1. Irama
: Sinus
Bukan Sinus
Atrial Fibrilasi
SVT
Irama JUNSION
60-100 x/menit (normal)
2. Laju QRS
: HR?
Regularitas
3. Aksis: Normal
RAD/LAD
Superior Aksis
4. Interval PR : 0.20 Detik (Normal)
5. Morfologi
a. Gelombang P
: Normal P.Pulmonal P.Mitral
b. Kompleks QRS
: Q patologis
RSR pattern di V1&V2
Interval-QRS (0.08 detik)
c. Segmen ST
: ST-elevasi, ST-depresi
d. Gel.T
: Flat-T, Inverted-T, tall-T
6.7 x 20 = 134x/menit
3.3 x 50 = 165x/menit
CARDIAC ARRHYTHMIAS
CLASSIFICATION :
1. Sinus Node diseases :
Sinus tachycardia / bradycardia
SA block
Wandering pace maker
Hypersensitive carotid sinus syndrome (SSS)
4. Pre-excitation syndrome :
Woeff Parkinson White syndrome (S-wave)
Jenis Aritmia
IV
Phase 2
III
Phase 3
Sinus rhythm
Sinoatrial node is cardiac
pacemaker
Normal sinus rhythm 60100 beats/min
Depolarisation triggers
depolarisation of atrial
myocardium (forest fire)
Conducts more slowly
through AV node
Conducts rapidly through
His bundles and Purkinje
fibres
Sinus rhythm
Sinoatrial rate controlled by autonomic nervous
system
Parasympathetic system predominates (M2
muscarinic receptors)
Sympathetic system (1 receptors)
Increased heart rate (positive chronotropic
effect)
Increased automaticity
Facilitation of conduction of AV node
ECG
Recording of electrical activity of the heart
Net sum of depolarisation and repolarisation
potentials of all myocardial cells
P-QRS-T pattern
P - atrial depolarisation
QRS - ventricular depolarisation
T - ventricular repolarisation
Sinus tachycardia
Multifocal atrial tachycardia. VES
3. Reentry
Atrial fibrillation (AF)
Atrial Flutter
Supraventricular tachycardia (SVT)
Ventricular tachycardia (VT)
Woeff-Parkinson-White Syndrome
4. Block
1o AV block
2o AV block
3o AV block (Total AV Block)
PVC (ESV)
Bigeminism
PVC (ESV)
paired
PVC (ESV)
Polymorphic
PVC (ESV)
Triplet
PVC (ESV)
Ischemic
Ventricle irritation
http://www.emedu.org
CLASSIFICATION OF ANTIARRHYTMIC
DRUGS
I. Sodium channel blockers
A. Sodium channel (++)
Blocks K+ effluks (+)
B. Sodium Channel (+)
Disopyramide
Quinidine
Procainamide
Lidocaine
Mekiletine
Tocainide
Flecamide, Encamide,
Propafenone
Beta blockers
Amiodarone
Sotalol
Verapamil, Diltiazem
V. Autonomic effects
Vagal stimulation
Adenosine receptor activation
Digoxin
Adenosine
DRUG
Quinidine
Procamamide
Disopyramide
Lidocaine
Propafenone
Amiodarone
+
+
+
Sotalol
+
+
+
+
+
BIO
(%)
T
(hari)
40 %
4-10
3-4
4-10
2
2-32
25-60
100%
10
Doses
Loading
1 mg/kg BB
800-1600
(2 weeks)
Doses Maintenance
300-600
750
400-800
4-3-2-1mg/kg BB
450-900
100-400
80-320
B-blocker
Increased Threshold
Na+ channel
blocker
Ca++ channel
blocker
Increased Max-diastolic
potential
Adenosine
Acetylcholine
K+ channel
blocker
DRUGS
INDICATIONS
Quinidine
AF
Procamamide
Disopyramide
Lidocaine
VES
VES
VES,VT
Propafenone
Amiodarone
VES,VT,AF,SVT
VES,VT,AF,SVT
Sotalol
VT,VES
ADVERSE EFFECTS
Cinchronism, Long QT
syndrome, Hypotension,
Diarrhea/Hepatitis,
Thrombocytopenia
Hypotension, Nausea, Lupus
(-) miotropic, Anti cholinergic :
dry mouth
Constipation, urine retention,
Glaukoma attack
Hypotension, nystagmus,
Seizure
Hypotension, Hepatic
disfunction, Pulmonary fibrosis,
Hypo/Hyper thyroidism, Cornea
microdeposit
Heart failure, Bradycardia
Tachycardia
Unstable
Stable
Atrial fibrillation
Atrial flutter
Narrow-complex
tachycardias
Stable monomorphic
VT or Polymorphic VT
Juctional
tachycardia
Heart function
preserved
Amiodarone, B-blokers,
Verapamil
EF < 40%
Amiodarone
Heart function
preserved
Paroxysmal SVT
EF < 40%
Ectopic / multifocal
atrial tachycardia
Heart function
preserved
EF < 40%
Verapamil, B-blokers,
Digoxin, Cardioversion,
Amiodarone, Sotalol,
Adenosine
Digoxin, Amiodarone
Verapamil, B-blockers,
Amiodarone
Amiodarone
Verapamil
B-Blocker
Impaired Heart
(EF < 40% or CHF )
Digoxin
CONVERT RHYTIM
Amiodarone
Propafenone
Sulfas quinidine
DC Cardioversion
RBBB
1 Degree AV block
st
Beta blockers
Frequent in elderly
AV node (valve surgery, MI)
http://www.emedu.org
1 Degree AV block
st
Beta blockers
Frequent in elderly
AV node (valve surgery, MI)
http://www.emedu.org
http://www.emedu.org
3 Degree AV block
rd
http://www.emedu.org
Bradicardy
Sinus Bradicardy
1.Ephedrine
2.Aminophyline
3.Atropine (I.V.)
Heart Block
1. Atropine (I.V.)
2. Temporary Pacemaker
3. Permanent Pacemaker
Permanent Pacemaker