ARRHYTHMIA

RECOGNITION

DR. JETTY SEDYAWAN SpJP.

Bagian Kardiologi FKUI

EKG & ARITMIA

USEFULNESS OF The ECG

1. Atrial and Ventricular Hypertrophy

2. Myocardial ischemia and infarction
3. Arrhythmia
4. Pericarditis
5. Systemic Disease that effect the heart
6. Effect of cardiac drugs, esp Digoxin and Quinidine
7. Distribution in electrolyte metabolisme

SA node
Sumber impuls normal/
alamiah , 60 100

AV node
Bisa mengeluarkan
impuls 40-50x/menit

Berkas His
Serabut Purkinje

Ventrikel
Bisa mengeluarkan impuls
30 x/menit

Atrial Depolarization

Ventricle
Depolarization

0.12 second

Terminologi morfologi QRS

qRs

Rs

QR

Q/QS

RsR

rS

rSr

MENGHITUNG LAJU JANTUNG :

A. Jarak R R :
-

1 kotak sedang
2 kotak sedang
3 kotak sedang
4 kotak sedang
5kotak sedang =
6 kotak sedang

= 300 x / menit
= 150 x / menit
= 100 x / menit
= 75 x / menit
60 x / menit
= 50 x / menit

B. Hitung jumlah R- R dalam 6 kotak besar = 6 detik

Jumlah R x 10 = heart rate / menit
C. 1500 / jarak R-R ( dlm mm ) = heart rate / menit

1 kotak kecil
= 0.04 detik

5 kotak kecil
= 1 kotak sedang
= 0.2 detik

5 kotak sedang
= 1 kotak besar
= 1 detik

Paper speed : 25 mm/second

CAUSE OF CARDIAC ARRHYTHMIAS :

Disturbances in automaticity : bertambah
cepat atau bertambah lambatnya suatu daerah
otomatisitas. Misal di sinus node, AV node, abnormal
beats/ depolarisasi atrium, AV junction, ventrikel, VT,
dll.
Disturbances in conduction : konduksi terlalu
cepat (WPW) atau terlalu lambat (blok AV).
Combinations of altered automaticity and
conduction.

How to identify arrhythmias ?

Dr. Roy Martin SpAn.KIC

Treat the patient, not the monitor

QRS complex
Regular / irregular ?

QRS complex
Normal-looking QRS complex?
Wide / narrow ?

P wave ?

Relationship between P and QRS ?

NORMAL SINUS RHYTHM

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

PSVT

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 Flutter :
- The result of a re-entry circuit within
the atria
- Irregular / regular QRS rate
- Narrow QRS complex
- Rapid P waves (300x/min), sawtooth

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

SR

VES

Sinus rhythm
with

Multifocal VES

VES

VES

SR

SR

SR

SR

SR

SR

Sinus rhythm with VES couple

Sinus Rhythm with VES, R on

THE BEAT GOES ON

Ventricular Tachycardia

Torsade de Pointes

Ventricular Fibrillation

1st degree AV block

Prolonged PR interval

2nd degree AV block, type 1

Missing QRS

Missing QRS

2nd degree AV block, type

Missing QRS

Total AV Block /
3rd degree AV block
QRS

QRS

QRS

PENGENALAN ARITMIA
MONITORING
CEPAT dan TEPAT
STATUS KLINIS??

MONIOR : VF / VT ?
T

No: PEA,asistol

Yes

Untung gue
Udah ikut
Perioperative care

Bambang Wahyu
ARJO

VF dan VT pulseless
90 % Kematian IMA
Terjadi dalam 2 jam pertama IMA
Penatalaksanaan:
1. DEFIBRILASI
2. RJP termasuk ETT
3. Farmakologis / obat-obatan
* Epinefrin
* Lidocaine, Amiodarone

P E A

TERDAPAT AKTIFITAS ELEKTRIK JANTUNG,

kecuali VT dan VF , TETAPI TIDAK TERABA
PULSASI

Obat:

EPINEFRIN

SULFAS ATROPIN

JETSED

AISSTOL