JANTUNG
Definition of arrhythmia
Cardiac arrhythmia is an
abnormality of the heart rhythm
Bradycardia heart rate slow
(<60 beats/min)
Tachycardia heart rate fast
(>100 beats/min)
GANGGUAN IRAMA
JANTUNG
Aritmia jantung merupakan istilah
kolektif untuk semua gangguan
irama jantung di luar irama sinus yg
normal.
Gangguan terjadi pada saat
pembentukan impuls,hantaran
maupun kombinasi keduanya.
Sering menimbulkan rasa cemas
3
GANGGUAN IRAMA
JANTUNG
Gangguan yg tergolong ringan,menimbulkan
berbagai keluhan(denyut jantung terasa
berat,dada bergetar,denyut berhenti).
Tidak jarang,aritmia yg berat,tidak
menimbulkan keluhan.
Penelitian sebelumnya,dilaporkan adanya
kematian mendadak,ternyata di sebabkan
oleh fibrilasi ventrikel,yg sebelumnya hanya
merpakan ekstra sistol yg tidak terkendali.
5
GANGGUAN IRAMA
JANTUNG
Aritmia dapat terjadi pada orang
sehat,segala umur.
Aritmia ekstra sistole ventrikel merupakan
aritmia yg dijumpai pada orang sehat dan
sakit.
Pada waktu olah raga dilaporkan pada33%
laki laki,dan 15% pada wanita.
Pembicaraan disini di tekankan pada
strategi praktis penanggulangan,selain
Atrium, aritmia ventrikel,yg merupakan
jenis aritmia yg terbanyak dijumpai
6
DIAGNOSIS ARITMIA
Riwayat penyakit,fisik diagnostik,px EKG
Mudah ditegakkan.
Merencanakan strategi
penanggulangan,cukup sulit.
Evaluasi yg tidak lengkap,mengalami
kegagalan untuk mengenal penyakit dasar
yg menimbulkan aritmia,yg sebenarnya
dapat diobati.Atau sebaliknya penderita
diberikan pengobatan berlebihan yg
sebenarnya tidak perlu
7
Cardiac Cycle
P Wave-Atrial Depolarization
PR Segment-Indicative of the delay in the AV node
PR Interval-Refers to all electrical activity in the heart before
the impulse reaches the ventricles
Q Wave-First negative deflection after the P wave but before the
R wave
R Wave-First positive deflection following the P wave
S Wave-First negative deflection after the R wave
QRS Complex-Signifies ventricual depolarization
T Wave-Indicates ventricular repolarization (Note: Atrial
repolarization wave is buried in the QRS complex).
Sinus Bradycardia
Sinus node is the pacemaker, firing regularly at a rate of less than 60 times per
minute. Each impulse is conducted normally through to the ventricles
Regularity: The R-R intervals are constant; Rhythm is regular
Rate: Atrial and Ventricular rates are equal; heart rate less than 60
P Wave: Uniform P wave in front of every QRS
PRI: PRI is between .12 -.20 and constant
10
Sinus Tachycardia
Sinus node is the pacemaker, firing regularly at a rate of greater
than 100 times per minute. Each impulse is conducted normally
through to the ventricles .
Regularity: The R-R intervals are constant; Rhythm is regular
Rate: Atrial and Ventricular rates are equal; heart rate greater
than 100
P Wave: Uniform P wave in front of every QRS
PRI: PRI is between .12 -.20 and constant
QRS:QRS is than .12
11
Atrial Flutter
A single irritable focus within the atria issues an impulse that is
conducted in a rapid, repetitive fashion. To protect the ventricles
from receiving too many impulses, the AV node blocks some of
the impulses from being conducted through to the ventricles.
Regularity: Atrial rhythm is regular. Ventricular rhythm will be
regular if the AV node conducts impulses through in a consistent
pattern. If the pattern varies, the ventricular rate will be irregular
Rate: Atrial rate is between 250-350 beats per minute.
Ventricular rate will depend on the ratio of impulses conducted
through to the ventricles.
12
Atrial Flutter
P Wave: When the atria flutter they produce a series of well
defined P waves. When seen together, these "Flutter"
waves have a sawtooth appearance.
PRI (PR INTERVAL): Because of the unusual "Flutter"
configuration of the P wave and the proximity of the wave to
the QRS comples, it is often impossible to determine a PRI
in the arrhythmia. Therefore, the PRI is not measured in
Atrial Flutter.
