Location via proxy:   [ UP ]  
[Report a bug]   [Manage cookies]                
Scribd Logo
Upload

Welcome to Scribd!

  • 23 views

    Hotel Dpalma, Bandung 16 Maret 2018: Dr. Benny Prasetya P

    Uploaded by

    kangheri
    The document provides a summary of the history and development of electrocardiography (ECG). Some key points include: - In 1842, Carlo Matteucci discovered the relationship between heartbeats and electrical processes. - In 1876, Marey analyzed the electrical patterns of a frog's heart. - In 1895, William Einthoven invented the string galvanometer, which led to the first successful recording of a human electrocardiogram in 1903. - Einthoven received the Nobel Prize in 1924 for his invention of the ECG. Since then, improvements have been made to ECG leads and techniques. The document then discusses ECG terminology, heart

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd

    Hotel Dpalma, Bandung 16 Maret 2018: Dr. Benny Prasetya P

    Uploaded by

    kangheri
    23 views145 pages
    The document provides a summary of the history and development of electrocardiography (ECG). Some key points include: - In 1842, Carlo Matteucci discovered the relationship between heartbeats and electrical processes. - In 1876, Marey analyzed the electrical patterns of a frog's heart. - In 1895, William Einthoven invented the string galvanometer, which led to the first successful recording of a human electrocardiogram in 1903. - Einthoven received the Nobel Prize in 1924 for his invention of the ECG. Since then, improvements have been made to ECG leads and techniques. The document then discusses ECG terminology, heart

    Original Description:

    usg

    Original Title

    usg

    Copyright

    © © All Rights Reserved

    Available Formats

    PPTX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    The document provides a summary of the history and development of electrocardiography (ECG). Some key points include: - In 1842, Carlo Matteucci discovered the relationship between heartbeats and electrical processes. - In 1876, Marey analyzed the electrical patterns of a frog's heart. - In 1895, William Einthoven invented the string galvanometer, which led to the first successful recording of a human electrocardiogram in 1903. - Einthoven received the Nobel Prize in 1924 for his invention of the ECG. Since then, improvements have been made to ECG leads and techniques. The document then discusses ECG terminology, heart

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    23 views145 pages

    Hotel Dpalma, Bandung 16 Maret 2018: Dr. Benny Prasetya P

    Uploaded by

    kangheri
    The document provides a summary of the history and development of electrocardiography (ECG). Some key points include: - In 1842, Carlo Matteucci discovered the relationship between heartbeats and electrical processes. - In 1876, Marey analyzed the electrical patterns of a frog's heart. - In 1895, William Einthoven invented the string galvanometer, which led to the first successful recording of a human electrocardiogram in 1903. - Einthoven received the Nobel Prize in 1924 for his invention of the ECG. Since then, improvements have been made to ECG leads and techniques. The document then discusses ECG terminology, heart

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 145

    Hotel dPalma , Bandung

    16 Maret 2018
    dr. Benny Prasetya P
    SEJARAH EKG
     1842: Ilmuwan Italia Carlo Matteucci  detak jantung
    berhubungan dengan proses kelistrikan

     1876: Ilmuwan Irlandia Marey melaukan analisis pola


    kelistrikan pada jantung katak
     1895: William Einthoven --> penemuan EKG

     1906: “The string electrometer EKG”, William Einthoven


     1924: William Einthoven mendapatkan hadiah nobel atas
    penemuan EKG
     1938: AHA and Cardiac society of great Britain--> Chest
    Lead
     1942: Goldberger --> melakukan peningkatan 50% pada
    Wilson’s Unipolar lead voltage + Augmented leads
    TERMINOLOGI
     ELEKTROKARDIOGRAFI
    Ilmu yang mempelajari aktivitas listrik jantung
     ELEKTROGARDIOGRAM
    grafik yang menggambarkan rekaman listrik
    jantung
    ELEKTROKARDIOGRAF
    alat yang dapat merekam aktivitas listrik jantung
    ANATOMI JANTUNG

    Anterior Posterior
    Vascularisasi Jantung
    SISTEM KONDUKSI JANTUNG
    GENERATOR PACU JANTUNG
     SINO ATRIAL NODE (SA NODE) : generator utama
    (60 - 100 x/menit)

     ATRIO-VENTRICULAR NODE (AV NODE) :


    generator kedua setelah SA node (40 - 60 x/menit)
     Standard calibration
     25 mm/s
     0.1 mV/mm

