dr. Hilfan Ade Putra Lubis, Sp.

JP (K)
 SA node
Sumber impuls normal/
alamiah , 60 – 100

AV node
Bisa mengeluarkan
impuls 40-60x/menit

Berkas His
Serabut Purkinje

Ventrikel
Bisa mengeluarkan impuls
20-40 x/menit
 +
-
positive

- +
negative

- +
Bifasik
 Sandapan bipolar
Merekam perbedaan potensial dari 2 elektroda
I = lengan kanan (-)  lengan kiri (+)
II = lengan kanan (-)  tungkai kiri (+)
III = lengan kiri (-)  tungkai kiri (+)
 Sandapan unipolar
- Merekam potensial listrik pada satu elektroda
yang lain sebagai elektroda indiferen (0)
- Ada dua sandapan: ekstremitas & prekordial
Sandapan unipolar ekstremitas
avR, avL, avF -
Sandapan prekordial
V1,V2,V3,V4,V5,V6
 Gelombang P
• Depolarisasi Atrium
R • Diikuti kontraksi atrium
• Sinus Ritme : + di II
• Sinus Ritme : - di avR
• N ; lebar < 0,12 dtk
• N : tinggi < 0,3 mV
P T
U

Q
S
Depolarisasi
atrium
 Gelombang QRS
• Depolarisasi ventrikel
• Diikuti kontraksi ventrikel
• Lebar 0,06 - 0,12 dtk
Depolarisasi ventrikel
• Tinggi tergantung lead
R • Q patologis: tanda infark miokard
• Transisisonal zone untuk gel. R

Q
S
Gelombang T
• Repolarisasi ventrikel
• Diikuti relaksasi ventrikel
• + di lead : I,II,V3-V6
• - di lead avR

Repolarisasi ventrikel
1. Calibration
2. Rate and rhythm
3. QRS axis
4. P morphology
5. PR interval
6. QRS duration
7. QRS morphology
8. ST segment morphology
9. T morphology
10. Others: LVH, LV strain, BBB
11. Conclusion: normal/abnormal
1. RATE
Normal heart rate : 60 – 100 x/minutes
• > 100 x/minutes : Sinus Tachycardia
• < 60 x/minutes : Sinus Bradicardia

Determination heart rate (normal paper speed 25 mm/s):

• 300
Count number of large square (bold boxes in one R – R’ interval)
• 1500
Count number of small square in one R – R’ intervals
• Number of QRS complex in 6 seconds, multiply by 10
2. RHYTHM

Normal cardiac rhythm : SINUS rhythm

Sinus rhythm characteristics :

• Rate 60-100 bpm
• Constant R – R interval
• Negative P wave in aVR and positive di II
• P wave is always followed by QRS complex
3. AXIS
4. HYPERTROPHIC SIGNS
 ACUTE CORONARY SYNDROME

No ST Elevation ST Elevation

NSTEMI

Unstable Angina
STEMI Non STEMI
EKG PADA ISKEMIA MIOKARD
EKG PADA INJURI MIOKARD & EVOLUSINYA
CAUSE OF CARDIAC ARRHYTHMIAS :

• Disturbances in automaticity : bertambah cepat

atau bertambah lambatnya suatu daerah otomatisitas.
Misal di sinus node, AV node, abnormal beats/
depolarisasi atrium, AV junction, ventrikel, VT, dll.

• Disturbances in conduction : konduksi terlalu cepat

(WPW) atau terlalu lambat (blok AV).

• Combinations of altered automaticity and

conduction.
Tachyarrhythmia Bradyarrhytmia
(rate >100 x/min) (rate < 60 X/min)

• QRS sempit (<0.12 ms) • AV blok derajat 1, 2 & 3

• QRS lebar (>0.12 ms) • RBBB & LBBB
 Lebar gel. QRS

 Keteraturan gel. QRS

P wave ??
 QRS sempit

Irama
Irama Teratur
Tidak teratur

Supraventricular
Sinus Tachycardia Atrial Fibrillation
Tachycardia

Atrial Flutter
SVT :
-due to re-entry mechanism
-narrow QRS complex
-regular
-retrograde atrial depolarization
-P wave ?
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 Flutter :
-The result of a re-entry circuit within
the atria
-Irregular / regular QRS rate
-Narrow QRS complex
-Rapid P waves (300x/min), “sawtooth”
 QRS lebar

Irama
Irama Teratur
tidak teratur

Ventricular Ventricular
Tachycardia Fibrillation
Ventricular Tachycardia
Torsade de Pointes
Ventricular Fibrillation
Failure of impulse AV conduction
formation abnormalities
 Sinus Bradycardia  1st and 2nd AV Block
 Sick Sinus Syndrome  Total AV Block
 BBB (Bundle Branch
Block)
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
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 waves
PR : Varies greatly
QRS : Normal if block in His bundle;
wide if block involves bundle branches
Treat the patient not the monitor