ARITMIA KORDIS

Pasien laki-laki 35 tahun datang ke poli umum

karena berdebar debar sejak pagi ini,pasien
merasa debaran jantungnya cepat pada
pemeriksaan fisik irama jantung reguler
dengan HR 154 x/menit,pada pemeriksaan
penunjang gambaran EKG gelombang p tidak
tampak, jarak dari R ke R sama, dan komplek
QRS normal.
irama jantung normal adalah irama yang
berasal dari nodus SA, yang datang secara
teratur dengan frekuensi antara 60- 100
/menit, dan dengan hantaran tak mengalami
hambatan pada tingkat manapun
 Sinoatrial
node

atrioventricular
node
Atrial
muscle

cartilage

Bundle
Of his

Left
bundle
branch
Right
bundle
branch
Ventricular
muscle

Electrical conduction system of the heart

Cardiac impulse and electrocardiographic patterns

AV

Septum

R SA
P T

SA Q
S
Atria AV

Plateau
septum

LV
repolarization
 Aritmia
Irama yang berasal dari nodus SA
- sinus aritmia
- sinus bradikardia
-sinus takikardia
Irama yang berasal dari nodus SA tapi
mengalami hambatan
-AV blok
-BBB
Irama yang berasal bukan dari nodus SA.
-Atrial extra sistol, Atrial fibrilasi
-Irama junktional, SVT
- Ventrikel ekstra sistol, Ventrikel takikardia, VF
 Gejala klinis
- Asimtomatik
-Berdebar-debar
-sakit dada terutama saat
beraktivitas
-sesak napas
- cepat lelah
- sinkop
- syok kardiogenik
- gejala tromboemboli.
 Tanda klinis
Irama jantung
- Reguler
- Ireguler reguler
- Ireguler-ireguler
Frekuensi jantung
-QRS dalam 6 detik x 10
- Pulsus defisit : atrial fibrilasi
Patofisiologi
 Reentry
automaticity

Mechanisms of
arrhythmogenesis
 Preventab
NEUROHORMONA le ELECTROLYTE
L SUDDEN ABNORMALITI
FACTORS DEATH ES

Sympathetic K+
tone Mg2+
Renin-
angiotensin
system
Catecholamines
HEMODYNAMIC CARDIAC IATROGENI
FACTORS ARRHYTHMIA C
S FACTORS
Diuretics
End-diastolic Inotropes
pressure Vasodilators
Afterload Antiarrhythmic
End-systolic volume
s
End-diastolic
volume
MECHANICA SUDDEN
L DEATH
FACTORS
Stretch ?
Myocardial Nonpreventabl
length e
Myocardial scars
(Singh,2002)
Management of a Cardiac
Arrhythmia
An accurate ECG interpretalion
Determination of the cause
Underlying heart disease
The consequences of the arrhythmias
Management of AF
The treatment of FA consists of
To suppress dysrhythmia
- Restorations and maintenance sinus
rhythm ( < 7 day)
- ventricular rate control
To reduce the risk of thromboembolism
To remove precipitating factors and optimal
treatment of underlying disease
Management of Atrial Flutter
Cardioversion is commonly the initial
treatment of choice synchronous DC <
50 J second choice at a higher energy
level
Verapamil an initial bolus of 5 10 mg
IV followed an infusion rate of 5 mg/kg/min
Diltiazem
Digitalis
Digitalis + Ca antagonist / betablocker
Amiodarone
Management of SVES
SVES generally do not require therapy
Symptomatic patients / precipitate SVT

Digitalis
Betablocker
Ca antagonist
Management of VES
Both fast and slow HR can provoke the
development of VES.
VES accompanying slow HR atropin
Slowing the HR in some patients with sinus
tachycardi can eradicate VES
In Hospital
Lidocaine
Amiodaron
Beta bloker
Management of Bradycardia
Treatment is usually not indicated in
asymptomatic bradycardia
Treatment is indicated in symptomatic
bradycardia (bradycardia + 1 of the following
signs or symptoms are present)
Hypotension (SBP < 90 mmHg)
CHF
Chest pain / dyspnea
Signs and symptoms of CO
PVCs particularly in the setting of MI
Treatment of Symptomatic
Bradycardia
Sulfas atropin 0.5 1 mg bolus repeat
every 3 5 minutes until HR 60 100 /
minute or the max doze 2 3 mg ( 0.03
0.04 mg/kg)
If bradycardia, hypotension or both
persist
dopamine : 2 5 g/kg/min 20 g/kg/mn
Epinephrine : 1 2 g/min ajust up to 10
g/min
Temporary Transvenous Pacemaker
 Sinus Bradycardia
Sinus Arrest / Sinoatrial (SA) Exit
Block

Asymptomatic Symptomatic
bradycardia bradycardia

Oxygen

Oxygen
Atropine 0.5 to 1.0 mg IV bolus and, if
necessary, repeat every 3 to 5 min up to a
total dose of 2 to 3 mg
AND / OR
Observe TC pacing; administer a
sedative/analgesicas needed
Dopamine 5- to 20-g/kg/min IV
infusion
Epinephrine 2- to 10-32g/min IV
infusion
TREATMENT ALGORITHMS
 TREATMENT
ALGORITHMS

Sinus
Tachycardia

Patient hemodynamically stable or

unstable
Oxygen

No specific treatment
indicated
Treat underlying cause :
Anxiety, exercise, pain,
fever
Congestive heart failure,
hypoxemia
Hypovolemia, hypotension,
shock
Discontinue such drugs as atropine,
epinephrine, vasopressors
Management of SVT
Vagal maneuvers
Adenosine 6 12 mg IV rapidly
Verapamil 5-10 mg slow IV push 2 -3
minutes which can be repeated 10 mg in
10 -15 minutes
Diltiazem 0,25/kg IV in about 2 minutes,
further doze 0.35 g/kg after10 minutes of
required.
Digoxin 0,5 1 mg IV over a period of 10-
15 minutes, followed by 0.25 mg over 2 to
4 hours, with a total doze less than 1,5 mg
within any 24 hour period