     Electrical impulse that travels towards the electrode


    produces an upright (“positive”) deflection
    NORMAL ECG
    GELOMBANG EKG NORMAL
    The ECG Paper
     Horizontally
     One small box - 0.04 s
     One large box - 0.20 s
     Vertically
     One large box - 0.5 mV
    REKAMAN STANDAR
    EKG

    1. Bipolar Leads: Two different points on the body (I-II-III,


    AVF-AVR-AVL)

    2. Unipolar Leads: One point on the body and a virtual


    reference point with zero electrical potential, located in
    the center of the heart ( V1-V6, V7-V9, V2R-V6R)
    The standard EKG has 12 leads:

    3 Standard Limb Leads (I-II-III)


    3 Augmented Limb Leads (AVF-AVR-AVL)
    6 Precordial Leads (V1-V2-V3-V4-V5-V6)
    TEHNIK PEMASANGAN LEAD
    BIPOLAR LEAD
    ECG MONITOR
    UNIPOLAR LEAD
    SADAPAN KANAN & POSTERIOR
    NORMAL ECG
    IRAMA JANTUNG
     Hal pertama yang harus dilakukan dalam pembacaan
    EKG adalah menentukan Irama Jantung
     Normal irama jantung adalah Irama Sinus
    Sinus Bradycardia
    Junctional Rhythm
    Heart Rate
    Rule of 300/1500
    10 Second Rule
    Rule of 300

    Count the number of “big boxes” between two


    QRS complexes, and divide this into 300. (smaller
    boxes with 1500)
    for regular rhythms.
    What is the heart rate?

    (300 / 6) = 50 bpm
    What is the heart rate?

    (300 / ~ 4) = ~ 75 bpm
    What is the heart rate?

    (300 / 1.5) = 200 bpm


    The Rule of 300
    It may be easiest to memorize the following table:

    No of big Rate
    boxes
    1 300
    2 150
    3 100
    4 75
    5 60
    6 50
    10 Second Rule

    EKGs record 10 seconds of rhythm per page,


    Count the number of beats present on the EKG
    Multiply by 6
    For irregular rhythms.
    What is the heart rate?

    33 x 6 = 198 bpm
    Calculation of Heart Rate
    Question
     Calculate the heart rate
    AXIS JANTUNG
     Untuk menentukan axis/sumbu jantung
     Yang dihitung adalah kekuatan listrik antara kanan
    dan kiri jantung
    Standard Limb Leads
    All Limb Leads
    The QRS Axis
    Normal QRS axis from -30° to
    +90°.

    -30° to -90° is referred to as a


    left axis deviation (LAD)

    +90° to +180° is referred to as


    a right axis deviation (RAD)
    Determining the Axis

    Predominantly Predominantly Equiphasic


    Positive Negative
    The Quadrant Approach
    1. QRS complex in leads I and aVF
    2. determine if they are predominantly positive or negative.
    3. The combination should place the axis into one of the 4
    quadrants below.
    GELOMBANG EKG NORMAL
     Tall (> 2.5 mm), pointed P waves (P Pulmonale)
     Notched/bifid (‘M’ shaped) P wave (P ‘mitrale’) in
    limb leads
     WPW (Wolff-Parkinson-
    White) Syndrome
     Accessory pathway
    (Bundle of Kent) allows
    early activation of the
    ventricle (delta wave and
    short PR interval)
    Long PR Interval

     First degree Heart Block


    Type 1 (Mobitz 1, Wenckebach):.

    •The P-P interval remains relatively constant


    •The greatest increase in PR interval duration is typically between the first and
    second beats of the cycle.
    •The RR interval progressively shortens with each beat of the cycle.
    •The Wenckebach pattern tends to repeat in P:QRS groups with ratios of 3:2,
    4:3 or 5:4.

    Causes of Wenckebach Phenomenon


    •Drugs: beta-blockers, calcium channel blockers, digoxin, amiodarone
    •Increased vagal tone (e.g. athletes)
    •Inferior MI
    •Myocarditis
    •Following cardiac surgery (mitral valve repair, Tetralogy of Fallot repair)
    Type 2 (Mobitz 2, Hay): PR interval remains unchanged prior to the P wave which
    suddenly fails to conduct to the ventricles.
    “fixed ratio” blocks
    2:1

    3:1

    •High-grade AV block (4:1 conduction ratio).


    Causes of Mobitz II :

    •Anterior MI (due to septal infarction with necrosis of the bundle branches).

