Aritmia dan

Kegawatan Jantung
Zulfikri Mukhtar
Departemen Kardiologi dan Kedokteran Vaskuler
Fakultas Kedokteran USU
Medan
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 arrhytmias
1. 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.
 EKG

I. Sebutkan iramanya :
Normal Sinus Rhythm
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 Bradyarrhytmia
(rate >100 x/min) (rate < 60 X/min)

• QRS sempit (<0.12 ms) • AV blok derajat 1, 2 & 3

• QRS lebar (>0.12 ms) • RBBB & LBBB
Diagnostic Tachyarrhytmia

 Lebar gel. QRS

 Keteraturan gel. QRS

P wave ??
 QRS complex
Teratur / tidak teratur ?

QRS complex
Sempit / lebar ?

P wave ?

Hubungan antara P and QRS ?

QRS sempit : Supraventricular origin

QRS sempit

Irama
Irama Teratur
Tidak teratur

Sinus Supraventricular Atrial

Tachycardia Tachycardia Fibrillation

Atrial Flutter
 QRS Lebar : Ventricular origin

QRS lebar

Irama
Irama Teratur
tidak teratur

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

VES couplet

VT-ventricular tachycardia
AF-atrial fibrillation, course P wave , RR interval irregular
SVT
RR 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 AV conduction

formation abnormalities
 Sinus Bradycardia  1st and 2nd AV Block

 Sick Sinus Syndrome  Total AV Block

 BBB (Bundle Branch
Block)
Sick Sinus Syndrome
LBBB
LBBB
 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

PEA
VT VF
VF (Pulse less
Electrical
Activity)
A systole
 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.