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Ima Rifiyanti

Sistem Konduksi Jantung

Serat konduksi pada jantung merupakan modifikasi dari serat otot jantung dan menghasilkan impuls. Serat konduksi terdiri dari 2 nodus di dinding atrium yaitu nodus SA dan AV, bundle of His dan serat purkinje.

Normal Sinus Rhythm To pump blood through the body, the heart "runs" on electrical impulses that stimulate its chambers (atria and ventricles) to rhythmically contract and relax with each heartbeat. Most healthy hearts have normal sinus rhythm. "Normal" refers to a heart (pulse) rate between 60 and 100. "Sinus" refers to the sinoatrial or SA node -- The origin of the electrical impulse that "starts" each beat. We trace the flow of electricity through the heart with an ECG (electrocardiogram) as shown in the animation. The "P wave" represents the electricity flowing through the atria or upper chambers of the heart. The "QRS complex" represents the flow through the ventricles, the bottom chambers, as they contract to push the blood out from the heart. The "T wave" represents repolarization, the electrical "resetting" of the heart for the next beat. In the normal sinus rhythm the ECG waves are usually regular, meaning their peaks are evenly spaced.

Atrial Fibrilations
Atrial Fibrillation The most common abnormal heart rhythm is atrial fibrillation, which causes an "irregularly irregular" heartbeat, with no repeat pattern. Instead of a single electrical impulse from the SA node, about 400 per minute "fire" in the atria - but only a few are transmitted through the AV node. On the ECG, the P wave is replaced by a bumpy line that doctors refer to as "fibrillatory waves," and the QRS complex is unevenly and irregularly spaced. In atrial fibrillation the atria are not contracting effectively, so the blood swirls, pools, and may form clots that could travel to the brain, causing a stroke.

Slow rate What is bradycardia? Having bradycardia (say "bray-dee-KAR-dee-uh") means your heart beats very slowly. For most people, a heart rate of 60 to 100 beats a minute while at rest is considered normal. If your heart beats less than 60 times a minute, your doctor may diagnose bradycardia. A slow heart rate is sometimes normal and can be a sign of being very fit. Healthy young adults and athletes often have heart rates of less than 60 beats a minute.

n other people, bradycardia is a sign of a problem with the heart s electrical system. It means that the heart's natural pacemaker is not working right or that the electrical pathways of the heart are disrupted. In severe forms of bradycardia, the heart beats so slowly that it does not pump enough blood to meet the body's needs. This can be lifethreatening.

What causes bradycardia? Bradycardia can be caused by: Changes in the heart that are the result of aging. Diseases that damage the heart's electrical system. These include coronary artery disease, heart attack, and infections such as endocarditis and myocarditis. Conditions that can slow electrical impulses through the heart. Examples include having a low thyroid level (hypothyroidism) or an electrolyte imbalance, such as too much potassium in the blood. Some medicines for treating heart problems or high blood pressure, such as beta-blockers, antiarrhythmics, and digoxin.

What are the symptoms? A very slow heart rate may cause you to: Feel dizzy or lightheaded. Feel short of breath and find it harder to exercise. Feel tired. Have chest pain or a feeling that your heart is pounding or fluttering (palpitations). Feel confused or have trouble concentrating. Faint, if a slow heart rate causes a drop in blood press

Some people don't have symptoms, or their symptoms are so mild that they think they are just part of getting older. You can find out how fast your heart is beating by taking your pulse. If your heartbeat is slow or uneven, talk to your doctor.

How is bradycardia diagnosed? Your doctor may be able to diagnose bradycardia by doing a physical exam, asking questions about your past health, and doing an electrocardiogram (EKG or ECG). An EKG measures the electrical signals that control heart rhythm, so it is the best test for bradycardia. But bradycardia often comes and goes, so a standard EKG done in the doctor s office may not find it. An EKG can identify bradycardia only if you are actually having it during the test. You may need to use a portable (ambulatory) electrocardiogram. This lightweight device is also called a Holter monitor or a cardiac event monitor. You wear the monitor for a day or more, and it records your heart rhythm while you go about your daily routine.

