DASAR PEMBUATAN REKAMAN JANTUNG (EKG)

DR.dr. Zainal Musthafa, SpJP, FIHA, MSi

EKG & ARITMIA

DR.dr. Zainal Musthafa, SpJP, FIHA, MSi

SA node

Sumber impuls normal/ alamiah , 60 100 / menit

AV node

Bisa mengeluarkan impuls 40-50x/menit

Berkas His Serabut Purkinje

Ventrikel

Bisa mengeluarkan impuls 30 x/menit

Atrial Depolarization

Ventricle Depolarization

0.12 second

Terminologi morfologi QRS qRs Rs R rS

QR

Q/QS

RsR

rSr

1 kotak kecil = 0.04 detik

5 kotak kecil = 1 kotak sedang = 0.2 detik Paper speed : 25 mm/second

5 kotak sedang = 1 kotak besar = 1 detik

MENGHITUNG LAJU JANTUNG : A. Jarak R R :

-1 kotak sedang -2 kotak sedang -3 kotak sedang -4 kotak sedang -5kotak sedang -6 kotak sedang

= 300 x / menit = 150 x / menit = 100 x / menit = 75 x / menit = 60 x / menit = 50 x / menit

B. Hitung jumlah R- R dalam 6 kotak besar = 6 detik Jumlah R x 10 = heart rate / menit C. 1500 / jarak R-R ( dlm mm ) = heart rate / menit

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.

How to identify arrhythmias ?

QRS complex Regular / irregular ?

QRS complex Normal-looking QRS complex? Wide / narrow ? P wave ?

Relationship between P and QRS ?

NORMAL SINUS RHYTHM

PSVT :
-due to re-entry mechanism -narrow QRS complex -regular -retrograde atrial depolarization -P wave ?

PSVT

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

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

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. -normal-looking QRS. -retrograde P wave. -P wave may preceede, coincide with, or follow the QRS

VENTRIKEL EXTRA SYSTOLE

SR

VES

Sinus rhythm with Multifocal VES

VES

VES

SR

SR

SR

SR

SR

SR

Sinus rhythm with VES couplet

Sinus Rhythm with VES, R on T

Ventricular Tachycardia

Torsade de Pointes

Ventricular Fibrillation

1st degree AV block

Prolonged PR interval

2nd degree AV block, type 1

Missing QRS

Missing QRS

2nd degree AV block, type 2

Missing QRS

Total AV Block / 3rd degree AV block

QRS QRS QRS

Treat the patient, not the monitor . . . . .!!!

SELESAI

EKG & ARITMIA