VENTRICULAR

ARRHYTHMIAS
Premature Ventricular Contraction
• Site of origin : ventricles

• Rhythm : varies according to underlying rhythm

• P wave : absent
• PR interval : not measurable
• QRS complex : wide, bizarre and .>0.12sec
• T wave :deflected, opposite direction of the QRS
• Complete compensatory pause
PVC
Unifocal PVC
• Site of origin : one ventricular site
• ORS : same size and shape
• Other characteristics : same as PVC
Unifocal PVC
Bigeminy
• Site of origin : one or more ventricular sites
• ORS : unifocal or multifocal
• Occurs : every other complex is a PVC
• Other characteristics : same as PVC
Bigeminy
Quadrigeminy
• Site of origin : one or more ventricular sites
• ORS : unifocal or multifocal
• Occurs : every fourth complex is a PVC
• Other characteristics : same as PVC
Quadrigeminy PVC
Couplet/Paired/Consecutive PVCs
• Site of origin : one or more ventricular sites
• ORS : unifocal or multifocal
• Occurs : two PVCs in a row
• Other characteristics : same as PVC
Couplet PVC
Triplet
• Site of origin : one or more ventricular sites
• ORS : unifocal or multifocal
• Occurs : three PVCs in a row
• Other characteristics : same as PVC
Triplet PVC
Multifocal PVCs
• Site of origin : two or more ventricular site
• ORS : varies in size and shape
• Other characteristics : same as PVC
Multimorphic PVC
R on T phenomenon
• Site of origin : one or more ventricular sites
• ORS : unifocal or multifocal
• Occurs : R wave of PVC falls on T wave of the
preceding ORS
• Other characteristics : same as PVC.
• high risk on triggering the onset VT /VF
R on T PVC
Kapan PVC mengancam nyawa?

• Frekwensi : >6PVCs dalam semenit

• Bentuk : multifocals,bi/trigeminy,couplet
triplet  VT,VF
Penyebab
• Digoxin toxicity
• Caffeine, nicotine
• Hypokalaemia
• Stress, kelelahan
• Iritabilitas otot jantung akibat hypoxia,
•  impulses ektopik
Tatalakana
• Nilai pasien, analisa PVCs adakah bentuk PVC yang
mengancam nyawa ?
• Beri oksigen
• Pasang infus
• Terapi sesuai dengan penyebab
• Obat lidocaine,procainamide,amiodarone
Ventricular Tachycardia
• Site of origin : one or more ventricular sites
• Rate : 140 -250 /1’
• Rhythm : usually regular
• P wave : absent
• ORS : same size &shape,bizzare,>0.12 sec
• Occurs : three or more PVCs in row, sudden onset
Ventricular Tachycardia
Tatalaksana
• Nilai pasien : stabil atau tidak? Raba nadi carotis, bila (-)
Tx seperti VF
• CPR
• Beri oksigen
• Pasang infus
• Langkah selanjutnya ACLS
Torsade de Pointes
VF
• Site of origin : multiple ventricular sites
• Rate : unable to dtermine
• Rhythm : no R – R interval
• P wave : absent
• ORS : absent, only chaotic wavy line
• Wave amplitude: coarse or fine
VF
Tatalaksana
• Konfirmasi rhythm pada lead lainnya dan periksa apakah
terdapat elektroda yang terlepas?
• Periksa ABC, mulailah dengan CPR
• Defibrillator
• ACLS guideline
?