EKG 12 SANDAPAN: SINDROM

KORONER AKUT
Definisi Infark Miokardium

Sindrom Koroner Akut adalah ketika oklusi

dari satu atau lebih arteri koroner terjadi,
biasanya akibat ruptur plak, sehingga suplai
oksigen menurun ke otot jantung
Iskemia, injuri dan nekrosis terjadi
 Diagnosing a ACS

Untuk menunjang diagnosa sindrom koroner

akut anda perlu lebih dari lebih dr EKG 1 strip &
mendapatkan EKG 12 sandapan.

12-Lead
ECG

Rhythm
Strip
The 12-Lead ECG

The 12-Lead ECG melihat jantung dr 12

titik pandang.
Oleh karena itu, 12-sandapan EKG
membantu Anda melihat apa yang terjadi
di bagian yang berbeda dari jantung.
EKG 1 strip hanya melihat 1 dari 12 titik
pandang.
The 12-Sandapan

12-Sandapan yaitu :
3 Sandapan
ekstremitas
(I, II, III)
3 Augmented leads
(aVR, aVL, aVF)
6 Precordial leads
(V1- V6)
Views of the Heart

Lateral portion
Some leads get a of the heart
good view of the:

Anterior portion
of the heart

Inferior portion
of the heart
Penempatan Elektroda
V7: Post-ax line
V8: ujung skapula
V9: antara V8 dan otot
paraspinous
 ECG Changes

Bentuk perubahan EKG dpt berupa:

ST elevation &
depression

T-waves

peaked flattened inverted

Appearance
of pathologic
Q-waves
 The Three Is

Iskemik= ST depression atau T-wave

inverted
Menunjukkan kurangnya oksigen ke jaringan
miokard
ST depression
 The Three Is

Infark = ST elevation menunjukkan prolonged

ischemia; signifikan bila lbh dr 1mm diatas baseline
The Three Is

Nekrosis = gel Q patologis defleksi

negatif pertama setlh gel P; lebar > 0,03 dtk,
kedalaman lbh dr 1/3 gel R
 Perubahan EKG & Perkembangan
MI
Non-ST Elevation
Tdpt 2 pola EKG
jika tjd infark

ST Elevation

ST Elevation (Transmural or Q-wave), or

Non-ST Elevation (Subendocardial or non-Q-wave)
 ST Elevation Infarction

The ECG changes seen with a ST elevation infarction are:

Before injury Normal ECG

Ischemia ST depression, peaked T-waves , lalu T-

wave inversion

Infarction ST elevation & dpt timbul gel Q

Fibrosis ST segments and gel T kembali

normal, tp gel Q muncul
What part of the heart is affected ?
II, III, aVF =

Inferior Wall

I aVR V1 V4
II aVL V2 V5
III aVF V3 V6
Inferior Wall MI
 Based on the EKG, which vessel in the heart is
blocked?

II, III & aVF = Inferior Wall MI =

Right Coronary Artery
blockage
Which part of the heart is affected ?

Leads V1, V2, V3, and V4 =

Anterior Wall MI

I aVR V1 V4

II aVL V2 V5

III aVF V3 V6
Anterior Wall MI
 Based on the EKG, which vessel in the heart is
blocked?

V1 - V4 = Anterior Wall
(Left Ventricle) =
Left Anterior
Descending Artery
Blockage
 What part of the heart is affected ?

I, aVL, V5 and V6

Lateral wall of left ventricle

I aVR V1 V4
II aVL V2 V5
III aVF V3 V6
Lateral Wall MI
 Based on the EKG, which vessel in the
heart is blocked?
I, aVL, V5 + V6 =
Lateral Wall =
Circumflex Artery
Blockage
Non-ST Elevation Infarction

Heres an ECG of an inferior wall MI later in time:

Now what do
you see in the
inferior leads?

ST elevation,
Q-waves and
T-wave
inversion
Petunjuk deteksi diinfark
koroner (ventrikel) kanan
ST Elevasi di II, III, aVF
ST Elevasi di V1
Resiprokal di ST depresi di I, aVL
ST elevasi di III > ST elevation di II

Lakukan perekaman di area jantung kanan

(V3R, V4R)
Posterior AMI
Tdk ada elektroda khusus bag posterior.
Ditandai depresi ST pada lead V1 - V4 menunjukkan
oklusi arteri L. CX
ST depresi dianggap resiprokal/gbran cermin dr ST elevasi
ST di dinding posterior.

Dapat mindikasi infark posterior ventrikel

Lakukan perekaman bagian poasterior u/
memastikan
Gel Q tampak sbg gel R yg tinggi
ST elevasi tampak sbg ST depresi
Gel T inverted tampak sbg gel T positif
POSTERIOR WALL AMI

ST Segment Depression in V1-V3 and posterior

thoracic leads with STE
NEXT SLIDE FOR INTERPRETATION
There is ST elevation in II, III, and aVF suggestive of an inferior STEMI. There is ST depression in
I and the lateral leads, likely reciprocal changes. There is ST depression, R waves and upright T
waves in V1-3 suggestions of posterior MI. This is a IPMI (Infero-Posterior Myocardial Infarction).
This patient should have a posterior EKG to define the extent of the MI.
ST elevation (>1mm) in
V8 and V9 confirms
posterior involvement.
Non-ST Elevation Infarction

The ECG changes seen with a non-ST elevation infarction are:

Before injury Normal ECG

Ischemia ST depression & T-wave inversion

Infarction ST depression & T-wave inversion

Fibrosis ST kembali ke baseline, tp T-wave

inversion msh ada
Non-ST Elevation Infarction

Heres an ECG of an evolving non-ST elevation MI:

Note the ST
depression and
T-wave
inversion in
leads V2-V6.

Question:
What area of
the heart is
infarcting?

Anterolateral
?QUESTIONS?

The PRIME ECG Technology

Single-patient Disposable Vest

Easily-applied, self-adhesive plastic strips
containing 80 data collection points
Strips allow analysis of the hearts electrical
activity with 360 degrees of spatial resolution
Data from the 80 leads are processed into
3-D color maps for easy visualization
Placement of the 80 Leads Provides
a Comprehensive View of the Heart
64 anterior and 16 posterior leads
Conventional V leads 1-6 are marked
PRIME ECG Allows You to Investigate
Data from All 80 Leads

View a single 10-second recording for leads of interest

 PRIME ECG Provides a 3-D, Color-coded,
Anatomically-referenced Visualization of the Injury

ST-segment elevation and depression are

translated into colors:
Red = ST elevation
Blue = ST depression
Green = No deflection

3-D Color Representation

of the 80-Lead ECG