Aritmia Dan Kegawatan Jantung1 ZM

7/23/2019 Aritmia Dan Kegawatan Jantung1 ZM

1/55

Aritmia danKegawatan Jantung

Departemen Kardiologi dan Kedokteran VaskulerDepartemen Kardiologi dan Kedokteran Vaskuler

Fakultas Kedokteran UMSUFakultas Kedokteran UMSU

MedanMedan


2/55

Arrhythmia.

Definition : Lack of rhythm or abnormal

rhythm.

Fre!uency " bradycardia or tachycardia#

"$ormal sinus rhythm %& ' (&& ) *min.#

+rregularity

Source of impuls

Se!uence of acti,ation


3/55

Precipitating factors

Underlying cardiac disease

+schemic heart disease

Val,ular heart disease -ypertensi,e heart disease

ongenital heart disease

/re e)citation "short of /0 inter,al#

Long 12 "congenital or ac!uired#


4/55


Drugs

antiarrhytmia

sympathomimetic. 34 agonis5 cocaine5 anti depresants

"tricyclic#5 6minophylline5 caffeine.

alcohol.


5/55


Metabolic abnormalities.

7lectrolyte "lo8 K5 $a5 a5 Mg #

-ypo)imia5 -ypercarbia. 6cidosis

& 7ndocrine abnormalities

2hyroto)icosis5 /haeochrocytoma.


6/55


Miscellaneous.

Febrile illness

7motional stress

Smoking

Fatigue.


7/55

Investigation for

arrhytmias(. (4 lead 79 and rhythm strip.4. 3lood test : routine blood5 electrolyte 5

glucose5 cardiac enyme5 thyroid le,el5

drug le,el "digo)in#5 arterial blood gas.

;. hest ) ray : heart sie 5 pulmonary

edema5 lung cancer5 pericardial

effusion.


8/55

I. Sebutkan iramanya :Normal Sinus Rhythm

7K9


9/55

The Heartbeat.lectromechanical association


10/55

II. MENGHITUNG DENYUTJANTUNG:


11/55


12/55

!iagnostic

Tachyarrhytmia

Lebar gel. 10S

Keteraturan gel. 10S

/ 8a,e


13/55

QRS complexTeratur / tidak teratur ?

QRS complexSempit / lebar ?

P wave ?

Hubungan antara P and QRS ?


14/55

"RS sempit : Supraventricularorigin


15/55

"RS #ebar : $entricular origin

QRS lebar

"rama #erat$r"rama

tidak terat$r

Ve%tri$lar#a'ardia

Ve%tri$laribrillatio%


16/55

V7S "Ventricular e)trasystole# V/3 ",entricular prematur beat# begemini bifocal.

V7S couplet

V2,entricular tachycardia


17/55

6Fatrial fibrillation5 course / 8a,e 5 00 inter,al irregular


18/55


19/55


20/55

SV200 inter,al regular5 / or 2 8a,e not identified


21/55

6F rapid


22/55

V2 5 8ide !rs 5 fi)ed a)is

VF5 ,entricular fibrillation5 changed a)is


23/55

V2

V2


24/55

V2


25/55

VF


26/55


27/55


28/55

2orsade de /ointes


29/55

Bradyarrhytmia(rate < 60 x/mi!

Failure of impulse

formation

Sinus 3radycardia

Sick Sinus Syndrome

AV conduction

abnormalities

(stand 4nd6V 3lock

2otal 6V 3lock

333 "3undle 3ranch3lock#


30/55


31/55

Sick Sinus Syndrome


32/55


33/55


34/55


35/55

"BBBL333


36/55

Treatment

6trial Fibrillation.

0ate control :

(. Digo)in.

Digitaliation dose : &5&; ) 3= "Kg#

Maintenance dose : &5(4> ' &54> mg

*day5 depends on ' renal function.

0oute :oral tablet &54> mg or

+n?ection ampule &5> mg


37/55

%. &eta blocker

/ropranolol

Metoprolol

6tenolol

3isoprolol

ar,edilol


38/55

%. Rhythm control

'ain purpose is conversion to sinusrhythm. 6miodaron

2ablet : 4&& mg.

+n?ection : (>& mg

Loading dose : ; ) 4&& mg " > days#

Maintenance dose : (&& ' 4&& mg * day.

ontraindication : 2hyroid and Lung

"fibrotic# dysfunction.


39/55

S$T(supraventricularTachycar)ia(. 6denosin in?ection " % mg ' (4 mg #

4. Verapamil in?ection " 45> ' (& mg#

;. 6miodaron in?ection.

Loading dose : ;&& mg * 4>& cc in ;&

' %& minutes.

Maintenance dose : @>& ' %&& mg *day

@. ardio,ersion : D shock synchronie

>. 6blation : radiofre!uency or laser.


40/55

$entricular *tra

Systole. 6miodaron oral or in?ection : depends on benign or

malignant e)trasystole.


41/55

$T

6miodaron : if patients hemodynamic:

good "conscious5 3/ #

D shock synchronie : if instability

hemodynamic.

(&& ' ;&& Aoule.


42/55

$+ , ventricular

-brillation. D shock asynchronied ;%& ?oule.

+D ' intracardiac defibrillation.

7MDelectromechanical dissociation.


43/55

#'e*eadl

R't'ms

VT VF+A

(+$lse lessletrialAti-it)

A systoleVF


44/55

P/

S-7M+6 : S2 depresi atau 2

in,erted

+$F602 : S2 7le,asi

$70BS+S "BLD +$F602# :

gel. 1 patologis atau 1S+


45/55


46/55


47/55


48/55


49/55


50/55

7arly 0epolarisasi


51/55

0333


52/55


53/55

6 t 6 t i M+


54/55

6cute 6nterior M+

f


55/55

6cute +nferoposterior M+

Aritmia Dan Kegawatan Jantung1 ZM

Documents

Transcript of Aritmia Dan Kegawatan Jantung1 ZM