Dokumen tersebut memberikan penjelasan mengenai elektrofisiologi dasar jantung dan pembentukan impuls, fungsi dan kegunaan EKG, anatomi detak jantung normal, vektor konsep dalam EKG, dan tahapan interpretasi EKG secara sistematis meliputi ritme, frekuensi, aksis, morfologi gelombang P, QRS, T, segmen ST, dan ciri-ciri normal lainnya.

1. BASIC CARDIAC
ELECTROPHYSIOLOGY AND
IMPULSE FORMATION

2. FIRST ECG

3. NOW

4. WHAT ECG MACHINE DO?
Detects heart’s
electrical current
activity
Displays it on a
screen or prints it
onto graph paper

5. ECG MACHINE FUNCTION
• Identifies irregularities in heart rhythm
• Reveals injury, death or other physical
• changes in heart muscle
• Used as an assessment and diagnostic tool
• Can continuously monitor heart’s electrical activity

6. WHAT ECG WONT DO
• Does not tell how well heart is pumping

7. THE STANDARD 12-LEAD ECG
• The 12 leads are:
◦ Six limb leads (I, II, III, aVR, aVL and aVF) ◦ Six precordial (chest) leads: V1 to V6
• The 12 leads are displayed at a standardised tracing speed of 25 mm per second,
and with 1 cm representing 1.0 mV on the vertical axis.

11. HEART BEAT ANATOMY
SINUS NODE
• The Heart’s ‘Natural Pacemaker’ -
60-100 BPM at rest

12. AV NODE
• Receives impulse from SA Node
• Delivers impulse to the His- Purkinje System
• 40-60 BPM if SA Node fails to deliver an impulse

13. BUNDLE OF HIS
• Begins conduction to the Ventricles
• AV Junctional Tissue: 40-60 BPM

14. THE PURKINJE NETWORK
• Bundle Branches
• Purkinje Fibers
• Moves the impulse through the ventricles for
contraction
• Provides ‘Escape Rhythm’: 20-40 BPM

16. ATRIAL DEPOLARISATION

17. DELAY AT AV NODE

18. CONDUCTION THROUGH BUNDLE
BRANCHES

19. CONDUCTION THROUGH PURKINJE
FIBERS

20. VENTRICULAR DEPOLARISATION

21. PLATEAU PHASE OF REPOLARIZATION

22. FINAL RAPID (PHASE 3)
REPOLARIZATION

23. NORMAL ECG ACTIVATION

24. LEAD PLACEMENT

26. VECTOR CONCEPT IN ECG

27. VECTOR CONCEPT

28. NORMAL AXIS

31. NORMAL P WAVE
• P wave is the first positive defection on the ECG
• Duration < 0.12s (3 Small squares)
• Amplitude < 2.5 mm in the limb leads, <1.5mm in the precordial leads
Normal Morphology
- Smooth contour
- Monophasic in lead II
- Biphasic in lead V1

33. P WAVE CHECKLIST
•Always positive in lead II during sinus rhythm.
•Virtually always positive in aVL, aVF, -aVR, I, V4,V5,
V6.
•Biphasic in V1, the negative deflection normally <
1mm
•Duration should be < 0.12 s
•Amplitude should be <2.5 mm in limb leads

34. NORMAL PR INTERVAL
PR interval is the time from the onset of the P wave to the start of the QRS complex, it
reflects conduction through the AV node
Normal PR interval
- Duration between 120-200ms (3-5 small squares)

35. PR INTERVAL

36. PR INTERVAL CHECKLIST
•Normal Ranges between 0.12-2.22 seconds.
•Prolong PR interval (> 0.22 s) s is consistent with
first degree AV block
•Shortened PR interval (<0.12 s) indicate pre-
excitation. (presence of an accessory pathway)

37. NORMAL QRS
• QRS complex represent Ventricle depolarization
Normal QRS
- Duration 70 - 100ms (±1-2.5 small squares)

39. R WAVE
• Should be < 26 mm in V5-V6
• R Amplitude in V5 and S wave in V1 should be < 35 mm
• R Amplitude in V6 and S wave in V1 should be < 35 mm
• R in aVL < 12 mm
• R wave in I,II, III should ne < 20 mm
• If R wave in V1 larger than S wave n V1, the R wave should be
< 5 mm

40. R WAVE PROGRESSION
• Assessed by using precordial leads
• Gradually increase in amplitude from V1 to V5 then diminishes in
amplitude from V5 to V6
• Abnormal R wave progression is common finding in the following
condition
◦ Myocardial infarction
◦ Cardiomyopathy
◦ Right and Left Ventricular Hypertrophy
◦ Preexcitation, BBB and COPD

41. R WAVE PROGRESSION

42. Q WAVE

43. NORMAL VARIANT OF Q WAVES
• Septal Q waves. Seen in lateral leads V5,V6. I, aVL
• Respiratory Q wave. An Isolated and often large Q wave
in llI.

