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L/O/G/O
DASAR
INTERPRESTASI
EKG
Dr Fonda RP Silalahi
www.themegallery.com
DASAR YANG AKAN
DIPELAJARI
• Menilai Ritme
• Mengetahui Frekuensi
• Mengetahui Jenis Irama
• Transisi...
www.themegallery.com
MENILAI RITME
Kita lihat regularitasnya dengan menghitung
Interval R-R dan P-P
Penghitungannya kita m...
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CARA MENILAI RITME
Setelah tahu reguler/ireguler kita akan
menghitung frekuensi.
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MENGHITUNG FREKUENSI
• Metode I  Menghitung Kotak Kecil
Rumusnya :
• Metode II  Menghitung Kotak Be...
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MENGHITUNG FREKUENSI
• Metode IIII  Menghitung 6 detik EKG
Rumusnya :
Frekuensi =
Jumlah komplek QRS...
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BELAJAR EKG
TERNYATA
MENYENANGKAN,
SIAP KE LANGKAH
SELANJUTNYA??!
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JENIS IRAMA EKG
• Irama EKG akan sangat dipengaruhi oleh
SUMBER KELISTRIKAN JANTUNG.
– jika berasal d...
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IRAMA SINUS
• Irama denyut jantung
yang sumber pacu
listriknya dari SA node
• Ciri gel P diikuti
komp...
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IRAMA ATRIAL
• Irama yang pemacu
utamanya adalah
atrium
• Mirip gel P namun
berbeda dengan
gelombang ...
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IRAMA JUNCTIONAL
• Irama yang pacuannya dari AV node
• Ciri:
– Gel P inversi = Junctional letak atas
...
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IRAMA VENTRIKULER
• Irama denyut jantung yang
pemacu dominannya
Ventrikel
• Ciri mirip komplek QRS
na...
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IRAMA PACING
• Irama yang berasal dari alat pacu jantung
(pace maker)
• Irama pacing atrial
• Irama p...
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RHYTHM
Atrial Fibrillation
A-fib is the most common cardiac arrhythmia involving atria.
Rate= ~150bpm...
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RHYTHM
Atrial Flutter
Atrial Rate=~300bpm, similar to A-fib, but have flutter waves, ECG baseline
ada...
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RHYTHM
Ventricular Fibrillation
A severely abnormal heart rhythm (arrhythmia) that can be life-threat...
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RHYTHM
Ventricular tachycardia
fast heart rhythm, that originates in one of the ventricles- potential...
www.themegallery.com
RHYTHM
Supraventricular Tachycardia
SVT is any tachycardic rhythm originating above the ventricular
t...
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RHYTHM
Asystole
a state of no cardiac electrical activity, hence no contractions of the
myocardium an...
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BELAJAR EKG
SEMAKIN
MENANTANG,
SIAP KE LANGKAH
SELANJUTNYA??!
www.themegallery.com
AKSIS JANTUNG
• Aksis adalah sudut yang dibentuk oleh
vektor listrik terhadap garis horizontal.
• Ana...
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AKSIS JANTUNG
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MENILAI AKSIS
Lead I Lead aVF Arah Aksis
+ - Deviasi kiri
+ + NORMAL
- + Deviasi kanan
- - Deviasi ka...
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MENILAI AKSIS
• Bisa juga dengan diagram
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Cardiac Axis Causes
Left axis deviation Normal variation in pregnancy, obesity; Ascites,
abdominal di...
www.themegallery.com
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ASAL GELOMBANG EKG
Untuk lebih
jelasnya bisa
dilihat di flash
dunia jantung
di Elisa Blok
4.2
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KERTAS EKG
1 kotak kecil horizontal = 0.04 detik
1 kotak kecil vertikal = 0.1 mV
1 kotak besar terdir...
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GELOMBANG EKG
Normal
Pada gambar
disamping dapat
kita lihat adanya
gelombang (P, Q,
R, S, T dan U),
k...
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Gelombang P
• Gelombang yang tampak pertama kali
• Bentuk normalnya melengkung kecil ke atas
• Menunj...
