K.34 Aritmia Andika

7/30/2019 K.34 Aritmia Andika

1/39

ARHYTHMIA


2/39

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


3/39

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


4/39


5/39

Atrial fibri llation

Atr ial flutter

AVRT

AVNRT

V Tach

V Fibri llation

SNRT

AT

JT

TACHYCARDIA


6/39

Ari tmia Sup raventr ikular

Premature beat

/ ekstra sistolikTakikardi aritmia

Atrial FlutterAtrial fibrilasi

Supra Ventrikel Takikardi/Paroksismal Atrial Takikardi

150 - 250 x/mnt


7/39

ARRHYTHMIAS (ATRIAL RHYTHMS)

Gambaran premature atr ia l com plex (tanda panah).

Gambaran EKG atrial tachycardia/SVT.


8/39

SVT


9/39

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


10/39

Gambaran delta wave pada sindroma WPW

Atr ial f lut ter dengan gambaran gigi gergaj i .


11/39

Wolff-Parkinson-White syndrome


12/39

Gambaran fibrilasi atrial dengan rapid ventr icu lar response


13/39

Approaches to Treatment

of atrial fibrillation

Ventricular rate control

Maintenance of sinus rhythm

Anticoagulation (acute and

chronic)


14/39

Ari tm ia Ventr iku lar

Premature beat

/ ekstra sistolikTakikardi aritmia

Ventrikel FibrilasiN

> 350 x/mnt

Ventrikel TakikardiN

100-250 x/mnt


15/39

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


16/39

Sinus ritme dengan dua R on T PVCs

Sinus ritme dengan run VT dan s atu episod e couplets


17/39

Gambaran t r igemin al PVC.

Gambaran accelerated idio ventr icu lar rhythm


18/39

Gambaran Ventr icu lar Tachy card ia (VT)

Gambaran Ventr ic ular Fibri l lat io n (VF)


19/39


20/39

Torsade de pointes


21/39

Management of Malignant

Ventricular arrhythmias Pharmacological

Class I

Class III

Class II, Beta blocker

Non-pharmacological

Surgical arrhythmias

Catheter ablation

Device : AICD


22/39

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


23/39

BRADYARRHYTHMIA AND CONDUCTION ABNORMALITIES

SPECIFIC ECG CHANGES


24/39

GANGGUAN KONDUKSI DI SA NODE

Gambaran sinus ritme dengan episode sinoatr ial blo ck.

Gambaran sinus ritme dengan episode sinus arrest


25/39

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


26/39

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


27/39

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


28/39

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


29/39

0.04

RBBB


30/39

LBBB


31/39


32/39

Gambaran asistol

Gambaran P wave asystole.


33/39

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


34/39

The

Deadly

Rhythms

VT VF

PEA

(Pulse lessElectrical

Activity)

AsystoleVF


35/39

T H A N K Y O U


36/39

VES


37/39

SVT


38/39

VES R on T

VT

VF


39/39

K.34 Aritmia Andika

Documents

Transcript of K.34 Aritmia Andika