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Dr. Muhammad Asrul Apris A, M.Kes, Sp.

JP, FIHA
PENANGANAN PENCEGAHAN
Pendahuluan : Tatalaksana
- anatomi Komplikasi
- sistem konduksi
- definisi
- klasifikasi
- mekanisme
- diagnosis
- penyebab
ARITMIA
MAU
TAHU

SANTAI
AJA
KALEEE
ANATOMI
Sistem Konduksi Jantung
‘0p
Irama Sinus Normal
Normal Cardiac Rhythm/ Normal Sinus Rhythm (NSR)

Dengan kalibrasi 25 mm/s dan 10 mm/mV


 Gelombang P :
- Setiap 1 gelombang P diikuti 1 kompleks QRS
- P di lead II positif, P di lead aVR negatif
 Interval PR :
- durasi 0,12 – 0,20 detik dan konstan
 Kompleks QRS sempit :
- durasi < 0,10 detik
- di bidang horizontal : gelombang R meningkat dari V1 ke
V6 , sedangkan gelombang S mengecil dari V1 ke V6
 FDJ antara 60-100x/menit, interval R-R teratur (reguler)
ARITMIA
A : tidak
Ritmia : irama
Aritmia : tidak seirama

Definisi :
Aritmia Jantung (Cardiac
arrhythmia) adalah abnormalitas
dari irama jantung
KLASIFIKASI ARITMIA
Sinus node diseases
•Sinus tachycardia/ bradicardia
•SA block
•Wandering pace-maker
•Hypersensitive carotid sinus syndrome
•Sick – sinus – syndrome (sss)

Disturbance of atrial rhythm


•Atrial fibrillation
•Atrial flutter

Disturbance of AV junction rhythm


•Supra ventricular tachycardia

Pre-excitation syndrome
•Wolff – Parkinson – white syndrome (δ – wave)
•LGL syndrome
•Mahaim syndrome

Disturbance of ventricular rhythm


•Ventricluar extra systole (VES)
•Ventricular tachycardia
•Ventrikular fibrilation

Heart block
•SA block
•1st degree HB
•2nd degree HB
•Wenckebach (mobitz type I)
•(mobitz type II)
•3rd degree HB (total AV block)
•Temporary pace-maker
•Permanent pace-maker
MEKANISME ARITMIA

Enhanced automaticity
• Sinus Tachycardia
Triggered automaticity
• Multifocal atrial tachycardia
• VES → VT Torsade de Pointes
Reentry
• Atrial Fibrilation (AF)
• Atrial flutter
• SVT
• VT
Block
• 1st degree AV block
• 2nd degree AV block
• 3rd degree AV block (total AV block)
Enhanced automaticity

Triggered automaticity

Reentry

JALAN RUSAK
BLOCK
CARA
DIAGNOSIS
70 %
Tolong Bu Dokter
Saya lagi sakit
DADA

To…too…tooloool
Eh… Tolong Dok

Eh..eh…aduuh
SAAKIIT
Gejala & Tanda Aritmia

•Palpitation • Jugular venous pulse


•Dizziness
• Arterial pulse
•Syncope/ pre-syncope
•Fatigue • Heart sound
•Dyspnea
•Chest pain
PENYEBAB – PENYEBAB ARITMIA
Ischemic heart disease
•Acute myocardial infarction
•Myocardial ischemic (HHD, LVH, CAD)
•Left ventricular aneurysm
Cardiomyopathy

Valvular heart disease

Myocarditis

Congenital heart diseases

Conduction system abnormality


•Sinus R AV – node disease
•By pass tract
Chronic pulmonary disease
•Hypokalemia

Endocrine
•Thyrotoxicosis

Electrolyte imbalance

Drug – induce
•Sympathomimetic, caffeine

Increase sympathetic/ vagal activity


PENANGANAN
TATALAKSANA
Fase-fase Aksi Potensial Sel Jantung
• Phase 0 rapid depolarisation (inflow
of Na+)
• Phase 1 partial repolarisation (inward
Na+ current deactivated, outflow of Phase 1
K+) IV
Phase 2
• Phase 2 plateau (slow inward calcium 0 mV
current)
• Phase 3 repolarisation (calcium Phase 0 III
I Phase 3
current inactivates, K+ outflow)
• Phase 4 pacemaker potential (Slow
Na+ inflow, slowing of K+ outflow) -80mV Phase 4
‘autorhythmicity’ II
• Refractory period (phases 1-3)
Mekanisme Kerja Obat Antiaritmia
Decreased phase 4 slope
• β blocker

Increased threshold
• Na+ channel blocker
• Ca++ channel blocker

Increased max – diastolic potential


• Adenosine
• Acetylcholine

Increased action potential duration


• K+ channel blocker

Obat-obat anti aritmia dapat memicu aritmia


Terkadang aritmia tidak perlu diobati
Klasifikasi Obat Anti Aritmia
Sodium channel blocker
• Sodium channel (++)
• Diisopyramide, Quinidine, Procainamide
• Blocks K+ Efflux (+)
• Lidocaine, Mexiletine, Tocainide
• Sodium channel (+++)
• Flecainide, Encainide, Propafenone

Anti adrenergic
• β blocker

K+ channel Efflux blockers also Na+ blockers


• Amiodarone
• Sotalol

Ca++ channel blockers


• Verapamil & Diltiazem

Autonomic Effects
• Vagus stimulation
• Digoxin
• Adenosine receptor activation
• Adenosine
Farmakokinetik
O P Dosis Kadar Metab Eks Indikasi Efek samping
puncak
KINIDIN + + 3 X 200 mg 60 – 90’ H G/H AF, SVT
PROKAINAMID + + 3X (250000 – 45 – 70’ H G VES, SVT Lupus like syndrome,
500) mg leukopeni

DIISOPIRAMID + - 3X 100 mg 60 – 120’ H G VES, SVT Mulut kering,


konstipasi,
penglihatan kabur
LIDOKAIN - + 1 MG/ KG bb H VT (pasca miokard hipotensi
=1mg/ jam infark)

PROPAFENON + + 3 x(150 -300) 60 – 180’ VES


mg

Hipotensi / Sinkop
Kardiovaskular
•SA block
•QRS – Interval •AV block
•Long QT •Torsades de Poentes
• ↑ ventrikuler rate (efek
anti kolinergik)

Cinchonism

•Demam
•Tinitus
•Penglihatn kabur
•Diplopia
•Sakit kepala
•Delirium
•Prikosis
•Gangguan GIT
Amiodaron
Farmakokinetik indikasi Efek samping

O P T1/2 Dosis VT, AF Pro aritmik,


Hipotensi, gangguan fungsi: hati, tiroid,
+ + 25 – 60 jam Loading 600 s/d paru & mata
800 mg/ hari
Maintenance
300mg/ hari

Sotalol
Farmakokinetik indikasi Efek samping

O P T1/2 Dosis SVT, VT Gagal jantung

+ - 11 jam 800 s/d 320


mg/hari
Bradikardi
Sinus Bradikardi
1. Ephedrine
2. Aminophyline
3. Atropine (I.V.)

Heart Block
1. Atropine (I.V.)
2. Temporary Pacemaker
3. Permanent Pacemaker
Permanent Pacemaker
KOMPLIKASI
• Hipotensi
• Penurunan kesadaran
• Tanda-tanda syok lainnya
• Nyeri dada iskemik
• Gagal jantung akut
• Tromboemboli
• Aritmia maligna
• Kematian