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ECG Diagnosis

Dr. David D. Ariwibowo SpJP, FIHA


Journal of the American College of Cardiology Vol. 38, No. 7, 2001
Journal of the American College of Cardiology Vol. 38, No. 7, 2001
Journal of the American College of Cardiology Vol. 38, No. 7, 2001
Journal of the American College of Cardiology Vol. 38, No. 7, 2001
Journal of the American College of Cardiology Vol. 38, No. 7, 2001
Journal of the American College of Cardiology Vol. 38, No. 7, 2001
Journal of the American College of Cardiology Vol. 38, No. 7, 2001
Journal of the American College of Cardiology Vol. 38, No. 7, 2001
Arrhythmias

Four basic types of arrhythmias:


1. Sinus origin
2. Ectopic rhythms
3. Conduction blocks
4. Preexcitation syndromes
1. Sinus Origin

Sinus bradycardia (< 60 bts/min)


Sinus tachycardia (>100 bts/min at rest)
Sinus Arrhythmia:
o Could be normal rate but rate changes
(does not remain regular)
Sinus Arrest
o Escape beats
2. Ectopic Rhythms
Originate outside of the SA node
Supra Ventricular :
Supra Ventricular Tachycardia
Atrial Flutter
Atrial Fibrillation
MultiFocal Atrial Tachycardia

Ventricular :
VT
VF
Klasifikasi Takikardia
Dengan QRS sempit
Reguler
Ireguler
Dengan QRS lebar
Reguler
Ireguler

KETAHUI KLASIFIKASI
Kompleks QRS

QRS SEMPIT

QRS LEBAR
+ ABBERANCY
Takikardia dengan QRS sempit

Dengan irama ireguler :


Atrial fibrilasi (AF)
Atrial flutter (Af) dengan varying block
Atrial takikardi (AT) dengan varying block
Dengan irama regular : SVT
Atrial flutter (Af)
Atrioventricular Reprocicating Tachycardia (AVRT)
Atrioventricular Nodal Reentrant Tachycardia (AVNRT)
AT
Junctional Tachycardia (JT)
Narrow complex Ventricle Tachycardia (VT)
Takikardia dengan QRS lebar

VT
Supraventrikular Takikardi (SVT) dengan
bundle branch block (BBB)
Aberrancy
Pre-existing BBB
SVT dengan pre-eksitasi
Treat the patient,
not the ECG. . . . . . . . . .!!!
Etiologi aritmia
The mnemonic, HIS DEBS, help to remember those arrhythmogenic factors
whenever you encounter a patient with an arrhythmia.
Hypoxia:
A myocardium deprived of oxygen is an irritable myocardium. Pulmonary disorders, whether
severe chronic lung disease or an acute pulmonary embolus, are major precipitants of
cardiac arrhythmias.
Ischemia and Irritability:
Myocardial infarctions are a common setting for arrhythmias. Angina, even without the actual
death of myocardial cells associated with infarction, is also a major precipitant. Occasionally,
myocarditis, an inflammation of the heart muscle often caused by routine viral infections, can
induce an arrhythmia.
Sympathetic Stimulation:
Enhanced sympathetic tone from any cause (hyperthyroidism, congestive heart failure,
nervousness, exercise, etc.) can elicit arrhythmias.
Drugs:
Many drugs can cause arrhythmias. Ironically, the antiarrhythmic drugs themselves, such as
quinidine, are among the leading culprits.
Electrolyte Disturbances:
Hypokalemia is notorious for its ability to induce arrhythmias, but imbalances of calcium and
magnesium can also be responsible.
Bradycardia:
A very slow heart rate seems to predispose to arrhythmias. One could include the brady-
tachy syndrome (also called the sick sinus syndrome) in this category.
Stretch:
Enlargement and hypertrophy of the atria and ventricles can produce arrhythmias. This is
one way in which congestive heart failure and valvular disease can cause arrhythmias.
Thank You

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