Home EKG muntah darah
muntah darah PDF Cetak Surel
Ditulis oleh Administrator   
Minggu, 08 Februari 2009 00:50
Electrocardiograms

James Lamberg

Electrical System Overview

2/7

Action Potentials

3/7

12-Lead Positioning

4/7

Values To Memorize
• Inherent Rates
– SA: 60 to 100 – AV: 40 to 60 – Ventricles: 20 to 40

• Normal PRI: 0.12 to 0.20
– 3 to 5 small boxes

• Normal QRS: < 0.12
– Less than 3 small boxes

• Normal QTc: 0.35 to 0.45
– QT < 1/2 RR; QTc = QT / sqrt(RR)

5/7

Calculating Rates
• Count R waves in 6 seconds x 10
– R waves between 2 sets of 3s marks

• Large boxes between R waves / 300
– Small boxes between R waves / 1500

6/7

Standard ECG

7/7

Precordial Leads

8/7

Determining Axis & Rotation
• Axis: Look at Lead I and aVF
– QRS complexes
• • • • Positive: Normal “Leaving”: Left “Reaching”: Right Negative: Indeterminate

– Perpendicular to isoelectric lead

• Rotation: Look at V1 to V6
– V1 or V2 isoelectric: Right – V3 or V4 isoselectric: Normal – V5 or V6 isoelectric: Left

9/7

Axis: Leads I, II, III

10 / 7

Determining Axis: An Example

11 / 7

Normal Sinus Rhythm

12 / 7

Sinus Bradycardia

13 / 7

Sinus Tachycardia

*

14 / 7

Sinus Arrhythmia

15 / 7

Congestive Heart Failure Causes
• FAILURE
– Forgot medication – Arrhythmia, Anemia – Ischemia, Infarction, Infection – Lifestyle (too much salt) – Upregulation of cardiac output (pregnancy, hyperthyroidism) – Renal failure – Embolism (PE)

16 / 7

First Degree Heart Block

17 / 7

Second Degree Block Type I

*

18 / 7

Second Degree Block Type II

19 / 7

Third Degree Heart Block

20 / 7

Premature Atrial Contraction

*

21 / 7

Premature Junctional Contraction

*

22 / 7

Premature Ventricular Contraction

23 / 7

Atrial Fibrillation

24 / 7

Atrial Fibrillation Causes
• THE ATRIAL FIBS
– – – – Thyroid Hypothermia Embolism (PE) Alcohol (“holiday heart”) – Trauma (cardiac contusion) – Recent surgery (post-CABG) – Ischemia – Atrial enlargement – Lone (idiopathic) – Fever, anemia, high-output states – Infarct – Bad values (mitral stenosis) – Stimulants (cocaine, theophylline, amphetamine, caffeine)

25 / 7

Atrial Flutter

26 / 7

Atrial Tachycardia

27 / 7

Atrial Bigeminy & Trigeminy
• Bigeminy

*
• Trigeminy

*

28 / 7

Supraventricular Tachycardia

29 / 7

Junctional Escape Rhythm

*

30 / 7

Junctional Tachycardia

31 / 7

Ventricular Fibrillation

32 / 7

Ventricular Tachycardia

33 / 7

Torsade de Pointes

34 / 7

Ventricular Bigeminy & Trigeminy
• Bigeminy

• Trigeminy

35 / 7

Ventricular Asystole

36 / 7

Bundle Branch Blocks
• Characteristic QRS pattern in lead I, V1, and V6

37 / 7

The Turn Signal Rule
• Turn-Signal Rule
– – – – QRS >0.12 everywhere Look V1 QRS Find J point Draw a horizontal line

• Triangle pointing up indicates RBBB • Triangle pointing down indicates LBBB

38 / 7

William Marrow (V1-V6)
• LBBB • RBBB

39 / 7

Left Bundle Branch Block

*

40 / 7

Right Bundle Branch Block

*

41 / 7

Wolff-Parkinson-White
• Pre-excitation
– Bundle of Kent – Delta wave
• Slurred QRS

• Lown-Ganong-Levine
– Bundle of James – Short PR Interval
• < 0.12s

42 / 7

Sick Sinus Syndrome

43 / 7

Atrial Hypertrophy

44 / 7

Atrial Hypertrophy
• P Pulmonale: Right (RAH)

• P Mitrale: Left (LAH)

45 / 7

Ventricular Hypertrophy
• Right (RVH)
– Right axis deviation and rotation – Tall QRS on right side leads
• (V1, V2, V3)

• Left (LVH)
– Left axis deviation and rotation – Tall QRS on left (V4, V5, V6)

46 / 7

Left Ventricular Hypertrophy

47 / 7

Significant Q Waves

48 / 7

Myocardial Infarction
• Significant Q wave = Necrosis • ST elevation = Injury • T wave inversion = Ischemia

49 / 7

MI Location

50 / 7

MI Location

51 / 7

Anterior Leads

52 / 7

Lateral Leads

53 / 7

Inferior Leads

54 / 7

Pericarditis
– Diffuse ST Elevation – PR Depression

55 / 7

Pericarditis Causes
• CARDIAC RIND
– Collagen vascular disease – Aortic aneurysm – Radiation – Drugs (hydralazine) – Infections – Acute renal failure – Cardiac infarction – – – – Rheumatic fever Injury Neoplasms Dressler syndrome (MI or surgery)

56 / 7

Non-STEMI versus STEMI
• Non-STEMI • STEMI

57 / 7

STEMI Progression

58 / 7

STEMI Progression

59 / 7

ST Segment Elevation
• ELEVATION
– Electrolytes – Left bundle branch block – Early repolarization – Ventricular hypertrophy – Aneurysm – Treatment (pericardiocentesis) – Injury (acute MI, contusion) – Osborne waves (hypothermia) – Nonocclusive vasospasm

60 / 7

ST Segment Depression
• DEPRESSED ST
– – – – – – – – – – – Drooping valve (mitral valve prolapse) Enlargement or LV with strain Potassium loss (hypokalemia) Reciprocal ST depression (inferior MI) Embolism (PE) Subendocardial ischemia Subendocardial infarct Encephalon hemorrhage Dilated cardiomyopathy Shock Toxicity of digitalis, quinidine

61 / 7

Abnormal T Waves
• Subarachnoid hemorrhage • Cerebral hemorrhage • Cerebral thrombosis

*

62 / 7

Electrolytes & Drugs
• Hyperkalemia
– High K+ – Peaked T

• Hypokalemia
– Low K+ – Flat T, U Wave

63 / 7

Electrolytes & Drugs
• Hypercalcemia
– Short QT

• Hypocalcemia
– Long QT

• Dititalis
– Sloping ST

• Quinidine
– Long QT – Notched P

64 / 7

Brudada Syndrome
• Asian Males • ST Elevation in V1, V2, V3

65 / 7

Interpretation Example #1

66 / 7

Interpretation Example #2

67 / 7

Right Sided ECG

*

68 / 7

Interpretation Example #3

69 / 7

Interpretation Example #4

70 / 7

Interpretation Example #5

71 / 7

Interpretation Example #6

72 / 7

Tools of the Trade
• Recommend
– Calipers

• Useful
– Magnifier

• Avoid
– Rulers

73 / 7

Questions?

74 / 7

Terakhir Diperbaharui pada Kamis, 02 April 2009 18:50
 

MALALARADIO 105.2 FM