Aritmia

Joko Anggoro
Bagian Penyakit Dalam
FK Unram/RSUP NTB

Electrical System of the Heart

Irama jantung normal

Irama yang berasal dari nodus SA, yang datang teratur dengan
frekuensi 60-100 x/mnt, dengan hantaran tak mengalami
hambatan pada tingkat manapun.

Definisi ARITMIA
1

Irama yang bukan berasal dari nodus SA

Irama yang tidak teratur, meskipun

berasal dari nodus SA misal sinus aritmia

Frekuensi < 60x/mnt (sinus bradikardi),

> 100x/mnt (sinus takikardi)

Terdapat hambatan impuls

supra dan intra ventrikular

Definisi
Lokasi
Aritmia supraventrikular
Aritmia (infra) ventrikular
Frekuensi denyut jantung
Bradiaritmia
Takiaritmia

Mekanisme aritmia
Pengaruh persarafan otonom (simpatis & parasimpatis)
yg mempengaruhi heart rate
Nodus SA yg mengalami depresi
fokus jantung diambil alih yg lain
Fokus yg lain lebih aktif dari nodus SA dan
mengontrol irama jantung
Impuls Nodus SA tdk keluar (sinus arrest) atau
mengalami hambatan (SA block)
Terjadi hambatan impuls sesudah keluar nodus SA

Etiologi
Persarafan otonom dan obt2an
yg mempengaruhinya
Keadaan sistemik seperti
beratnya iskemik, pH, kadar elektrolit,
dan obat2an
Kelainan jantung: IHD, decomp cordis
Inflamasi, kalsifikasi, kelainan katup,
Fibrosis, peny degeneratif
Rangsangan dari luar jantung
(pace maker)

ARITMIA

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Klasifikasi irama jantung & Aritmia

Irama yang berasal dari nodus SA

ARITMIA

Aritmia atrial
Aritmia Supraventrikular
Aritmia Ventrikular

Gangguan hantaran berkas His dan cabangnya

Diagnosis of Arrhythmia
Medical
Medical history
history
Palpitation,
Palpitation,
dizziness,
dizziness,
syncope,
syncope,
angina,
angina,
fatigue,
fatigue,chest
chest
incomfortable
incomfortable
,,short
shortof
of
breathness
breathness

Physical
Physical
examination
examination

S1
S1and
andrhythm
rhythmis
is
irregular,
irregular,
hypotension,
hypotension,
heart
heartfailure
failureand
and
shock
shock

Electrocardiograph
Electrocardiograph

1. Irama yg berasal dari nodus SA

Sinus tachycardia
Sinus rate > 100 beats/min (100-180)
Causes:
1. Some physical condition: exercise,
anxiety, exciting, alcohol, coffee
2. Some disease: fever,
hyperthyroidism, anemia,
myocarditis
3. Some drugs: Atropine, Isoprenaline
.

Neednt therapy

Sinus Bradycardia
Sinus rate < 60 beats/min

Normal variant in many normal and older people

Causes: Trained athletes, during sleep, drugs (blocker) , Hypothyriodism, CAD or SSS
Symptoms:
1. Most patients have no symptoms.
2. Severe bradycardia may cause dizziness, fatigue,
palpitation, even syncope.
. Neednt specific therapy, If the patient has severe
symptoms, planted an pacemaker may be needed.

Aritmia sinus

Sinus Arrest / henti sinus

Sinus arrest or standstill is recognized by a
pause in the sinus rhythm.
Causes: myocardial ischemia, hypoxia,
hyperkalemia, higher intracranial pressure,
sinus node degeneration and some drugs
(digitalis, -blocks).
Symptoms: dizziness, syncope

Sinoatrial exit block (SAB)/blok sinoatrial

SAB: Sinus pulse was blocked so it couldnt
active the atrium.
Causes: CAD, Myopathy, Myocarditis, digitalis
toxicity, et al.
Symptoms: dizziness, fatigue, syncope
Therapy is same to SSS

Sick Sinus Syndrome (SSS)

SSS: The function of sinus node was
degenerated. SSS encompasses both
disordered SA node automaticity and SA
conduction.
Causes: CAD, SAN degeneration, myopathy,
connective tissue disease, metabolic disease,
tumor, trauma and congenital disease.
Bradycardia-tachycardia syndrome

2. Aritmia Atrial

Atrial premature contractions

(APCs)/ekstrasistol atrial
APCs arising from somewhere in either
the left or the right atrium.

