Aritmia dan

Kegawatan Jantung
Departemen Kardiologi dan Kedokteran Vaskuler
Fakultas Kedokteran UMSU
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

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.
1.

EKG
I. Sebutkan iramanya :
Normal Sinus Rhythm

The Heartbeat.
Electromechanical association

II. MENGHITUNG DENYUT

JANTUNG :

Arrhytmia
Tachyarrhyth
mia (rate
>100 x/min)
QRS sempit
(<0.12 ms)
QRS lebar
(>0.12 ms)

Bradyarrhytmi
a
(rate < 60
X/min)

AV blok derajat
1, 2 & 3
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 Lebar : Ventricular origin

QRS lebar

Irama Teratur

Ventricular
Tachycardia

Irama
tidak teratur

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

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
formation
Sinus Bradycardia
Sick Sinus Syndrome

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

Sick Sinus Syndrome

LBBB
LBBB

Treatment

1.

Atrial Fibrillation.
Rate control :
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

2. Beta blocker
-

Propranolol
Metoprolol
Atenolol
Bisoprolol
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
Adenosin injection ( 6 mg 12 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.
1.

Ventricular Extra
Systole.

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
360 joule.
ICD intracardiac defibrillation.

EMD-electromechanical dissociation.

The
Deadly
Rhythms

VF
VT VF

PEA
(Pulse less A
Electrical
Activity)

systole

PJK

SCHEMIA
inverted

: ST depresi atau T

INFARCT

: ST Elevasi

NECROSIS (OLD INFARCT) :

gel. Q patologis atau QSI

Early Repolarisasi

RBBB

Acute Anterior MI

Acute Inferoposterior MI