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P -WAVE
P pulmonale
Tall peaked P wave. Generally due to enlarged
right atrium- commonly associated w...
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PR Interval
•Jarak antara gelombang P dan
permulaan komplek QRS
• Untuk mengukur perjalanan
depolaris...
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PR-INTERVAL
First degree heart block
P wave precedes QRS complex but P-R intervals prolong (>5 small
...
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Second degree heart block
1. Mobitz Type I or Wenckenbach
Runs in cycle, first P-R interval is often ...
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Second degree heart block
2. Mobitz Type 2
P-R interval is constant, duration is normal/prolonged. Pe...
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Third degree heart block (Complete heart block)
No relationship between P waves and QRS complexes
An ...
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QRS Komplek
• Tiga defleksi yang yang mengikuti gelombang
P
• Mengindikasikan depolarisasi (dan kontr...
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QRS COMPLEX
Left Bundle Branch Block (LBBB)
indirect activation causes left ventricle contracts
later...
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ST Segment
• Jarak antara gelombang S dan
permulaan gelombang T
•Menunjukkan repolarisasi ventrikel
•...
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ST-SEGMENT
Look at ST changes, Q wave in all leads. Grouping
the leads into anatomical location, we h...
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Criteria:
ST elevation in > 2 chest leads > 2mm elevation
ST elevation in > 2 limb leads > 1mm elevat...
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ST SEGMENT
ST-ELEVATION MI (STEMI)
0 HOUR
1-24H
Day 1-2
Days later
Weeks later
Pronounced T Wave init...
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I
II
III
aVR
aVL
aVF
V1
V2
V3
V4
V5
V6
Check again!
>2mm
Yup, It’s acute
anterolateral MI!
Let’s see ...
www.themegallery.com
I
II
III
aVR
aVL
aVF
V1
V2
V3
V4
V5
V6
Check again!
Inferior MI!
How about this one?
ST SEGMENT
www.themegallery.com
NSTEMI is also known as subendocardial or non Q-wave MI.
In a pt with Acute Coronary Syndrome (ACS) i...
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A ST depression is more suggestive of myocardial ischaemia than infarction
1mm ST-segment depression
...
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QT Interval
• Permulaan QRS hingga akhir T
• Menunjukkan aktivitas ventrikel total
• Normalnya
Lebar ...
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Gelombang T
• Gelombang lengkungan ke atas yang
mengikuti QRS
• Menunjukkan repolarisasi ventrikel
• ...
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Narrow and tall peaked T wave (A) is an early sign
PR interval becomes longer
P wave loses its amplit...
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SUMMARY
Unsur EKG Tinggi/Dalam Lebar
Gelombang P < 2,5 kotak kecil < 3 kotak kecil
PR Interval - - - ...
L/O/G/O
SELAMAT
BELAJAR
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Presentasi ekg rs agung

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  1. 1. L/O/G/O DASAR INTERPRESTASI EKG Dr Fonda RP Silalahi
  2. 2. www.themegallery.com DASAR YANG AKAN DIPELAJARI • Menilai Ritme • Mengetahui Frekuensi • Mengetahui Jenis Irama • Transisi Zone • Aksis Jantung • Morfologi gelombang (silahkan dilihat di slide “Pengenalan EKG Dasar ”)
  3. 3. www.themegallery.com MENILAI RITME Kita lihat regularitasnya dengan menghitung Interval R-R dan P-P Penghitungannya kita menggunakan kertas lalu diberi titik, lalu kita lihat regularitasnya.
  4. 4. www.themegallery.com CARA MENILAI RITME Setelah tahu reguler/ireguler kita akan menghitung frekuensi.
