Aritmia Dokter Muda
Aritmia Dokter Muda
Hauda el rasyid
Subbagian aritmia
Pembagian aritmia :
• Sinus Bradycardia
• Chronotropic Incompetence
• Brady/Tachy syndrome
Pembagian Aritmia Berdasarkan Asalnya
Sinus Aritmia
• Dasar diagnosis
• Irama sinus (vektor P dari sinus)
• Interval PP bervariasi lebih dari 0,16 detik
• Dibagi menjadi :
• Nonrespiratorik tidak tergantung pada pernapasan
• Respiratorik tergantung pada pernapasan (inspirasi frekuensi ↑, ekspirasi
frekuensi ↓ )
WHO/ISFC Task Force menyebut irama sinus ireguler
Sinus Arrest / Henti Sinus
• Dasar diagnosis
• Tak ada P dari sinus
• Biasanya frekuensi jantung (ventrikel) lambat dan pemacu jantung
diambil alih oleh pemacu-pemacu sekunder di bawah sinus ( AV node atau
purkinye )
Sick Sinus Syndrome
Bentuk khusus Ekstrasistole Atrial
Kuplet ekstrasistol atrial (x-x); ekstrasistol atrial yang tidak diteruskan (y)
Ekstrasistole Atrial
14
2015 ACC/AHA/HRS SVT Guideline
2015 ACC/AHA/HRS SVT Guideline
2015 ACC/AHA/HRS SVT Guideline
2015 ACC/AHA/HRS SVT Guideline
2015 ACC/AHA/HRS SVT Guideline
SVT
younger
Ciri khas :
• Gelombang gelepar : gelombang-gelombang P yg teratur, frek 250-350x/mnt, berbentuk
gergaji (terutama di II, III, dan aVF), sumbu pada bidang frontal – 90o
• Biasanya terdapat konduksi 2 : 1, karena simpul AV tak dapat meneruskan semua impuls
dari atria
• QRS sempit, kecuali terdapat konduksi ventrikuler aberan atau BCBKi/BCBKa
• Karena banyaknya gelombang yang bertumpukan, maka bentuk gergaji sering tidak
nampak jelas
Fibrilasi Atrial
35
Takikardia Ventrikuler
38
39
Fibrilasi Ventrikuler
• Dasar Diagnosis
• Gelombang QRS dan T menyatu menjadi undulasi yang
tidak teratur dan cepat
• Berdasarkan besar undulasi FV kasar dan FV halus
• Secara klinis FV sama dengan henti jantung, karena
ventrikel hanya bergetar, tidak memompa darah keluar
dari ventrikel
40
41
42
Arrhythmia Presentation
• Palpitation.
• Dizziness.
• Chest Pain.
• Dyspnea.
• Fainting.
• Sudden cardiac death.
Etiology
• Physiological
• Pathological:
Valvular heart disease.
Ischemic heart disease.
Hypertensive heart diseases.
Congenital heart disease.
Cardiomyopathies.
Carditis.
RV dysplasia.
Drug related.
Pericarditis.
Pulmonary diseases.
Others.
Arrhythmia Assessment
• ECG
• 24h Holter monitor
• Echocardiogram
• Stress test
• Coronary angiography
• Electrophysiology study
SINUS BRADYCARDIA
• Rate: 40-59 bpm
• P wave: sinus
• QRS: Normal (.06-.12)
• Conduction: P-R normal or slightly prolonged at slower rates
• Rhythm: regular or slightly irregular
• This rhythm is often seen as a normal variation in athletes, during sleep, or in response to a vagal
maneuver. If the bradycardia becomes slower than the SA node pacemaker, a junctional rhythm
may occur.
• Treatment includes:
treat the underlying cause,
atropine,
isuprel, or
artificial pacing if patient is hemodynamically compromised.
SINUS ARRHYTHIMIA
• Rate: 45-100/bpm
• P wave: sinus
• QRS: normal
• Conduction: normal
• Rhythm: regularly irregular
• The rate usually increases with inspiration and decreases with expiration.
• This rhythm is most commonly seen with respiration due to fluctuations in vagal tone.
• The non respiratory form is present in diseased hearts and sometimes confused with sinus arrset
(also known as "sinus pause").
• Treatment is not usually required unless symptomatic bradycardia is present.
PREAMATURE ATRIAL CONTRACTIONS
• Rate: normal or accelerated
• P wave: usually have a different morphology than sinus P waves because they originate from an
ectopic pacemaker
• QRS: normal
• Conduction: normal, however the ectopic beats may have a different P-R interval.
• Rhythm: PAC's occur early in the cycle and they usually do not have a complete compensatory
pause.
• PAC's occur normally in a non diseased heart.
• However, if they occur frequently, they may lead to a more serious atrial dysrhythmias.
• They can also result from CHF, ischemia and COPD.
SINUS PAUSE, ARREST
• Rate: normal
• P wave: those that are present are normal
• QRS: normal
• Conduction: normal
• Rhythm: The basic rhythm is regular. The length of the pause is not a multiple of the sinus
interval.
• This may occur in individuals with healthy hearts. It may also occur with increased vagal tone,
myocarditis, MI, and digitalis toxicity.
• If the pause is prolonged, escape beats may occur.
• The treatment of this dysrhythmia depends on the underlying cause.
If the cause is due to increased vagal tone and the patient is symptomatic, atropine may be indicated.
Sinus Pause/Arrest
Rate Varies
P-P Regularity Irregular
R-R Regularity Irregular
P wave Present, except during pause
P:QRS Ratio 1:1, associated
PR Interval Normal
QRS Width Normal
Sinus Node Exit Block
Rate Varies
P-P Regularity Irregular
R-R Regularity Irregular
P wave Present, except during dropped beats
P:QRS Ratio 1:1, associated
PR Interval Normal
QRS Width Normal
PAROXYSMAL ATRIAL TACHYCARDIA
• Rate: atrial 160-250/min: may conduct to ventricles 1:1, or 2:1, 3:1, 4:1 into the presence of a
block.
• P wave: morphology usually varies from sinus
• QRS: normal (unless associated with aberrant ventricular conduction).
• Conduction: P-R interval depends on the status of AV conduction tissue and atrial rate: may be
normal, abnormal, or not measurable.
• PAT may occur in the normal as well as diseased heart.
It is a common complication of Wolfe-Parkinson-White syndrome.
Narrow complex
tachycardia
QRS<120 ms
=SVT
1.AVNRT
1.Afib
2.AVRT
2.MAT
3.Atrial tachycardia
(P waves of
≥3 different 4.Atrial flutter
morphologies)
QRS width
Narrow complex
tachycardia
QRS<120 ms
=SVT