Aritmia dan Kegawatan Jantung

Zulfikri Mukhtar Departemen Kardiologi dan Kedokteran Vaskuler Fakultas Kedokteran USU Medan

Arrhythmia.
-

Definition : Lack of rhythm or abnormal rhythm. Frequency ( bradycardia or tachycardia) (Normal sinus rhythm 60 100 x /min.) Irregularity Source of impuls Sequence of activation

Precipitating factors
Underlying cardiac disease - Ischemic heart disease - Valvular heart disease - Hypertensive heart disease - Congenital heart disease - Pre excitation (short of PR interval) - Long QT (congenital or acquired)

Precipitating factors
Drugs - anti-arrhytmia - sympathomimetic. - B2 agonis, cocaine, anti depresants (tricyclic), Aminophylline, caffeine. - alcohol.

Precipitating factors
Metabolic abnormalities. - Electrolyte (low K, Na, Ca, Mg ) - Hypoximia, Hypercarbia. - Acidosis 0 Endocrine abnormalities -Thyrotoxicosis, Phaeochrocytoma.

Precipitating factors
Miscellaneous. - Febrile illness - Emotional stress - Smoking - Fatigue.

Investigation for arrhytmias

12 lead ECG and rhythm strip. 2. Blood test : routine blood, electrolyte , glucose, cardiac enzyme, thyroid level, drug level (digoxin), arterial blood gas. 3. Chest x ray : heart size , pulmonary edema, lung cancer, pericardial effusion.
1.

EKG
I. Sebutkan iramanya : Normal Sinus Rhythm

The Heartbeat.
Electromechanical association

II. MENGHITUNG DENYUT JANTUNG :

PJK

SCHEMIA inverted INFARCT

: ST depresi atau T

: ST Elevasi

NECROSIS (OLD INFARCT) : gel. Q patologis atau QSI

Early Repolarisasi

RBBB

Acute Anterior MI

Acute Inferoposterior MI

Arrhytmia
Tachyarrhythmia (rate >100 x/min)
QRS sempit (<0.12 ms) QRS lebar (>0.12 ms)

Bradyarrhytmia (rate < 60 X/min)

AV blok derajat 1, 2 & 3 RBBB & LBBB

Diagnostic Tachyarrhytmia

Lebar gel. QRS Keteraturan gel. QRS

P wave ??

QRS complex Teratur / tidak teratur ?

QRS complex Sempit / lebar ?

P wave ?

Hubungan antara P and QRS ?

QRS sempit : Supraventricular origin

QRS sempit

Irama Teratur

Irama Tidak teratur

Sinus Tachycardia

Supraventricular Tachycardia

Atrial Fibrillation

Atrial Flutter

QRS Lebar : Ventricular origin

QRS lebar

Irama Teratur

Irama tidak teratur

Ventricular Tachycardia

Ventricular Fibrillation

VES (Ventricular extrasystole)- VPB (ventricular prematur beat)- begemini -bifocal.

VES couplet

VT-ventricular tachycardia

AF-atrial fibrillation, course P wave , RR interval irregular

SVT

RR interval regular, P or T wave not identified

AF rapid

VT , wide qrs , fixed axis

VF, ventricular fibrillation, changed axis

VT

VT

VF

Torsade de Pointes

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

LBBB LBBB

Treatment
Atrial Fibrillation. - Rate control : 1. Digoxin. Digitalization dose : 0,03 x BW (Kg) Maintenance dose : 0,125 0,25 mg /day, depends on renal function. Route :oral tablet 0,25 mg or Injection ampule 0,5 mg

The Deadly Rhythms

VF VT VF

PEA
(Pulse less Electrical Activity)

A systole

2. Beta blocker
Propranolol - Metoprolol - Atenolol - Bisoplrolol - Carvedilol
-

2. Rhythm control
Main purpose is conversion to sinus rhythm.

Amiodaron Tablet : 200 mg. Injection : 150 mg Loading dose : 3 x 200 mg ( 5 days) Maintenance dose : 100 200 mg / day.
Contraindication : Thyroid and Lung (fibrotic) dysfunction.

SVT-supraventricular Tachycardia
ADP injection ( 8 mg 20 mg ) 2. Verapamil injection ( 2,5 10 mg) 3. Amiodaron injection. Loading dose : 300 mg / 250 cc in 30 60 minutes. Maintenance dose : 450 600 mg /day 4. Cardioversion : DC shock synchronize 5. Ablation : radiofrequency or laser.
1.

VES.

Amiodaron oral or injection : depends on benign or malignant extrasystole.

VT
Amiodaron : if patients hemodynamic: good (conscious, BP ) DC shock synchronize : if instability hemodynamic. 100 300 Joule.

VF ventricular fibrillation.

DC shock asynchronized 300- 350 joule. ICD intracardiac defibrillation. EMD-electromechanical dissociation.