How is it treated? How bradycardia is treated depends on what is causing it. Treatment also depends on the symptoms. If bradycardia does not cause symptoms, it usually is not treated. If damage to the heart s electrical system causes your heart to beat too slowly, you will probably need to have a pacemaker. A pacemaker is a device placed under your skin that helps correct the slow heart rate. People older than 65 are most likely to have a type of bradycardia that requires

If another medical problem, such as hypothyroidism or an electrolyte imbalance, is causing a slow heart rate, treating that problem may cure the bradycardia. If a medicine is causing your heart to beat too slowly, your doctor may adjust the dose or prescribe a different medicine. If you cannot stop taking that medicine, you may need a pacemaker. The goal of treatment is to raise your heart rate so your body gets the blood it needs. If severe bradycardia is not treated, it can lead to serious problems. These may include fainting and injuries from fainting, as well as seizures or even death

What can you do at home for bradycardia? Bradycardia is often the result of another heart condition, so taking steps to improve your heart health will usually improve your overall health. The best steps you can take are to: Control your cholesterol. Eat a low-fat, low-salt diet. Get regular exercise. Your doctor can tell you what level of exercise is safe for you. Stop smoking. Limit alcohol. Take your medicines as prescribed. See your doctor for regular follow-up care.

People who get pacemakers need to be careful around strong magnetic or electrical fields, such as MRI machines or magnetic wands used at airports. If you get a pacemaker, your doctor will give you information about the type you have and what precautions to take.

What is ventricular tachycardia? Ventricular tachycardia is a fast heart rhythm that starts in the lower part of the heart (ventricles). If left untreated, some forms of ventricular tachycardia may get worse and lead to ventricular fibrillation, which can be life-threatening. Ventricular tachycardia is a fast but regular rhythm. It can lead to ventricular fibrillation which is fast and irregular. With ventricular fibrillation, the heart beats are so fast and irregular that the heart stops pumping blood. Ventricular fibrillation is a leading cause of sudden cardiac death.

What causes ventricular tachycardia? Sometimes it is not known what causes ventricular tachycardia, especially when it occurs in young people. But in most cases ventricular tachycardia is caused by heart disease, such as a previous heart attack, a congenital heart defect, hypertrophic or dilated cardiomyopathy, or myocarditis. Sometimes ventricular tachycardia occurs after heart surgery.

Some medicines-including antiarrhythmic medicines, which are used to treat other types of abnormal heart rhythms-can cause ventricular tachycardia. Less common causes include blood imbalances, such as low potassium levels and other electrolyte imbalances.

Nonprescription decongestants, herbal remedies (especially those that contain ma huang or ephedra), diet pills, and "pep" pills often contain stimulants that can trigger episodes of ventricular tachycardia. Illegal drugs (such as stimulants, like cocaine) also may cause ventricular tachycardia. It is important to be aware of which substances have an effect on you and how to avoid them.

What are the symptoms? In ventricular tachycardia, the heart beats too rapidly and the ventricles cannot effectively pump oxygen-rich blood to the rest of the body. Ventricular tachycardia can be life-threatening. Symptoms include: Palpitations, an uncomfortable awareness of the heart beating rapidly or irregularly. Dizziness or lightheadedness. Shortness of breath. Chest pain, or angina. Near-fainting or fainting (syncope). Weak pulse or no pulse. This heart rhythm is dangerous because if it lasts more than just a few seconds, it can turn into ventricular fibrillation which causes sudden death.

How is ventricular tachycardia diagnosed? If an electrocardiogram (EKG, ECG) can be performed while ventricular tachycardia is occurring, it often provides the most useful information. An electrocardiogram is a tracing of the electrical activity of your heart. It is usually done along with a history and physical examination, lab tests, and a chest X-ray.

Because ventricular tachycardia can occur intermittently and may not always be captured by an EKG at the doctor's office, you may be asked to use a portable EKG to record your heart rhythm on a continuous basis, usually over a 24-hour period. This is referred to by several names, including ambulatory electrocardiography, ambulatory EKG, Holter monitoring, 24-hour EKG, or cardiac event monitoring.

Your doctor may recommend further tests, including an echocardiogram, to evaluate your heart's function, a stress test or coronary angiogram to determine whether a part of the heart is not getting enough blood, and/or an electrophysiology study. During an electrophysiology (EP) study, electrical currents are sent through a catheter into the heart to try to trigger ventricular tachycardia and record the flow of electricity through the heart. In this way, the EP study can locate specific areas of heart tissue that give rise to abnormal electrical impulses, which may be causing the ventricular tachycardia. This information is used to determine the best treatment.

If you are having symptoms and are in a sustained tachycardia, it is a medical emergency. You will require immediate treatment. You may need CPR or a shock from an automatic defibrillator (also known as an AED). Paramedics or your doctor may try intravenous medicines or electrical cardioversion to return your heart to a normal rhythm.