  5. 5. www.themegallery.com MENGHITUNG FREKUENSI • Metode I  Menghitung Kotak Kecil Rumusnya : • Metode II  Menghitung Kotak Besar Rumusnya: Frekuensi = 1500/jumlah kotak kecil Frekuensi = 300/jumlah kotak besar Hanya untuk yang REGULER saja
  6. 6. www.themegallery.com MENGHITUNG FREKUENSI • Metode IIII  Menghitung 6 detik EKG Rumusnya : Frekuensi = Jumlah komplek QRS dalam 6 detik x 10 BISA UNTUK REGULER MAUPUN IRREGULER 3 sec 3 sec 3 detik = 15 kotak besar
  7. 7. www.themegallery.com BELAJAR EKG TERNYATA MENYENANGKAN, SIAP KE LANGKAH SELANJUTNYA??!
  8. 8. www.themegallery.com JENIS IRAMA EKG • Irama EKG akan sangat dipengaruhi oleh SUMBER KELISTRIKAN JANTUNG. – jika berasal dari SA node  Irama Sinus, – jika berasal dari Atrium  Irama Atrial – jika dari penghubung (AV node ) Irama Junctional, – jika dari ventrikel  Irama Ventrikuler – jika dari pacemaker buatan  Irama Pacing
  9. 9. www.themegallery.com IRAMA SINUS • Irama denyut jantung yang sumber pacu listriknya dari SA node • Ciri gel P diikuti kompplek QRS
  10. 10. www.themegallery.com IRAMA ATRIAL • Irama yang pemacu utamanya adalah atrium • Mirip gel P namun berbeda dengan gelombang P yang dari sinus
  11. 11. www.themegallery.com IRAMA JUNCTIONAL • Irama yang pacuannya dari AV node • Ciri: – Gel P inversi = Junctional letak atas – Gel P hilang = Junctional letak tengah – Gel P retograde (setelah QRS komplek) = Junctional letak bawah
  12. 12. www.themegallery.com IRAMA VENTRIKULER • Irama denyut jantung yang pemacu dominannya Ventrikel • Ciri mirip komplek QRS namun tidak sempurna
  13. 13. www.themegallery.com IRAMA PACING • Irama yang berasal dari alat pacu jantung (pace maker) • Irama pacing atrial • Irama pacing ventrikuler
  14. 14. www.themegallery.com RHYTHM Atrial Fibrillation A-fib is the most common cardiac arrhythmia involving atria. Rate= ~150bpm, irregularly irregular, baseline irregularity, no visible p waves, QRS occur irregularly with its length usually < 0.12s
  15. 15. www.themegallery.com RHYTHM Atrial Flutter Atrial Rate=~300bpm, similar to A-fib, but have flutter waves, ECG baseline adapts ‘saw-toothed’ appearance’. Occurs with atrioventricular block (fixed degree), eg: 3 flutters to 1 QRS complex:
  16. 16. www.themegallery.com RHYTHM Ventricular Fibrillation A severely abnormal heart rhythm (arrhythmia) that can be life-threatening. Emergency- requires Basic Life Support Rate cannot be discerned, rhythm unorganized
  17. 17. www.themegallery.com RHYTHM Ventricular tachycardia fast heart rhythm, that originates in one of the ventricles- potentially life- threatening arrhythmia because it may lead to ventricular fibrillation, asystole, and sudden death. Rate=100-250bpm
  18. 18. www.themegallery.com RHYTHM Supraventricular Tachycardia SVT is any tachycardic rhythm originating above the ventricular tissue.Atrial and ventricular rate= 150-250bpm Regular rhythm, p is usually not discernable. *Types: •Sinoatrial node reentrant tachycardia (SANRT) •Ectopic (unifocal) atrial tachycardia (EAT) •Multifocal atrial tachycardia (MAT) •A-fib or A flutter with rapid ventricular response. Without rapid ventricular response both usually not classified as SVT •AV nodal reentrant tachycardia (AVNRT) •Permanent (or persistent) junctional reciprocating tachycardia (PJRT) •AV reentrant tachycardia (AVRT)
  19. 19. www.themegallery.com RHYTHM Asystole a state of no cardiac electrical activity, hence no contractions of the myocardium and no cardiac output or blood flow. Rate, rhythm, p and QRS are absent
  20. 20. www.themegallery.com
  21. 21. www.themegallery.com BELAJAR EKG SEMAKIN MENANTANG, SIAP KE LANGKAH SELANJUTNYA??!
