ARRHYTHMIA

SuryaDharma,MD,FIHA

DivisionofCardiacEmergency DepartmentofCardiologyandVascularMedicine FacultyofMedicine,UniversityofIndonesia NationalCardiovascularCenterHarapanKita Jakarta,Indonesia

Aritmia
Gangguaniramajantungberupasegalajenis iramajantungselainIRAMASINUS

QRSsempitsepertinormal (kecualibeberapahal: BBB,WPW,aberans)

Supraventrikular

QRSlebar>0,12dt

Ventrikular

Conduction System

SA Node Internodal branch AV Node Hiss Bundle Purkinje Fiber Contraction

Normal Sinus Rhythm Rhythm : Regular Rate : 60 100 P wave : Normal in configuration; precede each QRS PR : Normal ( 0. 12 0.20 seconds ) QRS : Normal ( less than 0.12 seconds )

SINUSBRADYCARDIA

SINUSARRYTMIA

SINUSTACHYCARDIA

Sinusritme

SinusRitme SinusAritmia SinusTakikardi Sinusbradikardi

AritmiaSupraventrikular
Prematurebeat /ekstrasistolik

Takikardiaritmia

AtrialFlutter Atrialfibrilasi

SupraVentrikelTakikardi/ ParoksismalAtrialTakikardi 150250x/mnt

TACHYCARDIA DiagramaticofthemechanismsofSVTandVT
Atrialfibrillation SNRT AT Atrialflutter AVRT AVNRT JT

VTach VFibrillation

SVT

TreatmentstrategiesofSVT Pharmacological AcuteTx(Adenosineiv,Verapamiliv) ChronicTx(Verapamil,Betablocker,Digoxin) Nonpharmacology 1980ssharpdissectionorcryosurgicalmodification HisbundleablationusingDCshock Radiofrequencycatheterablation

AtrialFibrilasi

ATRIALFLUTTER

I II III V1 V2

V6

ApproachestoTreatment Anyorallmayapply

Anticoagulation(acuteand chronic) Ventricularratecontrol Maintenanceofsinusrhythm

WolffParkinsonWhitesyndrome

AritmiaVentrikular

Prematurebeat /ekstrasistolik

Takikardiaritmia

VentrikelTakikardi
100250x/mnt

VentrikelFibrilasi
>350x/mnt

Torsadedepointes

ManagementofMalignant Ventriculararrhythmia
Pharmacological
ClassI ClassIII ClassII,Betablocker

Nonpharmacological
Surgicalarrhythmias Catheterablation Device:AICD

Bradycardia
GangguanAVnode
Derajatsatu Derajatdua Derajattiga

GangguanSAnode
SAblock SAarrest

Interventrikelblok:Bundlebranchblock Fasicularblock

GangguanSAnode

First-degree AV block Rhythm : Regular Rate : Usually normal P wave : 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 over 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

ThirddegreeAVblock

RBBB,1stdegreeAVBLOCK,LPHB

RBBB,1stdegreeAVB,LPHB,MCI

ACUTMCI

Kesimpulan
EKGpemeriksaanyangsangat sederhana,sangatmobile,segera didapatkanhasildansangatbermanfaatdi bidangkardiologi EKGhanyasebagaialatbantudiagnosis Sebagianbesararitmiadapatdidiagnosis berdasarkanEKG Semuadokterumumseyogyanya menguasaiEKG

T H

Y O

VES

VESRonT

VT

VF

Torsadedepointes

Ventricularfibrillation

GangguanSAnode

BlokAVderajat1

BlokAVderajat2

BlokAVderajat3