ABC's of ECG's: Basic ECG Analysis and Interpretation Skills
The Basic of Ecg
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Transcript of The Basic of Ecg
Wisnoe Pribadi SpJP
Conduction System
SA Node Internodal branch AV Node Hiss Bundle Purkinje Fiber Contraction
The Electrocardiogram ( ECG )The Electrocardiogram ( ECG )
P wave : atrial P wave : atrial depolarisationdepolarisation
QRS complex : QRS complex : ventricular ventricular depolarisationdepolarisation
T wave : T wave : ventricular ventricular repolarisationrepolarisation
Atrial repolarisation Atrial repolarisation hidden by QRShidden by QRS
P
Q
R
S
T
v9
P Wave
P Pulmonale
P Mitrale
PR Interval
QRS Complex
ST Segment
T Wave
INTERPRETATION ECGINTERPRETATION ECG
P waveP wave
PR intervalPR interval
Q waveQ wave
R waveR wave
S waveS wave
ST segmentST segment
T waveT wave
Normal Sinus Rhythm
Rhythm : RegularRate : 60 – 100P wave : Normal in configuration; precede each QRSPR : Normal ( 0. 12 – 0.20 seconds )QRS : Normal ( less than 0.12 seconds )
SINUS ARRYTMIA SINUS BRADYCARDIA
SINUS TACHYCARDIA
First-degree AV block
Rhythm : RegularRate : Usually normalP wave : Sinus P wave present; one P wave to each QRSPR : Prolonged ( greater than 0.20 seconds )QRS : Normal
Second -degree AV block, Mobitz I
Rhythm : IrregularRate : Usually slow but can be normalP wave : Sinus P wave present; some not followed by QRS complexesPR : Progressively lengthensQRS : Normal
Second-degree AV block, Mobitz II
Rhythm : Regular usually; can be irreguler if conduction ratios varyRate : Usually slowP wave : Two, three, or four P waves before each QRSPR : PR interval of beat with QRS is constant; PR interval may be normal or prolongedQRS : Normal if block in His bundle; wide if block involves bundle branches
Third-degree AV block
Rhythm : RegularRate : 40 – 60 if block in His bundle; 30 – 40 if block involves bundle branchesP wave : Sinus P wave present; bear no relationship to QRS; can be found hidden in QRS complexes and T wavesPR : Varies greatlyQRS : 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-satunyaperubahan EKG yang terlihat
HYPERACUTE T WAVE
ST DEPRESSION
HORIZONTAL
DOWN SLOOPING
UP SLOOPING
Anatomi Koroner dan EKG 12 sandapan ( LEAD )
• 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
L V H
L V H
L V H
R V H
R V H
R V H