Aritmia Peter Kabo
39
Cardiac arrhythmias Abnormal of Cardiac Rhythm Prof. dr. Peter Kabo PhD, MD, SpJP, SpFK, FIHA
Transcript of Aritmia Peter Kabo
Cardiac arrhythmias Abnormal of Cardiac Rhythm
Prof. dr. Peter Kabo PhD, MD, SpJP, SpFK, FIHA
Cardiac conduction system
Normal cardiac rhytm
Classification
Sympathomimetics : EphedrineAnticholonergic : Atrophine
Mechanism of Cardiac Arrhytmias
Trigger automaticityAfterdepolarization
Early Afterdepolarization
Delayed Afterdepolarization
Reentry
MacroreentryMacroreentry MicroreentryMicroreentry
Atrial Flutter Atrial Fibrillation
The commonly found arrthymias Sinus tachycardia/ sinus bradycardia Atrial-/ ventricular- extrasystole Supra-ventricular tachycardia Atrial fibrilation/flutter
Common underlying diseases causing arrhythmias
Parasimpatomimetik (Kolinergik) Simpatomimetik (Adrenergik)Parasimpatolitik (antikolinergik) Simpatolitik (Antiadrenergik)
FAAL SSO
Transmisi Neurohormonal
Ion Channel in Cell Membrane
Ca+2 ↓
Functional Consequences of The Arrhythmias
Palpitation Dizziness Syncope/ pre-syncope Fatigue Dyspnea Chest pain
The Physical Examination (ECG are complemantery)
Jugular venous pulse Arterial pulse Heart sound
Mechanism of anti arrhythmias drug action
Ant arrhythmic drugs can cause arrhythmiasSome arrhythmias should not be treated
Classification of anti arrhythmia drugs
O P Dosis Kadar puncak
Metab Eks Indikasi Efek samping
KINIDIN + + 3 X 200 mg 60 – 90’ H G/H AF, SVT
PROKAINAMID + + 3X (250000 – 500) mg
45 – 70’ H G VES, SVT Lupus like syndrome, leukopeni
DIISOPIRAMID + - 3X 100 mg 60 – 120’ H G VES, SVT Mulut kering, konstipasi, penglihatan kabur
LIDOKAIN - + 1 MG/ KG bb =1mg/ jam
H VT (pasca miokard infark)
hipotensi
PROPAFENON + + 3 x(150 -300) mg
60 – 180’ VES
Cinchonism
•Demam•Tinitus•Penglihatn kabur•Diplopia•Sakit kepala•Delirium•Prikosis•Gangguan GIT
Farmakokinetik
AmiodaronFarmakokinetik indikasi Efek samping
O P T1/2 Dosis VT, AF Pro aritmik,Hipotensi, gangguan fungsi: hati, tiroid, paru & mata+ + 25 – 60 jam Loading 600
s/d 800 mg/ hariMaintenance 300mg/ hari
Farmakokinetik indikasi Efek samping
O P T1/2 Dosis SVT, VT Gagal jantung
+ - 11 jam 800 s/d 320 mg/hari
Sotalol
Bradicardy
Heart Block1. Atropine (I.V.)2. Temporary Pacemaker3. Permanent Pacemaker
Sinus Bradicardy1.Ephedrine2.Aminophyline3.Atropine (I.V.)
Permanent Pacemaker
