Anatomi Jantung & Konsep dasar elektrokardiografi

THE HEART

Interventriculer Septum

Papillary muscle

Semilunar Valve

Anatomy of the HeartAnatomy of the Heart

Pericardium : Pericardium :

Outer fibrous sackOuter fibrous sack

Myocardium :Myocardium :

Thick muscle wallsThick muscle walls

Endocardium : Endocardium :

Innermost surfaceInnermost surface

EndotheliumEndothelium

Simple squamous Simple squamous

epitheliumepithelium

PerikardiumPerikardium

Perikardium Fibrosa

Lapisan paling luar rongga Pericardium

Menjaga kedudukan jantung di rongga mediastinum

Perikardium Serosa

Lapisan parietalis

Lapisan bagian dalam dari rongga pericardial

Lapisan visceralis / epicardium

Rongga Perikardium

Cairan pericardium

Mengurangi gesekan saat jantung bergerak

Anatomy of the HeartAnatomy of the Heart

Heart chambersHeart chambers ::

Left & right atriaLeft & right atria

Left & right ventriclesLeft & right ventricles

Heart valvesHeart valves ::

Atrioventricular valves :Atrioventricular valves :

Right : TricuspidRight : Tricuspid

Left : Bicuspid/MitralLeft : Bicuspid/Mitral

Semilunar valvesSemilunar valves

Right : Pulmonary valveRight : Pulmonary valve

Left : Aortic valveLeft : Aortic valve

Anatomy of the HeartAnatomy of the Heart

AortaAorta

Coronary arteriesCoronary arteries

ArteriolesArterioles

CapillariesCapillaries

VenulesVenules

Coronary sinusCoronary sinus

Right atriumRight atrium

Coronary circulationCoronary circulation

TipeTipe--tipetipe selsel OtotOtot JantungJantung

Autoritmik autoritmik mampu berdepolarisasi spontan

produce pacemaker potentials

menyalurkan aksi potensial ( impulses ) melewatimyocardium

tidak berkontraksi

Kontraktil Potensial aksi menimbulkan kontraksi

Aliran darah ditimbulkan oleh pergantian dari

kontraksi ( SISTOLIK ) dan Relaksasi ( DIASTOLIK )

Intrinsic Conducting SystemIntrinsic Conducting System

Sinoatrial nodeSinoatrial node

Electrical pace makerElectrical pace maker

Atrioventricular nodeAtrioventricular node

Receives impulses Receives impulses

originating from SA nodeoriginating from SA node

Bundle of HisBundle of His

Electrical link between Electrical link between

atria and ventriclesatria and ventricles

Purkinje fibresPurkinje fibres

Distribute impulses to Distribute impulses to

ventriclesventricles

Conduction System

SA Node Internodal branch AV Node Hiss Bundle Purkinje Fiber Contraction

Cardiac Action PotentialsCardiac Action Potentials

7/21/20107/21/2010 Dr Paul Bradley, Clinical Skills Resource Centre, University ofDr Paul Bradley, Clinical Skills Resource Centre, University of Liverpool, UKLiverpool, UK 1717

The chest leadsThe chest leads V1 V1 -- 4th ICS RSE4th ICS RSE V2 V2 -- 4th ICS LSE4th ICS LSE V3 V3 -- midway between V2 & V4midway between V2 & V4 V4 V4 -- 5th ICS MCL5th ICS MCL V5 V5 -- 5th ICS AAL5th ICS AAL V6 V6 -- 5th ICS MAL5th ICS MAL

V1 V2 V3 V4 V5 V6

Sternomanubrial joint - Angle of Louis

The Electrocardiogram ( ECG )The Electrocardiogram ( ECG )

P wave : atrial P wave : atrial depolarisationdepolarisation

QRS complex : QRS complex : ventricular ventricular depolarisationdepolarisation

T wave : ventricular T wave : ventricular repolarisationrepolarisation

Atrial repolarisation Atrial repolarisation hidden by QRShidden by QRS

P

Q

R

S

T

P Wave

GELOMBANG P

NormalTinggi : < 0,3 mvoltLebar : < 0,12 detikSelalu positif di L IISelalu negatif di aVR

KepentinganMengetahui kelainan di Atrium

Gelombang P Pulmonal

Gelombang P Mitral

Gambaran yang ditimbulkan oleh depolarisasi atrium

P Pulmonale

P Mitrale

PR Interval

Interval PRDiukur dari permulaan P s/d permulaan QRS

Normal : 0,12 - 0,20 detik

QRS Complex

GELOMBANG QRS

Gambaran yang ditimbulkan oleh depolarisasi ventrikel

Normal :Lebar : 0,06 - 0,12 detikTinggi : Tergantung lead

Normal gelombang QLebar : < 0,04 detikDalam : < 1/3 tinggi R

ST Segment

T Wave

AXIS AXIS AXIS AXIS AXIS AXIS AXIS AXIS

Right Axis DeviationRight Axis DeviationRight Axis DeviationRight Axis Deviation Left Axis DeviationLeft Axis DeviationLeft Axis DeviationLeft Axis Deviation

RADRADRADRADRADRADRADRAD

LADLADLADLADLADLADLADLAD

4343

ContohContoh EKG normalEKG normal

4444

ContohContohEKG NormalEKG Normal

4545

ElektrodaElektroda terbalikterbalik

4646

Dextrocardia : direkam biasa

4747

Cara merekam Dextrocardia