MODULE 6

SKENARIO 6 : MR. AFILS HEART Mr. Afil 50 years old, came to the clinic with dizziness and heart thumping since yesterday. Complaints pounding have felt since 4 month ago, but did not interfere mr. Afils daily activities. From the physical examination the doctor finds, , blood pressure 150/100 mmHg, pulse 120 x / min irregular, and 22 breaths / min. Lung examination result is normal limits, and the cardiac discovered HR 160x/min,irregular, murmur sound hard to assessed. From ECG examination was found Atrial Fibrillation with rapid ventricular response. Dokter sent mr. Afil to the hospital. In the hospital mr. Afil hospitalized in CVCU and installed monitoring, infusion, and oxygen. A minute later mr. Afil then asleep and suddenly awakened by the cries of the patients family beside him. Actually, the patient beside him newly enrolled patients died of cardiac arrest, and sent to the forensics to undergo an autopsy as the request of lawyer enforcement. How do you explain what happened to mr. Afil and the patient beside him?

TERMINOLOGY Atrial fibrillation : a chaotic rhythm with an atrial rate so fast (350 to 600 discharges / min) that distinct P waves are not discernible on the ECG.

Rapid ventricular respons : uncontrolled increase of ventricular responses with ventricular rate more than 100 discharges / min
Cardiac arrest : an emergency situation with there is no contraction from the left ventricular Otopsi : death examination to examinate the causes of death.

DEFINE THE PROBLEM 1. Why is mr. Afil feel dizziness and chest thumping since yesterday? 2. Why on the physical examination found irregular pulse of 120 beats per minute, and the cardiac examination found heart rate 100beats / minute, irregular? 3. How the interpretation of the results of physical examination and ECG? 4. Describing the results of ECG in atrial fibrillation? 5. Why is the atrial fibrillation found in mr.Afil? 6. Why mr.Afil installed monitoring, infusion and oxygen? 7. Why the patient beside mr. Afil get cardiac arrest? 8. Why the patient was taken to the forensic autopsy for? 9. What kind of examination is being done at autopsy? 10. Is there any relationship between atrial fibrillation and cardiac arrest?

PROBLEMS SOLVING 1. is mr. Afil feel dizziness and chest thumping since yesterday? Chest thumping is the clinical manifestations of cardiac abnormalities, as compensation for increasing the cardiac output Onset since 4 months ago: chronic. 2. Why on the physical examination found irregular pulse of 120 beats per minute, and the cardiac examination found heart rate 100beats / minute, irregular? Heart rate reflects the pulse. Cardiac arrhythmias failed trigger impulses in peripheral pulse naid heart rate> pulse.

3. How the interpretation of the results of physical examination and ECG? TD 150/100 mmHg Hipertensi grade II Nadi tachycardia Breath fast normal lung examination Hr 160x/mnt irregular tachyarrhythmia Murmur sound hard to assess because of high heart rate. 4. Describing the results of ECG in atrial fibrillation? - There is no regular- R wave interval - Do not preceded P wave - The rate of fast waves, irregular.

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Why is the atrial fibrillation found in mr.Afil? Pathophysiology of atrial fibrillation: - Elongation of heart muscle fibers, for example in ventricular dilatation - Decrease the speed of impulse delivery, for example in the provision of antiarrhythmics, epinephrine, etc. - Shortening the refractory period, for example in muscle ischemia, or increased potassium in the blood. Why mr.Afil installed monitoring, infusion and oxygen? Rapid ventricular response monitored by usg infusion to balance the levels of ion oxygen to cover the dyspnea

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Why the patient beside mr. Afil get cardiac arrest? The cause of cardiac arrest: - Impaired conduction, e.g Coronary heart disease - Slowing the heart rate in certain circumstances such as hepatomegaly, intoxication, etc. - Ventricular Tachycardia Signs of cardiac arrest: There is no response, abnormal breathing, no pulse in large arteries. Why the patient was taken to the forensic autopsy for? Autopsy purposes: - Performed in cases of sudden death - For insurance purposes - To rule out the possibility of criminal

9. What kind of examination is being done at autopsy? External examination; from head-foot, notice if there are signs of injury Examination: vital organs Histopathology: to determine the etiology of certainty Toxicology tests; hair, nails 10. Is there any relationship between atrial fibrillation and cardiac arrest? Atrial fibrillation can lead to cardiac arrest.

 LEARNING OBJECTIVES 1. Student are able to explain the Epidemiology and classification of arrhythmia 2. Student are able to explain the Etiology and predisposition factors of arrhythmia 3. Student are able to explain the Pathophysiology and clinical manifestation of arrhythmia 4. Student are able to explain the Diagnose and examination of arrhythmia 5. Student are able to explain the Theraphy of arrhythmia 6. Student are able to explain the complication of arrhythmia 7. Student are able to explain the Prognose of arrhythmia 8. Student are able to explain about Medica legal ardiac death