MEMBACA EKG

Bagian 1
EKG??
Mengenal Jantung untuk EKG
Kabel lead Ekstremitas
Einthoven’s triangle
Lead bipolar ekstremitas
Agmented Voltage leads
(unipolar limb leads)
6 limb leads
Chest Leads…
Chest Leads
6 chest leads
Harus Diperhatikan sebelum Baca EKG!!

 IDENTITAS:
 Nama pasien
 Usia pasien
 Jenis Kelamin pasien

 WAKTU:
 Tanggal pengambilan
 Jam pengambilan

 KELAYAKAN:
 Bisa dibaca
 Pemasangan Lead yang benar (gelb p positif di lead II dan negatif di aVR)
EKG PAPER
Kalibrasi
Gelb P QRS T U
APA YANG HARUS DIBACA PADA EKG??

 Irama
 Heart rate
 Axis & Posisi
 Gelb P/PR interval
 Gelb QRS
 Segmen ST/ Gelb T
 QT interval
 Transisi Zone
 Lain2
IRAMA
 Sinus?
 Supraventrikular?
 Atrial?

 junctional

 Ventrikular?
HEART RATE…
HR…
HR
Hitung berapa HR-nya?
Contoh 1
Contoh 2
Contoh 3
Contoh 4
Axis & Posisi…
Axis & Posisi
Axis & Posisi
Axis & Posisi
 Hexaxial Array for Axis Determination

determination of the
angle of the
HEART AXIS in the
frontal plain
 Hexaxial Array for Axis Determination – Example 1

Lead I

If lead I is mostly
positive, the
axis must lie in the
right half of
of the coordinate
system (the main
vector is moving
mostly toward the
lead’s positive
electrode)
 Hexaxial Array for Axis Determination – Example 1

Lead AVF

If lead AVF is mostly

positive, the
axis must lie in the
bottom half of
of the coordinate
system (again, the
main vector is moving
mostly toward the
lead’s positive
electrode
 Hexaxial Array for Axis Determination – Example 1

I AVF

Combining the two

plots, we see
that the axis must lie
in the bottom
right hand quadrant
 Hexaxial Array for Axis Determination – Example 1
I AVF AVL

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 AVL is the
most equiphasic lead, the
axis here is at
approximately 60o.
 Hexaxial Array for Axis Determination – Example 1
I AVF AVL

Since QRS complex in AVL

is a 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
(normal axis).
 Hexaxial Array for Axis Determination – Example 2

Lead I

If lead I is mostly
negative, the
axis must lie in the
left half of
of the coordinate
system.
 Hexaxial Array for Axis Determination – Example 2

Lead AVF

If lead AVF is mostly

positive, the
axis must lie in the
bottom half of
of the coordinate
system
 Hexaxial Array for Axis Determination – Example 2

I AVF

Combining the two

plots, we see
that the axis must lie
in the bottom
left hand quadrant
(Right Axis Deviation)
 Hexaxial Array for Axis Determination – Example 2

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.
 Hexaxial Array for Axis Determination – Example 2

I AVF II

Since the QRS in II is a

slightly 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 Axis
Calculation
Precise calculation of
the axis can be done
using the coordinate
system to plot net
voltages of
perpendicular leads,
drawing a resultant Net voltage =
rectangle, then Since Lead III is the 12
connecting the origin most equiphasic

Net voltage = 7
of the coordinate lead and it is
system with the slightly more
opposite corner of positive than
the rectangle. A negative, this axis
protractor can then could be estimated
be used to measure at about 40o.
the deflection from 0.
Hitung berapa axisnya??
Contoh 1
Contoh 2
Contoh 3
Gelb P / PR interval..
Gelb P / PR interval
Gelb P / PR interval
Gelb P / PR interval

P normal
Gelb P - Right Atrial Enlargement
Gelb P – Left Atrial Enlargement
Contoh 1
Contoh 2
Contoh 3
Gelb QRS
Gelb QRS
Gelb QRS
Contoh 1
Contoh 2
Contoh 3
Gelb T /
Segmen ST…
Gelb T / Segmen ST
Contoh 1
Contoh 2
Contoh 3
QT Interval

QTC = QT
√ R-R

QT normal = 0,35 -0,45 dtk

Contoh 1
Contoh 2
Transisi Zone

Normal: V3-V4 (dari – ke +)

Menunjukkan posisi septum
interventrikuler

CCWR (Counterclock wise

rotation) : bergeser ke arah V1
Ex: LVH

CWR (Clock wise rotation):

bergeser ke arah V6
Ex: RVH
Contoh 1
Contoh 2
TERIMA KASIH