To prevent the arrhythmia from recurring, you may need to take antiarrhythmic medicines. But these medicines may have side effects, so instead doctors often recommend a type of permanent pacemaker, called an implantable cardioverter defibrillator (ICD). This device is placed under the skin in your chest and continuously monitors your heart's rhythm. If ventricular tachycardia occurs, the ICD applies an electrical shock to the heart to restore a normal rhythm. After a normal rhythm is restored, the device goes back to continuous monitoring mode. Sometimes, both medicines and an ICD are necessary.

In some cases a procedure called catheter ablation is used to destroy small areas of heart tissue responsible for the arrhythmia. In this procedure, thin, flexible wires are inserted into a blood vessel in the thigh, groin, neck, or elbow and threaded to the heart. Through these wires, heat or freezing cold temperatures can be delivered to the specific heart tissue that is generating abnormal electrical impulses (previously located in the EP study). The heat or freezing cold destroy (ablate) this heart tissue and can stop ventricular tachycardia from happening again.

It is very important that any causes of ventricular tachycardia be identified and treated, if possible. For example, if a low potassium level is causing ventricular tachycardia, it needs to be corrected to prevent a recurrence. If the ventricular tachycardia results from a medicine, the medicine needs to be stopped. If heart disease caused the ventricular tachycardia, the heart disease needs to be treated. Treating coronary artery disease provides the best treatment for ventricular tachycardia caused by a heart attack.

What precautions should you take? If you have palpitations, dizziness, near-fainting, or chest pain, call911or other emergency services immediately . If you have had an episode of ventricular tachycardia or ventricular fibrillation, your doctor may recommend that you don't drive a car for a few months. This precaution is to make sure you don't have any other episodes that could make driving unsafe.1, 2

People with this condition should avoid caffeine-containing foods, which can trigger ventricular tachycardia. Caffeine is present in coffee, tea, colas, various other soft drinks, and chocolate. Also, fad diets such as liquidbased programs or high-protein regimens can affect the concentrations of electrolytes in your bloodstream. This can, in turn, cause problems with your heart.

Is this topic for you? Atrial fibrillation and ventricular tachycardia are types of fast heart rates that can be serious. If you have one of these heart problems, see the topic Atrial Fibrillation or Ventricular Tachycardia. What is supraventricular tachycardia? Supraventricular tachycardia (SVT) means that from time to time your heart beats very fast for a reason other than exercise, high fever, or stress. Types of SVT include: Atrioventricular nodal reentrant tachycardia (AVNRT). Atrioventricular reciprocating tachycardia (AVRT), including Wolff-Parkinson-White syndrome.

During an episode of SVT, the heart s electrical system doesn't work right, causing the heart to beat very fast. The heart beats at least 100 beats per minute and may reach 300 beats per minute. After treatment or on its own, the heart usually returns to a normal rate of 60 to 100 beats a minute. SVT may start and end quickly, and you may not have symptoms. SVT becomes a problem when it happens often, lasts a long time, or causes symptoms. SVT also is called paroxysmal supraventricular tachycardia (PSVT) or paroxysmal atrial tachycardia (PAT).

What causes SVT? Most episodes of SVT are caused by faulty electrical connections in the heart. What causes the electrical problem is not clear. SVT also can be caused by very high levels of the heart medicine digoxin (such as Lanoxicaps or Lanoxin) or the lung medicine theophylline (such as Theochron or Uniphyl). Some types of SVT may run in families, such as WolffParkinson-White syndrome. Or they may be caused by a lung problem such as COPD or pneumonia.

What are the symptoms? Some people with SVT have no symptoms. Others may have: Palpitations, a feeling that your heart is racing or pounding. A pounding pulse. A dizzy feeling or may feel lightheaded. Other symptoms include, near-fainting or fainting (syncope), shortness of breath, chest pain, throat tightness, and sweating.

How is SVT diagnosed? Your doctor will diagnose SVT by asking you questions about your health and symptoms, doing a physical exam, and perhaps giving you tests. Your doctor: Will ask if anything triggers the fast heart rate, how long it lasts, if it starts and stops suddenly, and if the beats are regular or irregular. May do a test called an electrocardiogram (EKG, ECG). This test measures the heart's electrical activity and can record SVT episodes. May do an electrophysiology (EP) study. This test finds out whether there is an extra electrical pathway inside your heart.

If you do not have an episode of SVT while you're at the doctor's office, your doctor probably will ask you to wear a portable EKG. When you have an episode, the device will record it. Your doctor also may do tests to find the cause of the SVT. These may include blood tests, a chest X-ray, and an echocardiogram, which makes a picture of the heart.