  22. 22. www.themegallery.com AKSIS JANTUNG • Aksis adalah sudut yang dibentuk oleh vektor listrik terhadap garis horizontal. • Analisis terhadap aksis dapat membantu menemukan lokasi kelainan yang terjadi pada jantung. – Aksis normal +90o hingga -30o – Deviasi Kiri -30o hingga -90o – Deviasi Kanan +90o hingga +180o – Deviasi Kanan Ekstrem -180o hingga -90o
  23. 23. www.themegallery.com AKSIS JANTUNG
  24. 24. www.themegallery.com MENILAI AKSIS Lead I Lead aVF Arah Aksis + - Deviasi kiri + + NORMAL - + Deviasi kanan - - Deviasi kanan ekstrim (+) artinya gelombang cenderung ke atas atau panjang gel R > q + S (-) artinya gelombang cenderung ke bawah atau panjang gel R < q + S
  25. 25. www.themegallery.com MENILAI AKSIS • Bisa juga dengan diagram
  26. 26. www.themegallery.com Cardiac Axis Causes Left axis deviation Normal variation in pregnancy, obesity; Ascites, abdominal distention, tumour; left anterior hemiblock, left ventricular hypertrophy, Q Wolff- Parkinson-White syndrome, Inferior MI Right axis deviation normal finding in children and tall thin adults, chronic lung disease(COPD), left posterior hemiblock, Wolff-Parkinson-White syndrome, anterolateral MI. North West emphysema, hyperkalaemia. lead transposition, artificial cardiac pacing, ventricular tachycardia CARDIAC AXIS
  27. 27. www.themegallery.com
  28. 28. www.themegallery.com ASAL GELOMBANG EKG Untuk lebih jelasnya bisa dilihat di flash dunia jantung di Elisa Blok 4.2
  29. 29. www.themegallery.com KERTAS EKG 1 kotak kecil horizontal = 0.04 detik 1 kotak kecil vertikal = 0.1 mV 1 kotak besar terdiri atas • 5 kotak kecil horizontal • 5 kotak kecil vertikal Hal ini penting untuk anda ingat karena dari sini kita bisa mengetahui apakah ada kelainan atau tidak pada sebuah hasil EKG.
  30. 30. www.themegallery.com GELOMBANG EKG Normal Pada gambar disamping dapat kita lihat adanya gelombang (P, Q, R, S, T dan U), komplek (QRS), interval (PR, QT) serta sebuah segmen (ST segmen)
  31. 31. www.themegallery.com Gelombang P • Gelombang yang tampak pertama kali • Bentuk normalnya melengkung kecil ke atas • Menunjukkan depolarisasi atrium • Kelainan gelombang P menunjukkan adanya kelainan di atrium. • Gelombang P normalnya adalah sebagai berikut: • Positif (kecuali di aVR & V1 bisa negatif) • Letak di depan QRS • Tinggi < 2,5 kotak kecil • Lebar < 3 kotak kecil Yang ditebal harus kamu hafal
  32. 32. www.themegallery.com P -WAVE P pulmonale Tall peaked P wave. Generally due to enlarged right atrium- commonly associated with congenital heart disease, tricuspid valve disease, pulmonary hypertension and diffuse lung disease. Biphasic P wave Its terminal negative deflection more than 40 ms wide and more than 1 mm deep is an ECG sign of left atrial enlargement. P mitrale Wide P wave, often bifid, may be due to mitral stenosis or left atrial enlargement.
