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Penilaian hasil rekaman EKG:
 
      Frekuensi (rate) dihitung / menit
      Irama (rythm): regular / irregular
      Zona transisi V1-V6
      Axis Elektrik: sumbu (derajat), posisi
(normal, left, right, indeterminate /
right superior / northwest)
      Interval PR, QRS, dan QT dalam detik
      Lain-lain
Berapa kecepatan kertas ECG bergerak: 25 mm/detik

1 mv beda potensial antara kedua elektroda


1 cm
akan terekam setinggi berapa cm ?
Berapa Frekuensinya:
Bila jarak R ke R dalam kotak besar (5 mm)

hitung
Bila 300/jarak
jarak R-R mm
R ke R dalam (150-100-75-60-50)
 1500/jarak
R-R dlm mm

Bila tidak teratur hitung jumlah kompleks


QRS dlm rekaman sepanjang 15 cm (6 detik)
kemudian hasilnya dikalikan 10
Penilaian hasil rekaman EKG:
 
      Frekuensi (rate) dihitung / menit
      Irama (rythm): regular / irregular
      Zona transisi V1-V6
      Axis Elektrik: sumbu (derajat), posisi
(normal, left, right, indeterminate /
right superior / northwest)
      Interval PR, QRS, dan QT dalam detik
      Lain-lain
Beats and Rhythms
Atrial Escape Beat
normal ("sinus") beats

sinus node doesn't fire


leading to a period of asystole p-wave has different shape
indicating it did not originate
in the sinus node, but
somewhere in the atria. It is
therefore an "atrial" beat
QRS is slightly different but still narrow,
Junctional Escape Beat indicating that conduction through the
ventricle is relatively normal

there is no p wave, indicating that it did not


originate anywhere in the atria, but since the
QRS complex is still thin and normal looking, we
can conclude that the beat originated
somewhere near the AV junction. The beat is
therefore called a "junctional" beat
QRS is wide and much
different ("bizzare") looking
Ventricular Escape Beat than the normal beats. This
indicates that the beat originated
somewhere in the ventricles

there is no p wave, indicating that the beat did


not originate anywhere in the atria

actually a "retrograde p-wave may sometimes


be seen on the right hand side of beats that
originate in the ventricles, indicating that
depolarization has spread back up through the
atria from the ventricles
Ectopic Beats or Rhythms
• beats or rhythms that originate in places other than the SA node

• the ectopic focus may cause single beats or take over and pace
the heart, dictating its entire rhythm

• they may or may not be dangerous depending on how they affect


the cardiac output
Penilaian hasil rekaman EKG:
 
      Frekuensi (rate) dihitung / menit
      Irama (rythm): regular / irregular
      Zona transisi V1-V6
      Axis Elektrik: sumbu (derajat), posisi
(normal, left, right, indeterminate /
right superior / northwest)
      Interval PR, QRS, dan QT dalam detik
      Lain-laian
Penilaian hasil rekaman EKG:
 
      Frekuensi (rate) dihitung / menit
      Irama (rythm): regular / irregular
      Zona transisi V1-V6
      Axis Elektrik: sumbu (derajat), posisi
(normal, left, right, indeterminate /
right superior / northwest)
      Interval PR, QRS, dan QT dalam detik
      Lain-lain
D e p o la r iz a tio n W a v e o f a S tr ip o f N e r v e C e lls + +

(o r M y o c a r d ia l M u s c le C e lls m in u s t h e d e p ic tio n o f C a in flu x )

“ W a v e o f D e p o la r iz a t io n “ o r ” P r o p ig a t io n o f A c t io n P o t e n t ia l” m o v in g f r o m le f t t o r ig h t

P o la r iz e d R e p o la r iz in g D e p o la r iz e d D e p o la r iz in g P o la r iz e d
C e ll C e ll C e ll C e ll C e ll
( K + e fflu x ) ( N a + in flu x )

N a + N a + N a +

K + N a + K + N a + K + K + K +
---- ++++ ----
++++ ---- ++++

T h e n e e d le o f th is T h e n e e d le o f th is
T h e n e e d le o f th is r e c o r d in g e le c t r o d e r e c o r d in g
r e c o r d in g e le c t r o d e is b ip h a s ic e le c t r o d e in s c r ib e s
in s c r ib e s a to t a lly b e c a u s e h a lf o f th e a to t a lly p o s it iv e
n e g a tiv e c o m p le x tim e th e w a v e o f c o m p le x b e c a u s e
b e c a u s e th e w a v e th e w a v e o f
d e p o la r iz a tio n is
o f d e p o la r iz t io n is d e p o la r iz tio n is
m o v in g to w a r d s it
m o v in g a w a y f r o m w h ile t h e o t h e r h a lf m o v in g t o w a r d s it
it d u r in g th e e n tir e o f t h e tim e it is d u r in g th e e n tir e
tim e th e s tr ip is m o v in g a w a y tim e th e s tr ip is
d e p o a r iz in g fr o m it d e p o a r iz in g
The Concept of a "Lead"

