocular (AV) junction can
result in a single junctional premature beat (JPB) or in
sustained junctional tachycardia
Produces narrow-complex regular tachycardia without
preceding atrial depolarization waves
RJTs often produce retrograde atrial depolarization but
these waves are usually buried within the QRS complex

RJT Schematic diagram

Delta Waves

WPW Syndrome types

VES BIGEMINI

AVRT

WPW

BRADIARITMIA
First-Degree AV Block (prolong AV conduction)
Second-Degree AV Block ( Intermittent AV
Conduction)
- Mobitz Type 1 (Wenkebach)
- Mobitz Type 2
Third-Degree AV Block / Total AB Block ( No AV
Conduction)

First-degree AV block

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

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

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

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 wav
PR
: Varies greatly
QRS : Normal if block in His bundle;
wide if block involves bundle branches

Mobitz I

Mobitz II atrioventricular block

Atrioventricular dissociation secondary to complete heart block

High-grade atrioventricular block

Incomplete right bundle branch block

Right bundle branch block

Left bundle branch block

Wolff-Parkinson-White syndrome

Wolff-Parkinson-White syndrome

EKG PACEMAKER

NBG Code Review

I
Chamber
Paced

II
Chamber
Sensed

III
Response
to Sensing

IV
Programmable
Functions/Rate
Modulation

V: Ventricle

V: Ventricle

T: Triggered

P: Simple
programmable

P: Pace

A: Atrium

A: Atrium

I: Inhibited

M: Multiprogrammable

S: Shock

D: Dual (A+V)

D: Dual (A+V) D: Dual (T+I)

C: Communicating

D: Dual (P+S)

O: None

O: None

R: Rate modulating

O: None

S: Single

S: Single

(A or V)

(A or V)

O: None

O: None

V
Antitachy
Function(s)

Subhanallah 32 year-old with TAVB