Cardiac arrhythmias

Abnormal of Cardiac Rhythm

Prof. dr. Peter Kabo PhD, MD, SpJP, SpFK, FIHA

Cardiac conduction system
Normal cardiac rhytm
Classification
Sinus node diseases
Sinus tachycardia/ bradicardia
SA block
Wandering pace-maker
Hypersensitive carotid sinus syndrome
Sick sinus syndrome (sss)

Disturbance of atrial rhythm

Atrial fibrillation
Atrial flutter

Disturbance of AV junction rhythm

Supra ventricular tachycardia

Pre-excitation syndrome
Wolff Parkinson white syndrome ( wave)

Disturbance of ventricular rhythm

Ventricluar extra systole: quadrigemini, Trigemini, <> Duplex, Triplex, quadriplex
Ventricular tachycardia

Heart block
1st degree HB
2nd degree HB
Wenckebach (mobitz type I)
(mobitz type II)
3rd degree HB (total AV block) Sympathomimetics : Ephedrine
Temporary pace-maker Anticholonergic : Atrophine
Permanent pace-maker
Mechanism of Cardiac Arrhytmias
Enhanced automaticity
Sinus Tachycardia
Triggered automaticity
Multifocal atrial tachycardia
VES VT Torsade de Pointes
Reentry
Atrial Fibrilation (AF)
Atrial flutter
SVT
VT

Block
1st degree AV block
2nd degree AV block
3rd degree AV block (total AV block)
Trigger automaticity
Afterdepolarization

Early Afterdepolarization

Delayed Afterdepolarization
Reentry
Macroreentry Microreentry

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
Ischemic heart disease
Acute myocardial infarction
Myocardial ischemic (HHD, LVH, CAD)
Left ventricular aneurysm
Cardiomyopathy

Valvular heart disease

Myocarditis

Congenital heart diseases

Conduction system abnormality

Sinus R AV node disease
By pass tract
Chronic pulmonary disease
Hypokalemia

Endocrine
Thyrotoxicosis

Electrolyte imbalance

Drug induce
Sympathomimetic, caffeine

Increase sympathetic/ vagal activity

Parasimpatomimetik (Kolinergik) Simpatomimetik (Adrenergik)
Parasimpatolitik (antikolinergik) Simpatolitik (Antiadrenergik)
 FAAL SSO

Conservative
Parasimpatis Reservation

Fight
Sympathies Flight reaction

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
Decreased phase 4 slope
blocker

Increased threshold
Na+ channel blocker
Ca++ channel blocker

Increased max diastolic potential

Adenosine
Acetylcholine

Increased action potential duration

K+ channel blocker

Ant arrhythmic drugs can cause arrhythmias

Some arrhythmias should not be treated
Classification of anti arrhythmia drugs
Sodium channel blocker
Sodium channel (++)
Diisopyramide, Quinidine, Procainamide
Blocks K+ Efflux (+)
Lidocaine, Mexiletine, Tocainide
Sodium channel (+++)
Flecainide, Encainide, Propafenone

Anti adrenergic
blocker

K+ channel Efflux blockers also Na+ blockers

Amiodarone
Sotalol

Ca++ channel blockers

Verapamil & Diltiazem

Autonomic Effects
Vagus stimulation
Digoxin
Adenosine receptor activation
Adenosine
Farmakokinetik
O P Dosis Kadar Metab Eks Indikasi Efek samping
puncak
KINIDIN + + 3 X 200 mg 60 90 H G/H AF, SVT
PROKAINAMID + + 3X (250000 45 70 H G VES, SVT Lupus like
500) mg syndrome,
leukopeni
DIISOPIRAMID + - 3X 100 mg 60 120 H G VES, SVT Mulut kering,
konstipasi,
penglihatan kabur
LIDOKAIN - + 1 MG/ KG bb H VT (pasca hipotensi
=1mg/ jam miokard infark)

PROPAFENON + + 3 x(150 -300) 60 180 VES

mg

Hipotensi / Sinkop
Kardiovaskular
SA block
QRS Interval AV block
Long QT Torsades de Poentes
ventrikuler rate (efek
anti kolinergik)

Cinchonism

Demam
Tinitus
Penglihatn kabur
Diplopia
Sakit kepala
Delirium
Prikosis
Gangguan GIT
Amiodaron
Farmakokinetik indikasi Efek samping

O P T1/2 Dosis VT, AF Pro aritmik,

Hipotensi, gangguan fungsi: hati,
+ + 25 60 jam Loading 600 tiroid, paru & mata
s/d 800 mg/
hari
Maintenance
300mg/ hari

Sotalol
Farmakokinetik indikasi Efek samping

O P T1/2 Dosis SVT, VT Gagal jantung

+ - 11 jam 800 s/d 320

mg/hari
Bradicardy
Sinus Bradicardy
1. Ephedrine
2. Aminophyline
3. Atropine (I.V.)

Heart Block
1. Atropine (I.V.)
2. Temporary Pacemaker
3. Permanent Pacemaker
Permanent Pacemaker