44. ABNORMAL Q WAVES
• Most common cause is Myocardial infarction. Pathological Q waves must exist in
two anatomically contigous leads
• Other causes
◦ Left sided pneumothorax
◦ Dextrocardia
◦ Perimyocarditis
◦ Cardiomyopathy
◦ Amyliodosis
◦ BBB, Fascicular blocks,
◦ WPW
◦ Ventricular hypertrophy,
◦ Acute cor pulmonale

45. NORMAL ST SEGMENT
The ST Segment is the flat, isoelectric section of the ECG between the end of the S
wave (the J point) and the beginning of the T wave
The ST segment represents the interval between ventricular depolarization and
repolarization
The most common important cause of ST Segment abnormality is myocardial
ischaemia or infarction

53. NORMAL T
The T wave is the positive deflection after each QRS complex
It Represent ventricular repolarization
Normal T wave
- Upright in all leads except aVR and V1
- Amplitude < 5mm in limb leads, <15mm in precordial leads
- T wave amplitude is highest in V2-V3 and diminishes with increasing age.
- T wave should be concordant with QRS complex

56. STEP BY STEP TO INTERPRATE ECG
Know you Patient First
Because
We Treat patient, not ECG

57. STEP BY STEP TO INTERPRATE ECG
DATA
Standardisasi,
- pastikan identitas pasien sesuai,
- kertas EKG setinggi 10mm sehingga 10mm = 1mV,
- pastikan kecepatan kertas sudah benar

58. IRAMA ATAU RITME (RHYTHM)
Karakteristik sinus rhythm:
- Laju : 60-100x/menit
- Interval P-P regular, interval R-R regular
- Gelpmbang P positif di sadapan II, selalu diikuti kompleks QRS
- PR interval : 0,12-0,20 detik dan konstan dari beat to beat
Jika laju QRS < 60x/menit disebut sinus bradikardia dan jika > 100x/menit disebut
sinus takikardia

59. FREKUENSI / HEART RATE
Ada 3 metode yaitu:
• Tiga ratus (300) dibagi jumlah kotak besar antara R-R.
• Seribu lima ratus (1500) dibagi jumlah kotak kecil antara R-R.
• Hitung jumlah gelombang QRS dalam 6 sekon, kemudian dikalikan 10, atau dalam
12 sekon dikalikan dengan 5.

60. 3.75 - 4 kotak besar
Rate : 300 / 3,75 = 80x/menit

61. AXIS
Cek lead I, bila positif artinya jantung
ada di area hijau
Cek lead aVF, bila positif artinya
jantung ada di area hijau

62. • Bila hasil resultan sandapan I positif dan aVF positif, maka sumbu
jantung (aksis) berada pada posisi normal.
• Bila hasil resultan sandapan I positif dan aVF negatif, jika resultan
sandapan II positif: aksis normal, tetapi jika sandapan II negatif
maka deviasi aksis ke kiri (LAD = Left Axis Deviation), berada pada
sudut -30˚ sampai -90˚.
• Bila hasil resultan sandapan I negatif dan aVF positif, maka deviasi
aksis ke kanan (RAD = Right Axis Deviation), berada pada sudut
+110˚ sampai +180˚.
• Bila hasil resultan sandapan I negatif dan aVF negatif, maka
deviasi aksis kanan atas, berada pada sudut -90˚ sampai +180˚.
Disebut juga daerah no man’s land.

63. MORFOLOGI GELOMBANG ECG
Gel P
Lihat di lead II dan V1

65. MORFOLOGI GELOMBANG ECG
Gelombang QRS
• Evaluasi tanda-tanda hipertrofi ventrikel kiri/kanan serta cari apakah terdapat
morfologi blok cabang berkas kiri atau blok cabang berkas kanan.
Cara cepat:
Lihat di V1
R wave tinggi melebihi normal  curiga Right Vent Hypertrophy
S wave kedalamannya melebihi normal  curiga Left Vent Hypertophy
(S di V1 + R di V5 > 35mm) sokolow lion criteria

66. MORFOLOGI GELOMBANG ECG
Gelombang T
• Apakah terdapat gelombang T yang lebar dan tinggi? Deskripsikan gelombang
tersebut

67. SEGMEN ST
Selalu lihat segmen ST di lead2 berikut (berpasangan):
II, III, aVF  bagian inferior jantung
I, aVL, V5,V6  lateral jantung
V1-V4  anterior jantung

68. TERIMA KASIH