  33. 33. www.themegallery.com PR Interval •Jarak antara gelombang P dan permulaan komplek QRS • Untuk mengukur perjalanan depolarisasi dari atrium ke ventrikel • Normalnya Lebar 3-5 kotak kecil
  34. 34. www.themegallery.com PR-INTERVAL First degree heart block P wave precedes QRS complex but P-R intervals prolong (>5 small squares) and remain constant from beat to beat
  35. 35. www.themegallery.com Second degree heart block 1. Mobitz Type I or Wenckenbach Runs in cycle, first P-R interval is often normal. With successive beat, P-R interval lengthens until there will be a P wave with no following QRS complex. The block is at AV node, often transient, maybe asymptomatic PR-INTERVAL
  36. 36. www.themegallery.com Second degree heart block 2. Mobitz Type 2 P-R interval is constant, duration is normal/prolonged. Periodically, no conduction between atria and ventricles- producing a p wave with no associated QRS complex. (blocked p wave). The block is most often below AV node, at bundle of His or BB, May progress to third degree heart block PR-INTERVAL
  37. 37. www.themegallery.com Third degree heart block (Complete heart block) No relationship between P waves and QRS complexes An accessory pacemaker in the lower chambers will typically activate the ventricles- escape rhythm. Atrial rate= 60-100bpm. Ventricular rate based on site of escape pacemaker. Atrial and ventricular rhythm both are regular. PR-INTERVAL
  38. 38. www.themegallery.com QRS Komplek • Tiga defleksi yang yang mengikuti gelombang P • Mengindikasikan depolarisasi (dan kontraksi) ventrikel • Gel Q = defleksi negatif pertama setelah P. Normalnya lebar < 1 kotak kecil, dalamnya < 2 kotak kecil. • Gel R = defleksi positif pertama setelah P. Normalnya tinggi < 27 kotak kecil, tidak bertakik • Gel S = defleksi negatif pertama setelah R. Normalnya tidak ditemukan di V6, dalamnya < 7 kotak besar di V1-V2 • Normal QRS Lebar 1 ½ - 3 kotak kecil
  39. 39. www.themegallery.com QRS COMPLEX Left Bundle Branch Block (LBBB) indirect activation causes left ventricle contracts later than the right ventricle. Right bundle branch block (RBBB) indirect activation causes right ventricle contracts later than the left ventricle QS or rS complex in V1 - W-shaped RsR' wave in V6- M-shaped Terminal R wave (rSR’) in V1 - M-shaped Slurred S wave in V6 - W-shaped Mnemonic: WILLIAM Mnemonic: MARROW
  40. 40. www.themegallery.com ST Segment • Jarak antara gelombang S dan permulaan gelombang T •Menunjukkan repolarisasi ventrikel • Normalnya Terletak pada garis iso elektris
  41. 41. www.themegallery.com ST-SEGMENT Look at ST changes, Q wave in all leads. Grouping the leads into anatomical location, we have this: Ischaemic change can be attributed to different coronary arteries supplying the area. Location of MI Lead with ST changes Affected coronary artery Anterior V1, V2, V3, V4 LAD Septum V1, V2 LAD left lateral I, aVL, V5, V6 Left circumflex inferior II, III, aVF RCA Right atrium aVR, V1 RCA *Posterior Posterior chest leads RCA *Right ventricle Right sided leads RCA *To help identify MI, right sided and posterior leads can be applied Localizing MI I II III aVR aVL aVF V1 V2 V3 V4 V5 V6 (LAD) (RCA)
  42. 42. www.themegallery.com Criteria: ST elevation in > 2 chest leads > 2mm elevation ST elevation in > 2 limb leads > 1mm elevation Q wave > 0.04s (1 small square). *Be careful of LBBB The diagnosis of acute myocardial infarction should be made circumspectively in the presence of pre-existing LBBB. On the other hand, the appearance of new LBBB should be regarded as sign of acute MI until proven otherwise DIAGNOSING MYOCARDIAL INFARCTION (STEMI) Definition of a pathologic Q wave Any Q-wave in leads V2–V3 ≥ 0.02 s or QS complex in leads V2 and V3 Q-wave ≥ 0.03 s and > 0.1 mV deep or QS complex in leads I, II, aVL, aVF, or V4–V6 in any two leads of a contiguous lead grouping (I, aVL,V6; V4–V6; II, III, and aVF) R-wave ≥ 0.04 s in V1–V2 and R/S ≥ 1 with a concordant positive T-wave in the absence of a conduction defect. A little bit troublesome to remember? I usually take pathological Q wave as >1 small square deep Pathologic Q waves are a sign of previous myocardial infarction.
