aritmia dan bradiaritmia
TRANSCRIPT
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Departemen Kardiologi FK USURSUP. H. Adam Malik
Medan
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SA nodeSumber impuls normal/alamiah , 60 – 100
AV nodeBisa mengeluarkan
impuls 40-60x/menit
Berkas HisSerabut Purkinje
VentrikelBisa mengeluarkan impuls20-40 x/menit
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CAUSE OF CARDIAC ARRHYTHMIAS :
• Disturbances in automaticity : bertambah cepatatau bertambah lambatnya suatu daerah otomatisitas.Misal di sinus node, AV node, abnormal beats/depolarisasi atrium, AV junction, ventrikel, VT, dll.
• Disturbances in conduction : konduksi terlalu cepat(WPW) atau terlalu lambat (blok AV).
• Combinations of altered automaticity andconduction .
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Tachyarrhythmia
(rate >100 x/min)
Bradyarrhytmia
(rate < 60 X/min)
• QRS sempit (0.12 ms )
•
AV blok derajat 1, 2 & 3
• RBBB & LBBB
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Underlying cardiac disease
- Ischemic heart disease
- Valvular heart disease
- Hypertensive heart disease
- Congenital heart disease
- Pre excitation (short of PR interval)
- Long QT (congenital or acquired)
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Drugs
- anti-arrhytmia
- sympathomimetic.
- B2 agonis, cocaine, anti depresants
(tricyclic), Aminophylline, caffeine.
- alcohol.
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Metabolic abnormalities.
- Electrolyte (low K, Na, Ca, Mg )
- Hypoximia, Hypercarbia.
- Acidosis
0 Endocrine abnormalities
-Thyrotoxicosis, Phaeochrocytoma.
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Miscellaneous.
- Febrile illness
- Emotional stress
- Smoking
- Fatigue.
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Symptoms
Palpitations: nontachycardiac; rapid and regular; rapid and
irregular (regularly irregular or irregularly irregular).
Abrupt or accelerating onset and termination?
DyspneaChest discomfort
Syncope; “nearly blacked out”; syncope with spell
Polyuria
Cardiac arrest
Signs
Heart rate and pulses: regularity; amplitude; deficit
Hypotension
Hypoperfusion
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Failure of impulseformation
Sinus Bradycardia
Sick Sinus Syndrome
AV conductionabnormalities
1st and 2nd AV Block
Total AV Block
BBB (Bundle Branch
Block)
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Junctional rhythm
-AV junction can function as a pace maker
(40-60 x/min).-due to the failure of sinus node to initiatetime impulse or conduction problem.-normal-looking QRS.-retrograde P wave.-P wave may preceede, coincide with, orfollow the QRS
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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
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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
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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
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Inj Sulfas Atropin/SA 0,5 mg IV
Dopamin drips
Temporary Pace Maker/TPM
Permanent Pace Maker/PPM pada kasus2bradiaritmia yang berat
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