Aritmia Dan Bradiaritmia

8/16/2019 Aritmia Dan Bradiaritmia

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Departemen Kardiologi FK USURSUP. H. Adam Malik

Medan


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SA nodeSumber impuls normal/alamiah , 60 – 100

AV nodeBisa mengeluarkan

impuls 40-60x/menit

Berkas HisSerabut Purkinje

VentrikelBisa mengeluarkan impuls20-40 x/menit


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CAUSE OF CARDIAC ARRHYTHMIAS :

• Disturbances in automaticity : bertambah cepatatau bertambah lambatnya suatu daerah otomatisitas.Misal di sinus node, AV node, abnormal beats/depolarisasi atrium, AV junction, ventrikel, VT, dll.

• Disturbances in conduction : konduksi terlalu cepat(WPW) atau terlalu lambat (blok AV).

• Combinations of altered automaticity andconduction .


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Tachyarrhythmia

(rate >100 x/min)

Bradyarrhytmia

(rate < 60 X/min)

• QRS sempit (0.12 ms )

•

AV blok derajat 1, 2 & 3

• RBBB & LBBB


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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)


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Drugs

- anti-arrhytmia

- sympathomimetic.

- B2 agonis, cocaine, anti depresants

(tricyclic), Aminophylline, caffeine.

- alcohol.


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Metabolic abnormalities.

- Electrolyte (low K, Na, Ca, Mg )

- Hypoximia, Hypercarbia.

- Acidosis

0 Endocrine abnormalities

-Thyrotoxicosis, Phaeochrocytoma.


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Miscellaneous.

- Febrile illness

- Emotional stress

- Smoking

- Fatigue.


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Symptoms

Palpitations: nontachycardiac; rapid and regular; rapid and

irregular (regularly irregular or irregularly irregular).

Abrupt or accelerating onset and termination?

DyspneaChest 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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Failure of impulseformation

Sinus Bradycardia

Sick Sinus Syndrome

AV conductionabnormalities

1st and 2nd AV Block

Total AV Block

BBB (Bundle Branch

Block)


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Junctional rhythm

-AV junction can function as a pace maker

(40-60 x/min).-due to the failure of sinus node to initiatetime impulse or conduction problem.-normal-looking QRS.-retrograde P wave.-P wave may preceede, coincide with, orfollow the QRS


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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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Inj Sulfas Atropin/SA 0,5 mg IV

Dopamin drips

Temporary Pace Maker/TPM

Permanent Pace Maker/PPM pada kasus2bradiaritmia yang berat


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Aritmia Dan Bradiaritmia

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