    •Idiopathic fibrosis of the conducting system (Lenegre’s or Lev’s disease).

    •Cardiac surgery (especially surgery occurring close to the septum, e.g. mitral
    valve repair)

    •Inflammatory conditions (rheumatic fever, myocarditis, Lyme disease).

    •Autoimmune (SLE, systemic sclerosis).

    •Infiltrative myocardial disease (amyloidosis, haemochromatosis, sarcoidosis).

    •Hyperkalaemia.

    •Drugs: beta-blockers, calcium channel blockers, digoxin, amiodarone.


    •The atrial rate is approximately 100 bpm.
    •The ventricular rate is approximately 40 bpm.
    •The two rates are independent; there is no evidence that any of the atrial
    impulses are conducted to the ventricles.

    Causes of complete heart block


    The causes are the same as for Mobitz I and Mobitz II second degree heart
    block. The most important aetiologies are:
    •Inferior myocardial infarction
    •AV-nodal blocking drugs (e.g. calcium-channel blockers, beta-blockers, digoxin)
    •Idiopathic degeneration of the conducting system (Lenegre’s or Lev’s disease)
     Nonpathological Q waves may present in I, III,
    aVL, V5, and V6

     R wave in lead V6 is smaller than V5

     Depth of the S wave, should not exceed 30 mm

     Pathological Q wave > 2mm deep and > 1mm wide


    or > 25% amplitude of the subsequent R wave
    Right Ventricular Hypertrophy
     Sokolow & Lyon Criteria
     S in V1+ R in V5 or V6 > 35 mm
     An R wave of 11 to 13 mm (1.1 to 1.3 mV) or more in
    lead aVL is another sign of LVH
     Normal T wave is asymmetrical, first half having a
    gradual slope than the second

     Should be at least 1/8 but less than 2/3 of the


    amplitude of the R

     T wave amplitude rarely exceeds 10 mm

     Abnormal T waves are symmetrical, tall, peaked,


    biphasic or inverted.

     T wave follows the direction of the QRS deflection.


    T wave
    HYPERKALEMIA
    SEVERE HYPERKALEMIA
    QT interval
    1. Total duration of
    Depolarization and
    Repolarization
    2. QT interval decreases when
    heart rate increases
    3. For HR = 70 bpm, QT<0.40
    sec.
    4. QT interval should be 0.35
    0.45 s,
    5. Should not be more than half
    of the interval between
    adjacent R waves (RR
    interval).
    HYPERCALCEMIA
    HYPOCALCEMIA
    U wave
     U wave related to afterdepolarizations
    which follow repolarization
     U waves are small, round, symmetrical and
    positive in lead II, with amplitude < 2 mm
     U wave direction is the same as T wave
     More prominent at slow heart rates
    ST SEGMEN
     ST Segment is flat (isoelectric)
     Elevation or depression of ST segment by 1 mm
    or more
     “J” (Junction) point is the point between QRS and
    ST segment
    ST Elevation
    One way to diagnose an
    acute MI is to look for
    elevation of the ST segment.
    garis iso-elektris
    PERJALANAN ST- SEGMEN
    Precordial Leads
    Precordial Leads
    Right Sided & Posterior Chest
    Leads
    Arrangement of Leads on the EKG
    Anatomic Groups
    (Septum)
    Anatomic Groups
    (Anterior Wall)
    Anatomic Groups
    (Lateral Wall)
    Anatomic Groups
    (Inferior Wall)
    Anatomic Groups
    (Summary)
    Anterior MI
    Remember the anterior portion of the heart is
    best viewed using leads V1- V4.
    Limb Leads Augmented Leads Precordial Leads
    Anterior Myocardial Infarction

    If you see changes in leads V1 - V4 that are


    consistent with a myocardial infarction, you
    can conclude that it is an anterior wall
    myocardial infarction.
    Lateral MI
    So what leads do you think
    the lateral portion of the
    Leads I, aVL, and V5- V6
    heart is best viewed?

    Limb Leads Augmented Leads Precordial Leads


    Inferior MI
    Now how about the
    inferior portion of the
    heart? Leads II, III and aVF

    Limb Leads Augmented Leads Precordial Leads


    ACUTE PERICARDITIS
    ACUTE PERICARDITIS
    PERICARDIAL EFFUSION-Electrical
    alterans
    CARDIAC TAMPONADE
    TERIMA KASIH

    You might also like