  43. 43. www.themegallery.com ST SEGMENT ST-ELEVATION MI (STEMI) 0 HOUR 1-24H Day 1-2 Days later Weeks later Pronounced T Wave initially ST elevation (convex type) Depressed R Wave, and Pronounced T Wave. Pathological Q waves may appear within hours or may take greater than 24 hr.- indicating full- thickness MI. Q wave is pathological if it is wider than 40 ms or deeper than a third of the height of the entire QRS complex Exaggeration of T Wave continues for 24h. T Wave inverts as the ST elevation begins to resolve. Persistent ST elevation is rare except in the presence of a ventricular aneurysm. ECG returns to normal T wave, but retains pronounced Q wave. An old infarct may look like this
  44. 44. www.themegallery.com I II III aVR aVL aVF V1 V2 V3 V4 V5 V6 Check again! >2mm Yup, It’s acute anterolateral MI! Let’s see this ST elevation in > 2 chest leads > 2mm Pathological Q wave Q wave > 0.04s (1 small square). ST SEGMENT
  45. 45. www.themegallery.com I II III aVR aVL aVF V1 V2 V3 V4 V5 V6 Check again! Inferior MI! How about this one? ST SEGMENT
  46. 46. www.themegallery.com NSTEMI is also known as subendocardial or non Q-wave MI. In a pt with Acute Coronary Syndrome (ACS) in which the ECG does not show ST elevation, NSTEMI (subendocardial MI) is suspected if ST SEGMENT NON ST-ELEVATION MI (NSTEMI) •ST Depression (A) •T wave inversion with or without ST depression (B) •Q wave and ST elevation will never happen To confirm a NSTEMI, do Troponin test: •If positive - NSTEMI •If negative – unstable angina pectoris
  47. 47. www.themegallery.com A ST depression is more suggestive of myocardial ischaemia than infarction 1mm ST-segment depression Symmetrical, tall T wave Long QT- interval MYOCARDIAL ISCHEMIA ST SEGMENT
  48. 48. www.themegallery.com QT Interval • Permulaan QRS hingga akhir T • Menunjukkan aktivitas ventrikel total • Normalnya Lebar < ½ interval R-R atau Lebar < 2 kotak besar
  49. 49. www.themegallery.com Gelombang T • Gelombang lengkungan ke atas yang mengikuti QRS • Menunjukkan repolarisasi ventrikel • Normalnya Postif (terutama bersama R tinggi) atau Inversi di III, aVR, V1
  50. 50. www.themegallery.com Narrow and tall peaked T wave (A) is an early sign PR interval becomes longer P wave loses its amplitude and may disappear QRS complex widens (B) When hyperkalemia is very severe, the widened QRS complexes merge with their corresponding T waves and the resultant ECG looks like a series of sine waves (C). If untreated, the heart arrests in asystole T wave becomes flattened together with appearance of a prominent U wave. The ST segment may become depressed and the T wave inverted. these additional changes are not related to the degree of hypokalemia. HYPERKALAEMIA HYPOKALAEMIA
  51. 51. www.themegallery.com SUMMARY Unsur EKG Tinggi/Dalam Lebar Gelombang P < 2,5 kotak kecil < 3 kotak kecil PR Interval - - - 3 – 5 kotak kecil Gelombang Q < 2 kotak kecil < 1 kotak kecil Gelombang R < 27 kotak kecil - - - - Gelombang S < 7 kotak besar di V1-V2 - - - - QRS Komplek - - - 1 ½ - 3 kotak kecil QT Interval - - - < ½ interval R- R < 2 kotak besar TERNYATA MUDAH DAN MENYENANGKAN YA BELAJAR EKG 
  52. 52. L/O/G/O SELAMAT BELAJAR
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