Matrikulasi Interpretasi Ekg

Interpretasi Interpretasi ElectrocardiogramElectrocardiogram

(EKG)(EKG)

What is an ECG?

• An EKG is a method of measuring, displaying and recording the electrical activity of a heart

• Electrical stimuli is amplified to create a “rhythm strip” by a machine that consistently produces representations of the heart’s electrical activity

Physiologic Properties of Myocardial Cells

• Automaticity : Ability to initiate an impulse• Excitability : Ability to respond to an impulse• Conducticity : Ability to transmit an impulse• Contractility : Ability to respond with• pumping action

Electrical System of Heart

BASIC TERMINOLOGY

• Arrhythmia : Abnormal rhythm

• Baseline : Flat, straight, isoelectric line

• Waveform : Movement away from the baseline,

up or down

• Segment : A line between waveforms

• Interval : A waveform plus a segment

• Complex : Combination of several waveforms

- The first positive deflection : R

- The first negative deflection : Q

Components of a NSR

Components of a NSR: P wave

1. Describe the sequence of right and left atrial2. Normal positif in lead I, II, aVF, and V4 – V63. Normal negative in lead aVR4. Duration < 0,12 sec5. Amplitudo < 2,5 mm

Components of a NSR : PR interval

1. Time needed to transmit impuls from SA node to AV node2. Normal 0,12 – 0,22 sec ( 3-5,5 small box)3. Short PR interval preeksitasion syndrome 4. Prolonged PR interval think about A-V block.

Components of a NSR :QRS complex

1. Describe activation of left and right ventrikel2. Duration 0,05 – 0,10 sec (<2,5 small box). 3. Measure usually in limbs lead4. If the amplitudo less than 10 mm in all leads low voltage. 5. Abnormal complex QRS seen in conduction defect


Nomenclature of complex QRS

• first negative deflection named Q wave• first positive deflection named R wave• negative deflection after R wave called S wave• R wave always above the baseline• Q`and S wave always below the baseline


Q wave

1. Normal Q wave seen in lead I, aVL, and V5-6. describe activation of septum left to right2. Q wave in V1-2 is abnormal3. Pathologic Q : duration > 0,04 sec and/ or height > dari 1/3 complex QRS

Components of a NSR:ST segment

Normal ST segment

1. Usually isoelectric, elevation < 1 mm in extremity still normal2. Depression < 0,5 mm3. Point at the end of QRS complex named J point

Components of a NSR:T wave

T wave criteria

1. Describe repolarization of ventricel 2. Normal positif in leads I,II and V3-V63. Normal negative in lead III

Components of a NSR:QT duration

QT duration

1. Describe total sistolic time2. variation according to heart rate, gender and age3. QT interval must be < ½ R-R interval in HR 65-90/mnt4. Normal QT correction 0,44 + 0,02 sec5. Prolonged QTc predispose R on T VT

Rate Determination

Paper speed is 25 mm/second : 1 small box = 1 mm = 0.04 second1 large box = 5 mm = 0.20 second6 large boxes = 30 mm = 1.20 second

Calculation of heart rate1. Calculate total QRS complex in 6 large box and x 50

2. Count the total small box between the 2 QRS kompleks and divide to 1500

Rate Determination

Electrical Axis

00

900

1800 I

IIIII

aVF

aVLaVR

Use QRS complex in lead I as x axis and lead aVF as Y axis to calculate axis.

Axis Deviation

-300

1800

-900

900

Normal

Left Axis

Right Axis

ExtremeRight Axis

Normal EKG ?

1. Sinus rhythm

2. Regular rhythm and heart rate 60 – 100x/mnt

3. Normal AV conduction, normal Intraventricular conduction

4. Normal activation of atrium

5. Normal activation of ventricel (axis)

6. No sign of necrosis

7. Normal repolarisation of ventricel (ST segmen,gel T,gel U)

How to report

Rhythm : - Heart rate :

- Axis QRS :

- Transisional Zone : - Morphology :

- Interval - P wave :

- PR : - QRS complex :

- QRS : - ST segmen :

- QT : - T wave :

- QTc : - U wave :

CONCLUSION :

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MORPHOLOGICAL MORPHOLOGICAL ABNORMALITIESABNORMALITIES

ElectrocardiogramElectrocardiogram(EKG)(EKG)

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Surgery For Coronary Artery Disease Coronary By-pass Graft (CABG)

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CORONARY ARTERY DISEASE : CORONARY ARTERY DISEASE : MYOCARDIAL ISCHAEMIAMYOCARDIAL ISCHAEMIA

MYOCARDIAL ISCHAEMIA : ANGINA/MYOCARDIAL ISCHAEMIA : ANGINA/

CORONARY INSUFFICIENCE : CORONARY INSUFFICIENCE :

Changes in the myocardial resulting from a Changes in the myocardial resulting from a temporalily insufficient blood supply.temporalily insufficient blood supply.

