ARHYTHMIA

Aritmia
Gangguan irama jantung berupa segala jenis irama jantung selain IRAMA SINUS

Supraventrikular
QRS sempit seperti normal (kecuali beberapa hal: BBB, WPW,aberans)

Ventrikular
QRS lebar > 0,12 dt

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

TACHYCARDIA

Atrial fibrillation SNRT Atrial flutter AT AVRT AVNRT JT

V Tach

V Fibrillation

Aritmia Supraventrikular

Premature beat / ekstra sistolik

Takikardi aritmia

Atrial Flutter Atrial fibrilasi

Supra Ventrikel Takikardi/ Paroksismal Atrial Takikardi 150 - 250 x/mnt

ARRHYTHMIAS (ATRIAL RHYTHMS)

Gambaran premature atrial complex (tanda panah).

Gambaran EKG atrial tachycardia/SVT.

SVT

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

Gambaran delta wave pada sindroma WPW

Atrial flutter dengan gambaran gigi gergaji.

Wolff-Parkinson-White syndrome

Gambaran fibrilasi atrial dengan rapid ventricular response

Approaches to Treatment of atrial fibrillation

Ventricular rate control Maintenance of sinus rhythm Anticoagulation (acute and chronic)

Aritmia Ventrikular

Premature beat / ekstra sistolik

Takikardi aritmia

Ventrikel Takikardi N
100-250 x/mnt

Ventrikel Fibrilasi N
> 350 x/mnt

VENTRICULAR RHYTHMS

VES

Gambar A menunjukkan sinus takikardi dengan frequent uniform PVC dan B menunjukkan sinus takikardi dengan multiform PVC.

Sinus ritme dengan dua R on T PVCs

Sinus ritme dengan run VT dan satu episode couplets

Gambaran trigeminal PVC.

Gambaran accelerated idioventricular rhythm

Gambaran Ventricular Tachycardia (VT)

Gambaran Ventricular Fibrillation (VF)

Torsade de pointes

Management of Malignant Ventricular arrhythmias

Pharmacological
Class I Class III Class II, Beta blocker

Non-pharmacological
Surgical arrhythmias Catheter ablation Device : AICD

ADULT CARDIAC ARREST

CPR Precordial thump

Assess rhythm
Check pulse +/VT/VF Attempt Defibrilation X3 Non-VT/VF

CPR 1 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

CPR up to 3 minute

ILCOR Guidelines. Circulation 2000;102 (suppl ): -1I-384

 BRADYARRHYTHMIA AND CONDUCTION ABNORMALITIES SPECIFIC ECG CHANGES

GANGGUAN KONDUKSI DI SA NODE

Gambaran sinus ritme dengan episode sinoatrial block.

Gambaran sinus ritme dengan episode sinus arrest

GANGGUAN KONDUKSI DI AV NODE

First-degree AV block Rhythm : Regular Rate : Usually normal P wave : Sinus P wave present; one P wave to each QRS PR : Prolonged ( greater than 0.20 seconds ) QRS : Normal

Second -degree AV block, Mobitz I Rhythm : Irregular Rate : Usually slow but can be normal P wave : Sinus P wave present; some not followed by QRS complexes PR : Progressively lengthens QRS : Normal

Second-degree AV block, Mobitz II Rhythm : Regular usually; can be irreguler if conduction ratios vary Rate : Usually slow P wave : Two, three, or four P waves before each QRS PR : 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

Third-degree AV block

Rhythm : Regular Rate : 40 60 if block in His bundle; 30 40 if block involves bundle branches P wave : Sinus P wave present; bear no relationship to QRS; can be found hidden in QRS complexes and T waves PR : Varies greatly QRS : Normal if block in His bundle; wide if block involves bundle branches

RBBB

0.04

LBBB

Gambaran asistol

Gambaran P wave asystole.

BRADYCARDIA
Serious signs and symptoms? Due to bradycardia?

No Type II second-degree AV block or

Yes Intervention sequence

Third degree AV block

Atropine 0.5-1.0 mg
Transcutaneous pacing Dopamine 5-20 g/kg/min Epinephrine 2-10 g/min

Yes

No

If symptoms develop, use

transcutaneous pacemaker until transvenous pacer placed Observed

ILCOR Guidelines. Circulation 2000;102 (suppl ): -1I-384

The Deadly Rhythms

VF VT VF

PEA
(Pulse less Electrical Activity)

Asystole

TH A N K YO U

VES

SVT

VES R on T

VT

VF