Tutorial Ekg
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![Page 1: Tutorial Ekg](https://reader033.fdocument.pub/reader033/viewer/2022061514/55cf991b550346d0339b9f51/html5/thumbnails/1.jpg)
EKG & ARITMIA
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EKG
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Elektrokardiogram serangkaian gambaran
yang mencerminkan aktivitas listrik jantung
Ilmunya Elektrokardiografi
Alatnya Elektrokardiograf
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SA nodeSumber impuls normal/ alamiah , 60 – 100 / menit
AV nodeBisa mengeluarkan impuls 40-50x/menit
Berkas HisSerabut Purkinje
VentrikelBisa mengeluarkan impuls30 x/menit
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Kertas EKG• Kertas EKG merupakan kertas
grafik yang merupakan garis horizontal dan vertikal dengan jarak 1mm ( kotak kecil ). Garis yang lebih tebal terdapat pada setiap 5mm disebut ( kotak besar ).
• Garis horizontal Menunjukan waktu, dimana 1mm = 0,04 dtk, sedangkan 5mm = 0,20 dtk.
• Garis vertikal menggambarkan voltage, dimana 1 mm = 0,1 mv. Sedangkan 5 mm = 0,5 mv
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EKG normal
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V1 : ICS 4, Linea Sternalis DekstraV2 : ICS 4, Linea Sternalis SinistraV3 : Pertengahan garis dari V2–V3V4 : ICS 5, Linea Midclavicularis SinistraV5 : Pertengahan garis dari V4–V6, Linea Aksillaris AnteriorV6 : ICS 5, Linea Midaksillaris
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Defined heart axis
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CARA MENENTUKAN IRAMA JANTUNG
1. Tentukan apakah Iramanya teratur atau tidak
2. Tentukan frekuensi heartratenya
3. Tentukan gelombang P normal atau tidak, bagaimana hubungannya dengan QRS komplek
4. Tentukan Interval PRnya normal atau tidak
5. Tentukan gelombang QRSnya, normal atau tidak
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CARA MENGHITUNG NADi
Menentukan frekuensi jantungA. 300 = ( jml kotak besar dlm 60 detik ) Jml kotak besar antara R – R
B. 1500 = (jml kotak kecil dlm 60 detik ) Jml kotak kecil antara R – R
C. Ambil EKG strip sepanjang 6 detik, hitung jumlah QRS dan kalikan 10.
CAT : RUMUS A/B UNTUK EKG YANG TERATUR. RUMUS C UNTUK YANG TIDAK TERATUR.
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Cara membaca EKG
1. Tentukan iramanya : Sinus / bukan2. Tentukan frekuensi/kecepatan : Normal / takikardia /
bradikardia3. Regularitas : R-R sama / tidak4. Tentukan axis : Normal / RAD / LAD5. Nilai gelombang P : Normal / tidak6. Hitung PR interval : Normal
/memanjang/memendek7. Nilai gelombang Q : Normal / patologis8. Hitung QRS komplek : Normal / melebar9. Nilai ST segmen : Isoelektrik / elevasi /
depresi10. Nilai gelombang T : Normal / Inverted / tinggi11. Gelombang U : normal / timggi /
terbalik12. Perhatikan tanda-tanda : Hipertropi / iskemia /
infark13. Kesimpulan/Diagnosa
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Prinsip Kelainan EKG
ST depresi dan atau T yang inverted → ischemic ST elevasi → injury Deplesi Q > 1/3 R → nekrosis Patogenesis : ischemic – injury – nekrosis Amplitudo P > 2,5 kotak kecil (P. Pulmonal) →
hipertrofi atrium kanan Jarak P > 1 kotak kecil (P. Mitral) → hipertrofi atrium kiri Perbandingan R/S pada V1 > 1 hipertrofi ventrikel kanan S pada V1 & R pada V6 > 35 kotak kecil
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hypertrophy
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RAH1. Gel P tinggi dan
lancip di II, III dan aVF : tinggi > atau sama dengan 2,5 mm dan interval > atau sama dengan 0,11 detik
2. P pulmonal 3. Rasio P/segmen
PR < 1
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LAH gelombang P yang lebar dan berlekuk
paling terlihat jelas pada lead I dan II biasa disebut gelombang P Mitral.
