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PLENARY DISCUSSION

Modul 6

HEART RHYTHM DISORDERS

Scenario 6 : Dag Dig Dug Dinas Heart


Group 8B Medical Faculty of Andalas University

Groupss Members
Anelia Tiara Suci Ardho Mahamada Suci Rulliansari Virissa Calista Harbaindo Ilham Ari Seja Ferihartinda Adilla Chika Asdiana Nazla Putri Sukma Siqbal Karta Asmana Vadhana Trunakarasu

TERMINOLOGY
1. SVT
Supraventricular tachycardia A condition presenting as a rapid heart rhythm originating at or above the atrioventricular node usually with the frequency 150-250 beats/minutes

2. Electric Shock
A therapeutic by giving strong electric current with asynchronous method to the patientss heart, through electrodes that placed on the surface of the patients chest. The goal is to coordinate the electrical activity of the heart

TERMINOLOGY
3. Heart Massage
an emergency procedure that employs rhythmic compression to the heart (either through the chest wall or, during surgery, directly to the heart) in an attempt to maintain circulation

4. Electrophysiological Study
a minimally invasive procedure which tests the electrical conduction system of the heart to assess the electrical activity and conduction pathways of the heart

Problems Identification
1. Why did Dina feel palpitation since 2 days ago? 2. Why did the palpitation often appears on many minds or busy? 3. Why did the complaint of Dina usually lost with coughing and straining? 4. Why the palpitation that appear 2 days ago cant lost with coughing and straining? 5. How about the correlation of age and sex with the complaint of Dina? 6. Why Dina diagnosed with SVT and what about the result of her examination?

Problems Identification
7. What caused of SVT? 8. Why the abnormality of heart rhythm can cause the sudden convulsion and death? 9. What the other causes of the sudden death? 10. What the indication and contraindication of electric shock? 11. Why Dina recommended for electrophysiological studies? 12. What are the treatment that given to Dina? 13. What are the complication that can appears if the heart arrhythmia untreated?

Brainstorming
1. Why did Dina feel palpitation since 2 days ago? Palpitations caused by an increase in sympathetic nerve activity. It can caused by : heart arrhythmia : abnormality of heart rhythm can cause the abnormality of heart beats Stress sympathetic epinephrine palpitation Drugs the disorders of heart etc

Brainstorming
2. Why did the palpitation often appears on many minds or busy? This condition can cause stress Stress simpatis epinephrine palpitation

Brainstorming
3. Why did the complaint of Dina usually lost with coughing and straining? coughing and straining suppress baroreceptor at the carotis arterial intra-thoracic pressure baroreceptor response Parasympathetic heart beat

Brainstorming
4. Why the palpitation that appear 2 days ago cant lost with coughing and straining? Maybe : because decrease of heart sensitivity to parasympathetic nervous as a long compensation

5. How about the correlation of age and sex with the complaint of Dina? SVT often occurs in adolescence

Brainstorming
6. Why Dina diagnosed with SVT and what about the result of her examination? From ECG SVT is one of Supraventricular arrhythmia that cause of the impuls around of AV node To know where the arhytm from : look for the P wave on ECG. If therere a normal P wave on ECG with normal axis, we can conclude that the arrhythmia is from intra atrial (SA node) If there arent P wave or therere retrograde P wave (abnormal axis), we can conclude that the arrhythmia is from the impuls that produced below of SA node (like AV node, or in ventricle) Frequency : 150-250x/minutes (tachycardia) The result of Dinas examination : nothere P wave or therere retrograde P wave on ECG with the frequence 150-250/minutes, regular heart rhythm

Brainstorming
7. What caused of SVT? Mostly : reentri circuit formed in the AV node. This circuit produced the impulses faster than SA nodes, and, cause this circuit taken over the function of SA node as the main pace maker. Can caused by : electrolyte disorder, drugs, MCI, RHD, etc

Brainstorming
8. Why the abnormality of heart rhythm can cause the sudden convulsion and death? Heart Arrhythmia cardiac output brain blood supply Convulsion Death Heart blood supply CHD fails to pump blood

Brainstorming
9. What are the other causes of the sudden death? Tiara tlong bantu diisi ya,,, ibl ga ada bahan tentang ini 10. What the indication and contraindication of electric shock? Indication : Ventricular tachycardia that not resolved with medical therapy, ventricular fibrillation, SVT, Atrial Fibrilation Contraindication : block, Chronic Atrial Fibrilation, normal condition

Brainstorming
11. Why Dina recommended for electrophysiological studies? to map electrical activity and electrical conduction pathways of the heart, to find the cause of arrhythmia, and to find the source of arrhythmia This sutides is usefull to give the best treatment to Dina

Brainstorming
12. What are the treatment that given to Dina? Adenosin : This drug will break the reentry circuit on the AV node carotid massage : break the reentry circuit, and stop the arrhythmia dll 12. What are the complication that can appears if the heart arrhythmia untreated?

SCHEME
Tiara lagi ya :D

Learning Objective
The students can explain about : 1. heart arrhythmia (definition, classification, epidemiology, etiology, risk factor, pathogenesis & pathophysiology, clinical manifestation, examination and diagnose, treatment, complication, referral) 2. sudden death