Lead I - +

G
Electrocardiograph

• Right arm (RA) negative, left arm (LA) positive, right


leg (RL) ground……this arrangement of electrodes
enables a "directional view" recording of the heart's
electrical potentials as they are sequentially activated
throughout the entire cardiac cycle
- +
The Concept of a "Lead"
Lead I

• The directional flow of electricity from Lead I can be


viewed as flowing from the RA toward the LA and
passing through the heart. Also, it is useful to imagine a
camera lens taking an "electrical picture" of the heart
with the lead as its line of sight
The Concept of a "Lead"
The Limb Leads

LEAD AVR LEAD AVL


-150o -30o

0o
LEAD I

60o
120o LEAD II
90 o
LEAD III
LEAD AVF

• Each of the limb leads (I, II, III, AVR, AVL, AVF)
can be assigned an angle of clockwise or
counterclockwise rotation to describe its position in
the frontal plane
The Concept of a "Lead" LA
Leads I II III
RA
- -

RA - + LA
LEAD I

LEAD III +LL


LL
+
LEAD II

Remember, the RL
is always the ground

• By changing the arrangement of which arms or legs


are positive or negative, two other leads ( II & III ) can
be created and we have two more "pictures" of the
heart's electrical activity from different angles
The Concept of a "Lead"
RA & LA
Leads AVR AVL AVF
-
LEAD AVR LEAD AVL
RA +
+ LA

- -
RA & RL LL & LA
LEAD AVF
LL +
• By combining certain limb leads into a central
terminal, which served as the negative electrode,
other leads could be formed to "fill in the gaps" in
terms of the angles of directional recording. These
leads required augmentation of voltage to be read and
are thus labeled.
The Concept of a "Lead"
The Precordial Leads
• Each of the precordial leads is unipolar (1 electrode
constitutes a lead) and is designed to view the electrical
activity of the heart in the horizontal or transverse
plane

V1 V2
V3
V4 V5 V6
aVR aVL

aVF
Hexaxial Array for Axis Determination
determination of the angle of the main
cardiac vector in the frontal plain
Lead I Example 1

If lead I is mostly positive, the


axis must lie in the right half of
of the coordinate system
If lead AVF is mostly positive, the
Lead AVF
axis must lie in the bottom half of
of the coordinate system
I AVF Combining the two plots, we see
that the axis must lie in the bottom
right hand quadrant
Once the quadrant has been
I AVF AVL determined, find the most
equiphasic or smallest limb lead.
The axis will lie about 90o away
from this lead. Given that AVL is
the most equiphasic lead, the axis
here is at approximately 60o.
Since QRS complex in AVL is a
I AVF AVL slightly more positive, the true
axis will lie a little closer to AVL
(the depolarization vector is
moving a little more towards AVL
than away from it). A better
estimate would be about 50o.
Example 2 If lead I is mostly negative, the
axis must lie in the left half of
Lead I of the coordinate system
Lead AVF If lead AVF is mostly positive, the
axis must lie in the bottom half of
of the coordinate system
I AVF
Combining the two plots, we see
that the axis must lie in the bottom
left hand quadrant (Right Axis
Deviation)
I AVF II Once the quadrant has been
determined, find the most
equiphasic or smallest limb lead.
The axis will lie about 90o away
from this lead. Given that II is the
most equiphasic lead, the axis
here is at approximately 150o.
Since the QRS in II is a slightly
I AVF II more negative, the true axis will
lie a little farther away from lead
II than just 90o (the depolarization
vector is moving a little more
away from lead II than toward it).
A better estimate would be 160o.
Precise calculation of the axis can be done using the
coordinate system to plot net voltages of perpendicular
leads, drawing a resultant rectangle, then connecting the
origin of the coordinate system with the opposite corner
of the rectangle. A protractor can then be used to
measure the deflection from 0. Consider the example:

Since Lead III is the most


equiphasic lead and it is
slightly more positive than
negative, this axis could be
estimated at about 40o.
Penilaian hasil rekaman EKG:
 
      Frekuensi (rate) dihitung / menit
      Irama (rythm): regular / irregular
      Zona transisi V1-V6
      Axis Elektrik: sumbu (derajat), posisi
(normal, left, right, indeterminate /
right superior / northwest)
      Interval PR, QRS, dan QT dalam detik
      Lain-lain
Penilaian hasil rekaman EKG:
 
      Frekuensi (rate) dihitung / menit
      Irama (rythm): regular / irregular
      Zona transisi V1-V6
      Axis Elektrik: sumbu (derajat), posisi
(normal, left, right, indeterminate /
right superior / northwest)
      Interval PR, QRS, dan QT dalam detik
      Lain-lain
ECG diagnosis

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