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RVH Gelombang R lebih besar
dari gelombang S pd Lead Prekordial Ka
VAT > 0,03 detik di VI Gelombang menetap di V5/
V6 Depresi segmen ST dan
gelombang T terbalik di VI – V3 (ST Depress + T inversi.)
Perubahan EKG baru tampak bila ada pembesaran yang nyata
Etiologi : tekanan tinggi yang terus menerus di ventrikel kanan
Rasio R/S yang terbalik : R/S di V1 > 1 R/S di V6 < 1 Perubahan bentuk kompleks
QRS : Gelombang R yang besar Terdapat kompleks R’
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LVH Gelombang R pada V5/ V6
lebih dari 27 mm atau gel S di V1 + gel R di V5 lebih dar 35 mm.
VAT (Ventricular activating time) > 0,05 detik di V5/ V6
Depresi segmen ST dan gel T terbalik di V5/ V6
LAD. Peningkatan voltage QRS Hipertrofi ventrikel dengan
dinding yang tebal serta permukaan yang lebih luas menyebabkan potensial listrik yg lebih besar
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Tanda iskemia/infark Iskemia
Depresi segmen ST Gelombang T inverted
Infark ST elevasi Gelombang Q abnormal Fase
Akut : ST elevasi + T inverted Subakut : ST elevasi + T inverted + gelombang Q
abnormal Kronik : gelombang Q abnormal
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ISKEMIK
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FASE INFARK
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INFARK
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TELAH ADA Q PATOLOGIS
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Localisation ST elevation Reciprocal ST depression
Anterior MI V1 – V6 None
Septal MI
V1 – V4, disappearance of septum Q in leads
V5, V6
None
Lateral MI I, avL, V5, V6 II, III, avF
Inferior MI II, III, avF I, avL
Posterior MI V7, V8, V9
High R in V1 – V3 with ST depression
V1 – V3 > 2 mm (mirror view)
Right ventricle MI V1, V4R I, avL
Atrial MI Pta in I, V5, V6 Pta in I, II or III
Help with the localisation of the MI
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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.
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How to identify arrhythmias ?
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QRS complex Regular / irregular ?
QRS complexNormal-looking QRS complex?
Wide / narrow ?
P wave ?
Relationship between P and QRS ?
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NORMAL SINUS RHYTHM
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Why Arrhythmias Happen????
HIS - DEBS
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NONSINUS PACE MAKERS
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4 QUESTIONS
Are the QRS Complexes Narrow (Less Than 0.12 Seconds in Duration) or Wide (Greater Than 0.12 Seconds in Duration)?
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PSVT :
-due to re-entry mechanism-narrow QRS complex-regular-retrograde atrial depolarization-P wave ?
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PSVT
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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-resiko stroke non perdarahan
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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”
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Junctional rhythm:
-AV junction can function as a pace maker (40-60 x/min).-due to the failure of sinus node to initiate time impulse or conduction problem(low nodal sinus).-normal-looking QRS.-retrograde P wave.-P wave may preceede, coincide with, or follow the QRS
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VES
SR
VENTRIKEL EXTRA SYSTOLE
-Jantung berdebar seperti tidak terisi-QRS (+) : ventrikel kiri-QRS (-) : ventrikel kanan-VES > 18x/menit : obati
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SR SR SR SRSR SR
VES VES
Sinus rhythm with Multifocal VES
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Sinus rhythm with VES couplet
Resiko aritmia ganas
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Sinus Rhythm with VES, R on T
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Ventricular Tachycardia
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Ventricular Fibrillation
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Prolonged PR interval (> 5 kotak kecil)
1st degree AV block
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Missing QRS Missing QRS
2nd degree AV block, type 1
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2nd degree AV block, type 2
Missing QRS
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P P P P P P P
QRS QRS QRS
Total AV Block / 3rd degree AV block
Atrium & ventrikel gerak sendiri-sendiri
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Tak ada yang lebih memuaskan hati kita selain melihat dua dokter ahli jantung sedang bertengkar tentang gangguan irama yang rumit – Malcolm S Thaler, MD
SELESAI