Commonly seen during spontaneous Commonly seen during spontaneous angina and induced coronary insufficiency. angina and induced coronary insufficiency.

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ETIOLOGYETIOLOGY

ATHEROSKLEROSIS : STENOSIS CORONARY ATHEROSKLEROSIS : STENOSIS CORONARY ARTERYARTERY

VENTRICULAR HYPERTROPHYVENTRICULAR HYPERTROPHY

AORTIC STENOSISAORTIC STENOSIS

SYPHILITIC AORTITISSYPHILITIC AORTITIS

PULMONARY HYPERTENSIONPULMONARY HYPERTENSION

POLYCITEMIAPOLYCITEMIA

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ECG FINDINGS IN CORONARY ECG FINDINGS IN CORONARY INSUFFICIENCYINSUFFICIENCY

ST SEGMEN CHANGESST SEGMEN CHANGEST WAVE CHANGES.T WAVE CHANGES.

DIFFERENTIAL DIAGNOSIS :DIFFERENTIAL DIAGNOSIS :VENTRICULAR HYPERTROPHYVENTRICULAR HYPERTROPHYDRUG EFFECTDRUG EFFECTHIPOKALEMIAHIPOKALEMIAPERICARDITISPERICARDITISMYOCARDITISMYOCARDITIS

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CORRELATION BETWEEN LOCATION OF CORRELATION BETWEEN LOCATION OF ISCHAEMIC, ECG AND CORONARY ARTERY ISCHAEMIC, ECG AND CORONARY ARTERY

ANATOMYANATOMYLOCATION OF INFARCT/ LOCATION OF INFARCT/ ECG CORONARY ARTERY ECG CORONARY ARTERY INVOLVEDINVOLVED

ISCHAEMIC ISCHAEMIC

ANTERIOR EKSTENSIVE I, aVL, V1-V6 LAD, LCXANTERIOR EKSTENSIVE I, aVL, V1-V6 LAD, LCX

ANTEROSEPTAL V1- V3 LADANTEROSEPTAL V1- V3 LAD

ANTEROLATERAL I, aVL, V4- V6 LCXANTEROLATERAL I, aVL, V4- V6 LCX

INFERIOR II, III, aVF RCA, PDAINFERIOR II, III, aVF RCA, PDA

POSTERIOR V7- V9 PL POSTERIOR V7- V9 PL (POSTEROLATERAL)(POSTEROLATERAL)

RV V3R – V5R RCA/ RV BRANCHRV V3R – V5R RCA/ RV BRANCH

LAD Left Anterio Descenden. LCX circumflex. RCA Righ Cor.Art.

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MYOCARDIAL INFARCTIONMYOCARDIAL INFARCTION

Myocardial infarction is characterized by the necrosis of Myocardial infarction is characterized by the necrosis of a portion of the myocard resulting from a lack of a portion of the myocard resulting from a lack of sufficient blood suply to keep the muscle viable.sufficient blood suply to keep the muscle viable.

The most common cause is complete occlusion of The most common cause is complete occlusion of coronary artery by atherosclerotic coronary trombosis. coronary artery by atherosclerotic coronary trombosis.

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Terminology of infarctTerminology of infarct

Acute infarct : several hours untill daysAcute infarct : several hours untill days ECG : ST elevationECG : ST elevation

Recent infarct : several days- weeks.Recent infarct : several days- weeks. ECG : evolution ECG : evolution

Old infarct Old infarct : more than 6 months. : more than 6 months. ECG : Q wave or QSECG : Q wave or QS

complex or slowcomplex or slow progression of R waveprogression of R wave

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VENTRICULAR HYPERTROPHYVENTRICULAR HYPERTROPHY

LEFT VENTRICULAR HYPERTROPHYLEFT VENTRICULAR HYPERTROPHY : :Etiology : - HypertensionEtiology : - Hypertension

- Aortic stenosis / Insufficiency- Aortic stenosis / Insufficiency - Mitral Insufficiency- Mitral Insufficiency - Longstanding CAD- Longstanding CAD - Nutritional and idiopathic- Nutritional and idiopathic

hypertrophyhypertrophy - Congenital heart disease- Congenital heart disease

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CRITERIACRITERIA

Chest lead (Sokolow, Lyon) :Chest lead (Sokolow, Lyon) :S wave in V1 + R wave in V5 or V6 > 35 mm S wave in V1 + R wave in V5 or V6 > 35 mm R in V5 or R in V5 or V6 > 26 mm.V6 > 26 mm.R plus S in any chest leads > 45 mmR plus S in any chest leads > 45 mm

Limb leads (Gubner, Ungerleider) :Limb leads (Gubner, Ungerleider) :R in I + S in III > 25 mmR in I + S in III > 25 mmR in aVF > 20 mmR in aVF > 20 mmR in aVL > 11 mmR in aVL > 11 mmR in aVR > 15 mm R in aVR > 15 mm

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THE END

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Thanks for your attention!!Thanks for your attention!!

Matrikulasi Interpretasi Ekg

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