Aritmia dan Kegawatan Jantung

Zulfikri MukhtarZulfikri MukhtarDepartemen Kardiologi dan Kedokteran Vaskuler Departemen Kardiologi dan Kedokteran Vaskuler

Fakultas Kedokteran USU Fakultas Kedokteran USU MedanMedan

Arrhythmia.

Definition : Lack of rhythm or abnormal rhythm.

- Frequency ( bradycardia or tachycardia)

(Normal sinus rhythm 60 – 100 x /min.)- Irregularity- Source of impuls- Sequence of activation

Precipitating factors

Underlying cardiac disease- Ischemic heart disease- Valvular heart disease- Hypertensive heart disease- Congenital heart disease- Pre excitation (short of PR interval)- Long QT (congenital or acquired)

Precipitating factors

Drugs- anti-arrhytmia- sympathomimetic.- B2 agonis, cocaine, anti depresants

(tricyclic), Aminophylline, caffeine.

- alcohol.

Precipitating factors

Metabolic abnormalities.- Electrolyte (low K, Na, Ca, Mg )- Hypoximia, Hypercarbia. - Acidosis

0 Endocrine abnormalities

-Thyrotoxicosis, Phaeochrocytoma.

Precipitating factors

Miscellaneous.- Febrile illness- Emotional stress- Smoking- Fatigue.

Investigation for arrhytmias1. 12 lead ECG and rhythm strip.

2. Blood test : routine blood, electrolyte , glucose, cardiac enzyme, thyroid level,

drug level (digoxin), arterial blood gas.

3. Chest x ray : heart size , pulmonary edema, lung cancer, pericardial effusion.

I. Sebutkan iramanya :Normal Sinus Rhythm

EKG

The Heartbeat.Electromechanical association

II. MENGHITUNG DENYUT JANTUNG :

PJK

SCHEMIA : ST depresi atau T inverted

INFARCT : ST Elevasi

NECROSIS (OLD INFARCT) :

gel. Q patologis atau QSI

Early Repolarisasi

RBBB

Acute Anterior MI

Acute Inferoposterior MI

Arrhytmia

Tachyarrhythmia (rate >100 x/min)

Bradyarrhytmia(rate < 60 X/min)

• QRS sempit (<0.12 ms)• QRS lebar (>0.12 ms)

• AV blok derajat 1, 2 & 3• RBBB & LBBB

Diagnostic Tachyarrhytmia

Lebar gel. QRS

Keteraturan gel. QRS

P wave ??

QRS complex Teratur / tidak teratur ?

QRS complexSempit / lebar ?

P wave ?

Hubungan antara P and QRS ?

QRS sempit : Supraventricular origin

QRS Lebar : Ventricular origin

QRS lebar

Irama TeraturIrama

tidak teratur

Ventricular Tachycardia

Ventricular Fibrillation

VES (Ventricular extrasystole)- VPB (ventricular prematur beat)- begemini -bifocal.

VES couplet

VT-ventricular tachycardia

AF-atrial fibrillation, course P wave , RR interval irregular

SVTRR interval regular, P or T wave not identified

AF rapid

VT , wide qrs , fixed axis

VF, ventricular fibrillation, changed axis

VT

VT

VF

Torsade de Pointes

Bradyarrhytmia(rate < 60 x/min)

Failure of impulse formation

Sinus Bradycardia Sick Sinus Syndrome

AV conduction abnormalities

1st and 2nd AV Block Total AV Block BBB (Bundle Branch

Block)

Sick Sinus Syndrome

LBBBLBBB

Treatment

Atrial Fibrillation.- Rate control :

1. Digoxin.

Digitalization dose : 0,03 x BW (Kg)

Maintenance dose : 0,125 – 0,25 mg /day, depends on – renal function.

Route :oral tablet 0,25 mg or

Injection ampule 0,5 mg

The Deadly

Rhythms

VT VFPEA

(Pulse less ElectricalActivity)

A systoleVF

2. Beta blocker

- Propranolol- Metoprolol- Atenolol- Bisoplrolol- Carvedilol

2. Rhythm control Main purpose is conversion to sinus rhythm.

Amiodaron

Tablet : 200 mg.

Injection : 150 mg

Loading dose : 3 x 200 mg ( 5 days)

Maintenance dose : 100 – 200 mg / day.

Contraindication : Thyroid and Lung (fibrotic) dysfunction.

SVT-supraventricular Tachycardia

1. ADP injection ( 8 mg – 20 mg )

2. Verapamil injection ( 2,5 – 10 mg)

3. Amiodaron injection.

Loading dose : 300 mg / 250 cc in 30 – 60 minutes.

Maintenance dose : 450 – 600 mg /day

4. Cardioversion : DC shock synchronize

5. Ablation : radiofrequency or laser.

VES.

Amiodaron

oral or injection : depends on benign or malignant extrasystole.

VT

Amiodaron : if patients hemodynamic: good (conscious, BP )

DC shock synchronize : if instability hemodynamic.

100 – 300 Joule.

VF – ventricular fibrillation.

DC shock asynchronized

300- 350 joule.

ICD – intracardiac defibrillation.

EMD-electromechanical dissociation.