QRS: QRS is less than .12 seconds; measurement can be
difficult if one or more flutter waves is concealed within the
QRS complex.
13
Atrial Fibrillation
14
Atrial Fibrillation
P Wave: In this arrhythmia
the atria are not depolarizing
in an effective way; instead,
they are fibrillating. Thus, no
P wave is produced. All atrial
activity is depicted as
"fibrillatory" waves, or
grossly chaotic undulations
of the baseline.
PRI: Since no P waves are
visible, no PRI can be
measured.
QRS: QRS is less than .12
15
1 Brand
2 Van
16
Presyncope
Fatigue
Chest
pain
Dyspnea
Syncope
Signs:
Irregularly irregular pulse
Raised JVP/Absent a Waves
Cardiomegaly
RA dilatation
Valvular disease
17
Digoxin
Beta blockers
18
Action
Digoxin
Cardiac
Immediate
IV dose
0.5 mg +
Oral
maintenance
therapy
Avoid use in
Verapamil Calcium
channel
5-10 mg every
120-240 mg/day; Same as diltiazem,
30 min or 5 mg/h hepatic
risks with CHF
Adapted from Blackshear JL. Mayo Clin Proc. 1996;71:150-160.
blocker
possibly greater 19
Action
Immediate
IV dose
Oral
maintenance
therapy
Avoid use in
Propranolol
-blocker
0.5-1.0 mg every
5 min up to 5 mg
total
40-320 mg/day;
hepatic
Bronchospastic
lung disease,
CHF
Metaprolol
-blocker
5 mg every 5 min
up to 15 mg total
50-200 mg/day;
hepatic
Same as
propranolol
Esmolol
-blocker
0.5 mg/kg/min
load over 1 min
+ 0.05-0.3 mg/
kg/min
None
Same as
propranolol
20
Ventricular Arrhythmia
21
Ventricular Tachycardia
22
Ventricular Fibrillation
Multiple foci in the ventricles become irritable and generate
uncoordinated, chaotic impulses that cause the heart to fibrillate
rather than contract.
Regularity: There are no waves or complexes that can be
analyzed to determine regularity. The baseline is totally chaotic.
Rate: The rate cannot be determined since there are no
discernible waves or complexes to measure.
P Wave: There are no discernible P waves.
PRI: There is no PRI.
QRS: There are no discernible QRS complexes.
23
PENANGGULANGAN ARITMIA
VENTRIKEL
24
25
KELUHAN PENDERITA
26
27
28
29
1.KLASIFIKASI ARITMIA
VENTRIKEL
30
32
B.TAKIKARDI VENTRIKEL(TV)
TIDAK MENETAP
Disebut takikardi ventrikel tdk menetap apabila dijumpai
3 atau lebih eksta sistole ventrikel(EVS) berturut
turut(denyut nadi lebih dari 100/mnt).
Dibedakan atas:
A. TV paroksismal(mono/poli morfik)dg atau tanpa
keluhan.
B. TV monomorfik repetitif:episode TV berulang dg
konfigurasi QRS uniform terjadi sepanjang hari dan
kopleks QRS normal diantara serangan.
Prognosis penderita dg TV jenis ini tergantung pd
kelainan dan fugsi miokard.
33
34
35
PENYAKIT JANTUNG YG
MENJADI LANDASAN
36
37
Atherothrombosis: a Generalized
and Progressive Process
Normal
Normal
Normal
FattyStreak Fibrous
Fatty
streak
plaque
Atherosclerotic
plaque
Plaque
rupture/
fissure &
thrombosis
Unstable
angina
MI
}ACS
Ischemic
stroke/TIA
Clinically silent
Stable angina
Intermittent claudication
Critical leg
ischemia
Cardiovascular
death
Increasing age
ACS, acute coronary syndrome; TIA, transient ischemic
attack
38
39
Cardiomyopathy
Dilated/Congestive
Nursing Review, 2001
40 of 48
40
3.KARDIO MIOPATI
HIPERTROFIK
41
Functional Classification
Dilated
Hypertrophic
Restrictive
(Infiltrative)
Arrhthymogenic
42 of 48
42
43
44
Phase 1
IV
Phase 2
0 mV
Phase 0
-80mV
III
Phase 3
Phase 4
II
45
PENGOBATAN
46
48
Summary
Eff:mnjur
THE END
50
TER MA KAS H
51