Copy of Ecg Basic
Transcript of Copy of Ecg Basic
Cara membuat rekaman Cara membuat rekaman EKGEKG
Syamsu IndraSyamsu Indra
Division of Cardiology, Division of Cardiology, Dept of Internal Medicine, Dept of Internal Medicine,
Sriwijaya University,Sriwijaya University,Dr. Moh Hoesin General HospitalDr. Moh Hoesin General Hospital
POKOK BAHASANPOKOK BAHASAN
1. Persiapan pasien1. Persiapan pasien
2. pelaksanaan perekaman(posisi standard dan posisi 2. pelaksanaan perekaman(posisi standard dan posisi
tidak standard)tidak standard)
3. Pengertian kertas EKG3. Pengertian kertas EKG
4. Pengertian EKG 12 lead4. Pengertian EKG 12 lead
5. EKG layak baca(identitas jelas & gelombang-5. EKG layak baca(identitas jelas & gelombang-
gelombang standar sesuai dg kriteria normal.gelombang standar sesuai dg kriteria normal.
Anatomical PositionAnatomical Position of the Heart of the Heart
Lies in the mediastinum behind the sternumLies in the mediastinum behind the sternum
between the lungs, just above the diaphragmbetween the lungs, just above the diaphragm
the apex (tip of the left ventricle) lies at the fifth intercostal space, the apex (tip of the left ventricle) lies at the fifth intercostal space, mid-clavicular linemid-clavicular line
Location of The Heart in The ThoraxLocation of The Heart in The Thorax
Surfaces of the Left VentricleSurfaces of the Left Ventricle
Inferior - underneathInferior - underneath
Anterior - frontAnterior - front
Lateral - left sideLateral - left side
Posterior - backPosterior - back
Coronary Artery SystemCoronary Artery System
Coronary Artery CirculationCoronary Artery Circulation Left Main Stem Artery divides in two:Left Main Stem Artery divides in two:
Left Anterior Descending Left Anterior Descending ArteryArtery
antero-lateral surface of antero-lateral surface of left ventricleleft ventricle2/3 interventricular 2/3 interventricular septumseptum
Circumflex ArteryCircumflex Arteryleft atriumleft atriumlateral surface of left lateral surface of left ventricleventricle
From : Sheelagh Scott, Practice Development Centre, NHS Lanarkshire
What does cardiovascular system do?
The Conduction System of The HeartThe Conduction System of The Heart..
Conduction SystemSinoatrial (SA) node– Natural pacemaker– Automaticity– Atrial contraction– Produces the P wave
Conduction System
Atrio-Ventricular Node– Allows conduction from
atria to ventricles– Occurs slowly– Normal delay of
0.12 to 0.20 seconds– Produces PR interval
on EKG
Conduction System
His Bundle & Bundle Branches– Beginning of ventricular system– Depolarization occurs rapidly– Immediately bifurcates
into L & R bundles– Bundles are Purkinje fibers
His Bundle
R Bundle
L Bundle
Conduction SystemPurkinje fibers then
depolarize the ventricles
Produces a QRS complex
on the EKG
Aktifita SA node (pace maker alamiah)
Miokardium atrial : Depolarisasi (P): repolarisasi (Ta)
Jalur internodal
Nodus AV
Bundle His
Bundle Branches
Miokardium ventrikel: depolarisasi (QRS), repolarisasi (T)
Sistim konduksi jantung
Gambar sistim konduksi Jantung
Apa yang direkam ?Apa yang direkam ?
Potensial listrik yang merupakan jumlah Potensial listrik yang merupakan jumlah keseluruhan dari arus listrik yang keseluruhan dari arus listrik yang dihasilkan oleh setiap sel otot jantung.dihasilkan oleh setiap sel otot jantung.
Tahun 1903 Willem Einthoven dengan Tahun 1903 Willem Einthoven dengan menggunakan string galvanometer menggunakan string galvanometer menghasilkan beberapa menghasilkan beberapa konvensikonvensi mengenai kelistrikan ini.mengenai kelistrikan ini.
ElectrophysiologyElectrophysiology
If an electrode is placed so that wave of If an electrode is placed so that wave of depolarization spreads toward the depolarization spreads toward the recording electrode, the ECG records a recording electrode, the ECG records a positive (upward) deflection.positive (upward) deflection.
If wave of depolarization spreads away If wave of depolarization spreads away from recording electrode, a negative from recording electrode, a negative (downward) deflection occurs.(downward) deflection occurs.
ElectrophysiologyElectrophysiology
Cardiac Current FlowCardiac Current Flow
Cardiac Current FlowCardiac Current Flow
ECG Time & VoltageECG Time & Voltage
ECG machines can run at 50 or 25 ECG machines can run at 50 or 25 mm/sec.mm/sec.
Major grid lines are 5 mm apart, at Major grid lines are 5 mm apart, at standard 25 mm/s, 5 mm corresponds standard 25 mm/s, 5 mm corresponds to .20 seconds.to .20 seconds.
Minor lines are 1 mm apart, at standard 25 Minor lines are 1 mm apart, at standard 25 mm/s, 1 mm corresponds to .04 seconds.mm/s, 1 mm corresponds to .04 seconds.
Voltage is measured on vertical axis.Voltage is measured on vertical axis.
Standard calibration is 0.1 mV per mm of Standard calibration is 0.1 mV per mm of deflection.deflection.
ElectrophysiologyElectrophysiology
When myocardial muscle is completely When myocardial muscle is completely polarized or depolarized, the ECG will not polarized or depolarized, the ECG will not record any electrical potential but rather a record any electrical potential but rather a flat line, flat line, isoelectric lineisoelectric line..
After depolarization, myocardial cells After depolarization, myocardial cells undergo repolarization to return to undergo repolarization to return to electrical state at rest.electrical state at rest.
