K.34 Aritmia Andika
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Transcript of K.34 Aritmia Andika
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ARHYTHMIA
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Ar i tmia
Gangguan irama jantung berupa segala jenisirama jantung selain IRAMA SINUS
SupraventrikularQRS sempit seperti normal
(kecuali beberapa hal:
BBB, WPW,aberans)
VentrikularQRS lebar > 0,12 dt
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Symptoms
Palpitations: nontachycardiac; rapid and regular; rapid and
irregular (regularly irregular or irregularly irregular).
Abrupt or accelerating onset and termination?
Dyspnea
Chest discomfort
Syncope; nearly blacked out; syncope with spell
Polyuria
Cardiac arrest
Signs
Heart rate and pulses: regularity; amplitude; deficit
Hypotension
Hypoperfusion
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Atrial fibri llation
Atr ial flutter
AVRT
AVNRT
V Tach
V Fibri llation
SNRT
AT
JT
TACHYCARDIA
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Ari tmia Sup raventr ikular
Premature beat
/ ekstra sistolikTakikardi aritmia
Atrial FlutterAtrial fibrilasi
Supra Ventrikel Takikardi/Paroksismal Atrial Takikardi
150 - 250 x/mnt
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ARRHYTHMIAS (ATRIAL RHYTHMS)
Gambaran premature atr ia l com plex (tanda panah).
Gambaran EKG atrial tachycardia/SVT.
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SVT
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Treatment strategies of SVT:
Pharmacological
Acute Tx (Adenosine iv, Verapamil iv)
Chronic Tx (Verapamil, Betablocker, Digoxin)
Non-pharmacology
1980s sharp dissection or cryosurgical modification
His bundle ablation using DC shock
Radiofrequency catheter ablation
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Gambaran delta wave pada sindroma WPW
Atr ial f lut ter dengan gambaran gigi gergaj i .
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Wolff-Parkinson-White syndrome
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Gambaran fibrilasi atrial dengan rapid ventr icu lar response
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Approaches to Treatment
of atrial fibrillation
Ventricular rate control
Maintenance of sinus rhythm
Anticoagulation (acute and
chronic)
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Ari tm ia Ventr iku lar
Premature beat
/ ekstra sistolikTakikardi aritmia
Ventrikel FibrilasiN
> 350 x/mnt
Ventrikel TakikardiN
100-250 x/mnt
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VENTRICULAR RHYTHMS
Gambar A menunjukkan sinus takikardi denganf requent u ni form PVC dan
B m enunjukkan sinu s takikard i dengan mu lt i form PVC.
VES
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Sinus ritme dengan dua R on T PVCs
Sinus ritme dengan run VT dan s atu episod e couplets
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Gambaran t r igemin al PVC.
Gambaran accelerated idio ventr icu lar rhythm
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Gambaran Ventr icu lar Tachy card ia (VT)
Gambaran Ventr ic ular Fibri l lat io n (VF)
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Torsade de pointes
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Management of Malignant
Ventricular arrhythmias Pharmacological
Class I
Class III
Class II, Beta blocker
Non-pharmacological
Surgical arrhythmias
Catheter ablation
Device : AICD
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ADULT CARDIAC ARREST
CPR
Precordial thump
Assess rhythm
Check pulse +/-
VT/VF Non-VT/VF
Attempt
Defibrilation X3
CPR 1 minuteCPR
up to 3 minute
VT/VF refractory to initial
shock:
epinephrine 1 mg iv every
3-5 minutes Consider buffers, pacing,
antiarrhythmics
Search for and correct
reversible causes
ILCOR Guidelines. Circulation 2000;102 (suppl ): -1I-384
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BRADYARRHYTHMIA AND CONDUCTION ABNORMALITIES
SPECIFIC ECG CHANGES
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GANGGUAN KONDUKSI DI SA NODE
Gambaran sinus ritme dengan episode sinoatr ial blo ck.
Gambaran sinus ritme dengan episode sinus arrest
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First-degree AV block
Rhythm : RegularRate : Usually normalP wave : Sinus P wave present; one P wave to each QRSPR : Prolonged ( greater than 0.20 seconds )
QRS : Normal
GANGGUAN KONDUKSI DI AV NODE
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Second -degree AV block, Mobitz I
Rhythm : IrregularRate : Usually slow but can be normalP wave : Sinus P wave present;
some not followed by QRS complexes
PR : Progressively lengthensQRS : Normal
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Second-degree AV block, Mobitz II
Rhythm : Regular usually;
can be irreguler if conduction ratios varyRate : Usually slowP wave : Two, three, or four P waves before each QRSPR : PR interval of beat with QRS is constant;
PR interval may be normal or prolonged
QRS : Normal if block in His bundle;wide if block involves bundle branches
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Third-degree AV block
Rhythm : Regular
Rate : 40
60 if block in His bundle;30 40 if block involves bundle branchesP wave : Sinus P wave present; bear no relationship to QRS;
can be found hidden in QRS complexes and T wavesPR : Varies greatly
QRS : Normal if block in His bundle;wide if block involves bundle branches
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0.04
RBBB
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LBBB
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Gambaran asistol
Gambaran P wave asystole.
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BRADYCARDIA
Serious signs and symptoms?
Due to bradycardia?
YesNo
Type II second-degree AV block or
Third degree AV block
Intervention sequence
Atropine 0.5-1.0 mg
Transcutaneous pacing
Dopamine 5-20 g/kg/min Epinephrine 2-10 g/min
NoYes
If symptoms develop, use
transcutaneous pacemaker
until transvenous pacer placedObserved
ILCOR Guidelines. Circulation 2000;102 (suppl ): -1I-384
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The
Deadly
Rhythms
VT VF
PEA
(Pulse lessElectrical
Activity)
AsystoleVF
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T H A N K Y O U
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VES
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SVT
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VES R on T
VT
VF
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