Some SVTs don't cause symptoms, and you may not need treatment. If you do have symptoms, your doctor probably will recommend treatment. To treat sudden episodes of SVT, your doctor may: Prescribe a medicine to take when the SVT occurs. Show you how you can slow your heart rate on your own. You may be able to do this by coughing, gagging, or putting your face in ice-cold water. These are called vagal maneuvers.

f these treatments don't work, you may have to go to your doctor's office or the emergency room. You may get a fast-acting medicine such as adenosine or verapamil. If the SVT is serious, you may have electrical cardioversion, which uses an electrical current to reset the heart rhythm. If you often have episodes of SVT, you may need to: Take medicine every day to prevent the episodes or slow your heart rate. Try catheter ablation. This procedure removes a tiny part of the heart that causes the problem.

What can you do at home to prevent SVT? You can do a lot to prevent SVT by avoiding the things that trigger it. Limit alcohol to 2 drinks a day if you are a man and 1 drink a day if you are a woman. Limit caffeine. Even decaffeinated teas or coffee can cause SVT in some people. Don't smoke. Avoid over-the-counter decongestants, herbal remedies, diet pills, and "pep" pills. Don't use illegal drugs, such as cocaine, ecstasy, or methamphetamine. To find your triggers, keep a diary of your heart rate and your symptoms. You might find, for example, that smoking or caffeine causes your SVT episodes.

Atrial Flutter Overview Atrial flutter is an abnormality in the beating of the heart. Such abnormalities, whether in rhythm of heartbeat or speed of heartbeat, are known as arrhythmias. The heart is a muscle that pumps the blood through the body. Each beat of the heart is a very rapid series of 2 contractions. The first contraction is in the upper chambers, the atria; the second contraction is in the lower chambers, the ventricles. The atria receive blood back into the heart and pump it into the ventricles; the ventricles pump the blood out into the aorta, which feeds all the blood vessels to the body.

The beating of the heart is controlled by electrical impulses. Under normal circumstances, these impulses are generated by the heart's "natural pacemaker," the sinoatrial (SA) or sinus node, which is located in the right atrium. The impulse travels across the atria, generating a contraction. It pauses very briefly at the atrioventricular (AV) node, which is located in the upper part of the muscular wall between the 2 ventricles. This delay gives the blood time to move from the atria to the ventricles. The impulse then moves down and through the ventricles, generating the second ventricular contraction that pumps the blood out of the ventri

Atrial flutter occurs when an abnormal conduction circuit develops inside the right atrium, allowing the atria to beat excessively fast, about 250-300 beats per minute. These rapid contractions are slowed when they reach the AV node, but are still too fast (typically about 150 beats per minute, or every other atrial beat getting through the AV node to the ventricles). This type of rhythm is called tachycardia. Because atrial flutter comes from the atria, it is called a supraventricular (above

The main danger of atrial flutter is that the heart does not pump blood very well when it is beating too fast. Vital organs such as the heart muscle and brain may not get enough blood. This can cause them to fail. Congestive heart failure, heart attack, and/or stroke all can result.

Atrial flutter can come and go; it is then known as paroxysmal atrial flutter. An episode of atrial flutter usually lasts hours or days. Less often, atrial flutter is more or less permanent and is known as persistent atrial flutter. With proper treatment, atrial flutter is rarely life threatening. Complications of atrial flutter can be devastating, but they usually can be prevented with treatment.

Atrial Flutter Causes Atrial flutter may be caused by abnormalities or diseases of the heart itself, by a disease elsewhere in the body that affects the heart, or by consuming substances that change the way electrical impulses are transmitted through the heart. In a few people, no underlying cause is ever found.

Heart diseases or abnormalities that can cause atrial flutter include the following: Decreased blood flow to the heart (ischemia) due to coronary heart disease, atherosclerosis, or a blood clot High blood pressure (hypertension) Disease of the heart muscle ( cardiomyopathy) Abnormalities of the heart valves (especially the mitral valve) An abnormally enlarged chamber of the heart (hypertrophy) After open heart surgery

Diseases elsewhere in the body that affect the heart include the following: Overactive thyroid gland ( hyperthyroidism) Blood clot in a blood vessel in the lungs (pulmonary embolism) Chronic (ongoing, long-term) lung diseases (COPD), such as emphysema, that lower the amount of oxygen in the blood

Substances that may contribute to atrial flutter include the following:

Alcohol (wine, beer, or hard liquor) Stimulants such as cocaine, amphetamines, diet pills, cold medicines, even caffeine

