Dr Hananto Adriantoro, SpJP

Departemen Kardiologi dan Vaskuler FKUI

National Cardiac Center Harapan Kita
Jakarta
2004

Conduction System

SA Node
Internodal branch
AV Node
Hiss Bundle
Purkinje Fiber
Contraction

The Electrocardiogram ( ECG )

P wave : atrial
depolarisation
QRS complex :
ventricular
depolarisation
T wave : ventricular
repolarisation
Atrial repolarisation
hidden by QRS

P Wave

P Pulmonale

P Mitrale

PR Interval

QRS Complex

ST Segment

T Wave

Normal Sinus Rhythm

Rhythm : Regular
Rate : 60 100
P wave : Normal in configuration; precede each QRS
PR
: Normal ( 0. 12 0.20 seconds )
QRS : Normal ( less than 0.12 seconds )

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

Wolff-Parkinson-White syndrome

ST depresi dan perubahan gelombang T

ST depresi dianggap bermakna bila > 1 mm di bawah garis dasar PT di titik J
Titik J didefinisikan sebagai akhir kompleks QRS dan permulaan segmen ST
Bentuk segmen ST :
up-sloping ( tidak spesifik )
horizontal ( lebih spesifik untuk iskemia )
down-sloping ( paling terpercaya untuk iskemia )

Perubahan gelombang T pada

iskemia kurang begitu spesifik
Gelombang T hiperakut
kadang2 merupakan satu-satunya
perubahan EKG yang terlihat

Anatomi Koroner dan EKG 12 sandapan

Sandapan V1 dan V2 menghadap septal area ventrikel kiri
Sandapan V3 dan V4 menghadap dinding anterior ventrikel kiri
Sandapan V5 dan V6 ( ditambah I dan avL ) menghadap
dinding lateral ventrikel kiri
Sandapan II, III dan avF menghadap dinding inferior ventrikel kiri

Unstable angina

Acute anteroseptal myocardial infarction.

Hyperacute T-wave changes are noted

Acute anterolateral myocardial infarction

High lateral infarction

Inferior myocardial infarction

Acute inferoposterior myocardial infarction

LVH

LVH

LVH

RVH

RVH

RVH