Atrial flutter
Etiology:
1. It can occur in patients with normal atrial
or with abnormal atrial.
2. It is seen in rheumatic heart disease
(mitral or tricuspid valve disease), CAD,
hypertension, hyperthyroidism, congenital
heart disease, COPD.
3. Related to enlargement of the atria
4. Most AF have a reentry loop in right atrial

Atrial fibrillation

1.
2.
3.
.
1.
2.

Etiology:
Morbidity rate increase in older patients
Etiology just like atrial flutter
Idiopathic
Mechanism:
Multiple wavelet re-entry;
Rapid firing focus in pulmonary vein, vena
cava or coronary sinus.

Atrial fibrillation

Gelepar Atrial/Atrial flutter

denyutan atria yang cepat dan teratur,

Adanya gelombang geletar/flutter; gelombanggelombang P yang teratur, frekuensi
250
350/menit, berbentuk gergaji (terutama di II,III,dan aVF)

3. Atrioventricular Junctional
arrhythmia

Paroxysmal tachycardia
Most PSVT (paroxysmal supraventricular
tachycardia) is due to reentrant mechanism.
Occur in any age individuals, usually no structure
heart disease.

Takikardi supraventrikular paroksismal

irama yang mutlak teratur dengan frekuensi 150250 x/menit,
seringkali gelombang P terbenam pada kompleks QRS dan tidak dapat
diidentifikasi sama sekali

Paroxysmal tachycardia
Therapy:
1. Increase vagal tone: carotid sinus
massage, Valsalva maneuver.if no
successful,
2. Drug: verapamil, adrenosine,
propafenone
3. DC shock

4. Ventricular arrhythmia

Ventricular Premature Contractions (VPCs)/

ekstrasitol ventrikel
Etiology:
1. Occur in normal person
2. Myocarditis, CAD, valve heart disease,
hyperthyroidism, Drug toxicity (digoxin,
quinidine and anti-anxiety drug)
3. electrolyte disturbance, anxiety,
drinking, coffee

Ventricular tachycardia
Etiology: often in organic heart disease
CAD, MI, DCM, HCM, HF,
Sustained VT (>30s), Nonsustained VT
Monomorphic VT, Polymorphic VT

Ventricular flutter and fibrillation

Often occur in severe organic heart disease: AMI,
ischemia heart disease, electrolyte disturbance,
Anaesthesia, lightning strike, electric shock, heart
operation
Its a fatal arrhythmia

6. Gangguan hantaran berkas

His dan cabangnya

Atrioventricular (AV) Block

AV block is a delay or failure in
transmission of the cardiac impulse from
atrium to ventricle.
Etiology:
Atherosclerotic heart disease; myocarditis;
rheumatic fever; cardiomyopathy; drug
toxicity; electrolyte disturbance, collagen
disease, levs disease.

AV Block
AV block is divided into three
categories:
1. First-degree AV block
2. Second-degree AV block: further
subdivided into type I and type II
3. Third-degree AV block: complete block

AV Block
Treatment:
1. I or II degree AV block neednt
antibradycardia agent therapy
2. II degree II type and III degree AV
block need antibradycardia agent
therapy
3. Implant Pace Maker

Intraventricular Block
Intraventricular conduction system:
1. Right bundle branch
2. Left bundle branch
3. Left anterior fascicular
4. Left posterior fascicular

RBBB

LBBB

Therapy Principal of Arrhythmia

Pathogenesis therapy
Stop the arrhythmia immediately if the
hemodynamic was unstable
Individual therapy

Anti-tachycardia agents
Modified Vaugham Williams classification:
I class: Natrium channel blocker
Ia: less use in clinic
Ib: Lidocaine , Mexiletine VT
Ic: Moricizine , Propafenone
II class: -receptor blocker: propanolol,
metoprololCAD
III class: Potassium channel blocker:
Amiodarone, sotalolCAD,HF
IV class: Calcium channel blocker Verapamil,
DiltiazemSVT
Others: Adenosine, DigitalisSVT

Anti-bradycardia agents
1. -adrenic receptor activator
2. M-cholinergic receptor blocker
3. Non-specific activator
. Isoprenaline
. Epinephrine
. Atropine
. Aminophylline

Non-drug therapy
Cardioversion: For tachycardia especially
hemodynamic unstable patient
Radiofrequency catheter ablation (RFCA): For
those tachycardia patients (SVT, VT, AF)
Artificial cardiac pacing: For bradycardia, heart
failure and malignant ventricular arrhythmia
patients.

TERIMA KASIH
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