Atrial Flutter Symptoms Some people have no symptoms at all with atrial flutter. Others describe the following symptoms: Palpitations (rapid heartbeat or a pounding sensation in the chest)

A "fluttering" or tremorlike feeling in the chest Shortness of breath Anxiety

People with underlying heart or lung disease who experience atrial flutter may have these and other, more significant symptoms. Angina pectoris (chest or heart pains) Feeling faint or light-headed Fainting (syncope)

When to Seek Medical Care If you experience any of the symptoms of atrial flutter, call your health care provider for an appointment. If you are taking medication for atrial flutter, and you experience any of the signs and symptoms described, call your health care provider. If you have been diagnosed and are being treated for atrial flutter, go immediately to a hospital emergency department if you experience any of the following symptoms: Severe chest pain Feeling faint or light-headed Actual fainting

Exams and Tests Upon hearing your symptoms, your health care provider (whether your primary care provider or the provider in the emergency department) will probably suspect an arrhythmia. Because other conditions can cause similar symptoms, the evaluation will at first focus on ruling out the most dangerous ones. Fortunately, there is one simple test that can tell quite a lot about what is happening with the heart.

Electrocardiogram (ECG): The ECG measures and records the electrical impulses that control the beating of the heart. The ECG highlights irregularities in these impulses and abnormalities in the heart. In arrhythmias, the ECG tracings can help pinpoint the type of arrhythmia and where in the heart it comes from. ECG also shows signs of heart attack, heart ischemia, conduction abnormalities, abnormal heart enlargement (hypertrophy), and even certain chemical abnormalities in the heart tissue such as potassium and calcium.

People sometimes have symptoms suggesting atrial flutter, but their ECG result in the emergency department or medical office is normal. This does not mean that you are "imagining things." It just means that your arrhythmia comes and goes, a very common condition. It may mean you just have some premature beats, which is benign. If this happens to you, you may be asked to undergo ambulatory ECG. The purpose of ambulatory ECG is to get documentation of whether you do or do not have a significant arrhythmia and what type. This is important because you cannot receive treatment until your specific arrhythmia type has been identified.

Ambulatory ECG involves wearing a monitoring device for a few days while you go about your normal activities. The device, known as a Holter monitor, is usually worn around your neck. ECG electrodes are worn on the chest. Typically, the device records your heart rhythm on a continual basis for 24-72 hours. Some health care providers prefer that you wear the device for a longer time, with intermittent recording of your heart rhythm. This is called an event recorder, which can be turned on by yourself when you feel something abnormal. Even more rarely, an event recorder can be implanted under the skin and worn for several weeks or months. Either method works well. The important thing is to get ECG documentation of your arrhythmia.

Atrial Flutter Treatment The goals of treatment are to control the heart rate, restore normal sinus rhythm, prevent future episodes, and prevent stroke. Control rate: The first treatment goal is to control the ventricular rate. If you experience serious clinical symptoms, such as chest pain or congestive heart failure related to the ventricular rate, the health care provider in the emergency department will decrease your heart rate rapidly with IV medications or electrical shock (defibrillation). If you have no serious symptoms, you may be given medications by mouth. Sometimes you may require a combination of oral medications to control your heart rate. Surgery may be done to control rate, but this is rare. Restore and maintain normal sinus rhythm: Some people with newly diagnosed atrial flutter convert to normal sinus rhythm spontaneously in 24-48 hours. The goal of treatment is to convert the atrial flutter to normal sinus rhythm and prevent recurrence of atrial flutter. Not everyone with atrial flutter needs anti-arrhythmic medication. The frequency with which your arrhythmia returns and the symptoms it causes partly determine whether you receive anti-arrhythmic medication. Medical professionals carefully tailor each person's anti-arrhythmic medication(s) to produce the desired clinical effect without creating unwanted side effects, some potentially lethal.

Prevent future episodes: This is usually done by taking daily medication to keep the heart at a safe and comfortable rate. Prevent stroke: Stroke is a devastating complication of atrial flutter. It occurs when a piece of a blood clot formed in the heart breaks off and travels to the brain, where it blocks blood flow. Coexisting medical conditions, such as congestive heart failure and mitral valve disease, significantly increase the risk of stroke. Patients with persistent atrial flutter need a "blood-thinning" drug called warfarin to lower this risk. Warfarin blocks a certain factor in the blood that promotes clotting. People at lower risk of stroke and those who cannot take warfarin may use aspirin. Aspirin is not without its own side effects, including bleeding problems and stomach ulcers.