Copy of ecg normal n arrythmiaaaaaAAAAAAAAAAAA.ppt

transcript

Electrocardiography

OVERVIEWOVERVIEW

Cardiac Physiology

Electrocardiography

Diagnosing Heart Conditions

Electrocardiography

Cardiac Physiology Electrocardiography Diagnosis

ARTERIESdistributes blood from

VEINSbrings blood back to heart

Ventricles

Sinoatrial Node

Atrioventricular Node

Electrocardiography (EKG)

• Prinsip Dasar EKG

• EKG Leads

• Interpretasi Basic EKG

Directions of Ventricular Depolarization and Repolarization Waves

Depolarization

Repolarization

Depolarization Wave

Repolarization Wave

Apex(+)

Major Electrical Axis of the Heart

Major Electrical Axis

EKG Leads

• The 12 EKG leads measure the electrical activity of the heart from 12 different directions

• Bipolar Leads: Lead I, Lead II, Lead III

• Unipolar Leads: aVR, aVL, aVF

• Precordial Leads: V1, V2, V3, V4, V5, V6

Precordial leads

Right Arm

Left LegRight Leg(Ground)

Left Arm

Lead I +-

Major Electrical Axis

Lead II +

Lead III

VII = VI + VIII

Bipolar Leads

Left ArmRight Arm

Left Leg

Unipolar Lead (aVR)

Unipolar Lead (aVL)

Left ArmRight Arm

Left Leg

Left ArmRight Arm

Left LegaVF+

Unipolar Lead (aVF)

Left ArmRight Arm

Left Leg

V2+V3+V4+V5+V6+

Precordial Leads (V1 to V6)

Lead I

Lead IIILead II

aVRaVL

Directionality of Bipolar and Unipolar Leads

Body Cross-section at Heart Level

Directionality of Precordial Leads

Basic EKG Interpretation

• EKG Waves (P, QRS, and T waves)

• EKG Intervals (P-R, Q-T intervals)

Timing of ECG

P wave(AtrialDepolarization)

QRS Complex (Ventricular Depolarization)

T wave(Ventricular

Repolarization) P wave

One Cardiac Cycle

EKG Waves

P wave

QRS Complex

T wave P wave

P-RInterval

Q-TInterval

P-R Interval = A-V Conduction TimeQ-T Interval = Ventricular Contraction TimeR-R Interval = Cardiac Cycle TimeHeart Rate = 1/R-R Interval

EKG Intervals

0.5 Sec

Graphic ECG

ECG Graphic

Menghitung Heart Rate

• Kecepatan standard =25 mm/sec

• 1 menit : 25x60 =1500/menit

• Kotak besar = 5mm

• 1500/5 =300

• Kotak kecil = 1mm

• 1500/1 =1500

300/6 =50 bpm

300/? =……..bpm

Mean Electricle Axis

• Cari lead yang paling ‘nol’• Axisnya adalah yg tegak lurus terhadap ‘nol’• Garis tegak ini ada + dan -• Lihat kembali lead ‘nol’

– Bila benar-benar nol = axis– Bila lebih positif axis 15 derjat dekat ‘nol’– Bila lebih negatif axis 15 derhat jauh dari ‘nol’

0.5 Sec

ECG Normal

Rhythm (Irama)

• Sinus

• Arrythmia

Frequency

• Normal

• Tachycardia

• Bradycardia

Arrythmia

Arrhytmia

Tachyarrhythmia (rate >100 x/min)

Bradyarrhytmia(rate < 60 X/min)

• QRS sempit (<0.12 ms)• QRS lebar (>0.12 ms)

• AV blok derajat 1, 2 & 3• RBBB & LBBB

Approach to electrocardiographic diagnosis

• Duration of QRS

• Regularity of QRS

P wave ??

QRS complex Regular / irregular ?

QRS complexNormal-looking QRS complex?

Wide / narrow ?

P wave ?

Relationship between P and QRS ?

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”

Atrial Flutter

PSVT :

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

PSVT (Paroxysmal SupraVentricular Tachyradia)

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 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

Rapid AF

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

Preventricular Contractions

• Coffee

• Cigarettes

• Sleep deprivation

• Pathology

ECG with Preventricular Contractions

Normal ECG

VENTRIKEL EXTRA SYSTOLE

SR SR SR SRSR SR

VES VES

Sinus rhythm with Multifocal VES

Ventricular Tachycardia

Ventricular Fibrillation

ECG during Ventricular Fibrillation

Normal ECG

Ventricular Fibrilation

• Ischemia

• Electric Shock

Bradyarrhytmia(rate < 60 x/min)

Failure of impulse formation

• Sinus Bradycardia• Sick Sinus Syndrome

AV conduction abnormalities

• 1st and 2nd AV Block• Total AV Block• BBB (Bundle Branch

Block)

Sick Sinus Syndrome

The Deadly

Rhythms

PEA(Pulse less ElectricalActivity)

A systole

ECG with Atrioventricular Block

Normal ECG

SUMMARYSUMMARY

Cardiac Physiology

Electrocardiography

• Atria• Ventricles• Nodes• Electrical

Propagation

SUMMARYSUMMARY

Cardiac Physiology

Electrocardiography

• ECG Measurement

• P-Wave• QRS-Complex• T-Wave

SUMMARYSUMMARY

Cardiac Physiology

Electrocardiography

• AV Block• PVCs• V-Fib

SummaryCardiac Arrthythmias

• Tachycardia: abnormally fast heart rate

• Bradycardia: Abnormally slow heart rate

• Incomplete Atrioventricular Block: Prolonged P-R interval

• Complete Atrioventricular Block: P waves and QRS complexes become dissociated

• Fibrillation: Complete lack of coordination

Dr.MARNA SURYA ISMY, Sp.PD

Copy of ecg normal n arrythmiaaaaaAAAAAAAAAAAA.ppt

Documents