Dimana Lokasi Merekam ?Dimana Lokasi Merekam ?Pertimbangkan aspek anatomi !Pertimbangkan aspek anatomi !
Limb leadsLimb leads Chest LeadsChest Leads
Limb LeadsLimb Leads
3 Bipolar Leads 3 Bipolar Leads
form (Einthovens Triangle)form (Einthovens Triangle)
Lead I Lead I - measures electrical potential - measures electrical potential
between right arm (-) and left arm (+)between right arm (-) and left arm (+)
Lead IILead II - measures electrical potential - measures electrical potential
between right arm (-) and left leg (+)between right arm (-) and left leg (+)
Lead IIILead III - measures electrical potential - measures electrical potential
between left arm (-) and left leg (+)between left arm (-) and left leg (+)
Limb LeadsLimb Leads
3 Unipolar leads3 Unipolar leads
avR - right arm (+)avR - right arm (+)avL - left arm (+)avL - left arm (+)avF - left foot (+)avF - left foot (+)
note that right foot is a note that right foot is a ground leadground lead
Limb lead tampak dari jantung dalam bidang vertikal
Lead prekordial terletak dalam bidang horizontal
Perspektif lead vertikal dan horizontal
RIGHT
Antero-SeptalV1,V2, V3,V4
Lateral I, AVL, V5, V6
LEFT
Inferior II, III, AVF
V1-V2: 4th intercostal space –R/L of sternumV4: 5th intercostal space – midclavicle lineV3: Between V2 and V4V5: At horizontal level of V4, anterior to axillaV6: Midaxillary at horizontal level of V4
Lokasi Lead Prekordial
V1 : Sisi kanan sternum ICS 4V2 : Sisi kiri sternum ICS 4V3 : Antara V2 dan V4V4 : Mid klavikula kiri ICS 5V5 : Garis aksilaris ant ICS 5V6 : Garis mid aksilaris ICS 5V3R : simetris V3, di kananV4R : simetris V4, di kanan
ELEKTRODE PREKORDIAL
ELEKTRODE ELEKTRODE EKSTRIMITASEKSTRIMITASDAN DAN PREKORDIALPREKORDIAL
Limb leadsLimb leads Chest LeadsChest Leads
The standard 12 Lead ECGThe standard 12 Lead ECG
6 Limb Leads 6 Limb Leads 6 Chest Leads (Precordial leads)6 Chest Leads (Precordial leads)avR, avL, avF, I, II, IIIavR, avL, avF, I, II, III V1, V2, V3, V4, V5 and V6 V1, V2, V3, V4, V5 and V6
Rhythm StripRhythm Strip
Bagaimana Merekam ?Bagaimana Merekam ?
Pasien dalam keadaan tenang / rileks.Pasien dalam keadaan tenang / rileks.
Letakkan 12 lead dgn benar dan Letakkan 12 lead dgn benar dan firm.firm.
Limb leadLimb lead– Lead I, II dan IIILead I, II dan III
Augmented limb leadAugmented limb lead– aVR, aVL dan aVFaVR, aVL dan aVF
Precordial / Chest leadPrecordial / Chest lead– V1 – V6V1 – V6
Recording an ECGRecording an ECG
1. Explain procedure to patient, obtain consent and check for allergies
2. Check cables are connected
3. Ensure surface is clean and dry
4. Ensure electrodes are in good contact with skin
5. Enter patient data
6. Wait until the tracing is free from artifact
7. Request that patient lies still.
8. Push button to start tracing
Ingat bahwa ke – 12 lead tersebut akan Ingat bahwa ke – 12 lead tersebut akan merekam secara sama persis dengan merekam secara sama persis dengan kejadian / aktivitas listrik di dalam kejadian / aktivitas listrik di dalam jantung !!!jantung !!!
Posisi dan orientasi lead yang berbeda Posisi dan orientasi lead yang berbeda akan memberikan hasil yang berbeda. akan memberikan hasil yang berbeda.
Mengelola RekamanMengelola Rekaman
Identitas pasienIdentitas pasienWaktu --- sekuensialWaktu --- sekuensialLayak baca ??Layak baca ??– Identitas dan waktu rekamIdentitas dan waktu rekam– Ada tanda kalibrasi ½, 1 atau 2 mV dan kecepatan Ada tanda kalibrasi ½, 1 atau 2 mV dan kecepatan
(EKG non computer reading)(EKG non computer reading)– Gelombang P di lead aVR hampir selalu negatif Gelombang P di lead aVR hampir selalu negatif – Rekaman di V1-6 tidak boleh sama.Rekaman di V1-6 tidak boleh sama.
Copyright ©2002 BMJ Publishing Group Ltd.
Meek, S. et al. BMJ 2002;324:415-418
Kalibrasi EKG
0,20 SEC
0,5 mV5 mm
0,04 sec
0,1 mV1 mm
Kertas Grafik EKG
Kecepatan kertas (standard)25 mm/menit
Bisa 50,100/mnt
Cara Membaca EKGCara Membaca EKG
Menentukan iramaMenentukan irama
Menentukan heart rateMenentukan heart rate
Menentukan aksis Menentukan aksis
Menentukan IntervalMenentukan Interval
Kesimpulan Kesimpulan EKG yang layak baca harus menyampaikan hasil EKG yang layak baca harus menyampaikan hasil
perekaman yang benar yaitu :perekaman yang benar yaitu :
Ada data pasien yang direkamAda data pasien yang direkamDilakukan peneraan sebelum proses perekamanDilakukan peneraan sebelum proses perekamanGelombang P selalu positif di lead II dan negative di Gelombang P selalu positif di lead II dan negative di aVRaVR
TERIMA KASIHTERIMA KASIH