CRITICAL ARRYHTHMIA

(1)

Sanggap Indra Sitompul

RSUD dr. DORIS SYLVANUS/FK UPR
PALANGKARAYA

1
 TUJUAN

MAMPU:
• Mengidentifikasi kelainan aritmia kritikal
pada EKG
• Memberikan penanganan awal di UGD

2
 EKG Kritikal
Aritmia:
• Bradikardia  HR < 40bpm
• Takikardia  HR > 120bpm

3
Sistem Konduksi Jantung (SKJ)t
Sifat-sifat :
–Automaticity
–Rhythmicity
–Conductivity

SA NODE : 60 - 100 x/m

AV NODE : 40 – 60 x/m

PURKINYE : 20 – 40 x/m

4
 Mekanisme Aritmia
1. Mekanisme takikardi :
1.1.Re-entry  paling sering
1.2. Accelerated automaticity.
1.3. Triggered activity
2. Mekanisme bradikardi:
2.1. AV block: Konduksi abnormal AV node atau
distal AV node
2.2. Sinus bradikardi : automatisasi lambat 5
 Supraventricular dan Ventricular

QRS <120 sec 6

QRS ≥120 sec
 1. Sinus
ARITMIA Takikardi
Reguler •AVNRT
•AVRT
Narrow QRS 2. SVT
•AT
(<0,12 sec)
•JT
3. AF
Ireguler 4. A. Flutter
Takikardia 5. MAT

6. VT
Reguler
7. SVT + aberancy
Wide QRS 8. SVT +preeksitasi (WPW)
(≥0,12 sec)
9. Torsades de Pointes
12. Disfungsi Ireguler 10. AF + aberancy
Bradikardia sinus 11. AF + preeksitasi (WPW)
7
13. AV block
 1. Sinus Biasanya HR < 150
ARITMIA Takikardi Gel P diikuti QRS
Reguler

Narrow QRS
(<0,12 sec)

Takikardia

8
 EKG NORMAL
Irama Sinus Normal

9
 1. Sinus Tachycardia
Penyebab: sepsis, hipovolemia, anemia, emboli pulmonal,
nyeri, takut, aktifitas, iskemi miokard, hipertiroid, heart failure

10
ARITMIA
Reguler •AVNRT
•AVRT
Narrow QRS 2. SVT
•AT
(<0,12 sec)
•JT

Takikardia

11
 2. SVT
• AVNRT
• AVRT
• Atrial tachycardia
• Junctional Tachycardia

• 90% reentry ; 10 % bukan reentry

• 60% AV nodal reentry tachycardia (AVNRT)
• 30% AVRT orthodromic
• 10% Atrial tachycardia
• 2 to 5% melibatkan WPW syndrome
12
 AV Nodal Reentrant Tachycardia
(AVNRT)
Rate 150-250 x/menit

Gel P
diteruskan
secara
retrograde
(AV node
 atria) dan
berada pada
akhir QRS

13
 Retrograde P wave Pseudo-r’ in V1 + Pseudo S in II,III, aVF

After adenosine. Note the difference (no “pseudo-r’ “ or “pseudo S”)

14
 AVRT Orthodromic
Atria
Rate 150-250
AP beats per min

AVN

Ventricles
Retrograde P’s fall
in the ST segment
with fixed, short RP

15
Atrial Tachycardia

16
Junctional Tachycardia

17
ARITMIA
Narrow QRS
(<0,12 sec)
3. AF
Ireguler 4. A. Flutter
Takikardia 5. MAT

18
 Atrial fibrillation 6%
± 1/3 total aritmia PSVT
6%
PVCs 18%
Unspecified
4%
Atrial
Flutter

9% 34%
SSS Atrial
Fibrillation

8%
Conduction
Disease
10% VT
3% SCD

2% VF
Data source: Baily D. J Am Coll Cardiol. 1992;19(3):41A.
19
Chaotic, rapid
atrial rate at
400-600
beats per min 3. A-Fib (AF)
Rhythm: irregularly irregular. (hallmark )

20
Reentrant
mechanism
4. A - Flutter

21
5. Multifocal Atrial Tachycardia (MAT)
(Rapid Wandering Pacemaker)
• Similar to wandering pacemaker (< 100)
• MAT rate is >100
• Usually due to pulmonary issue
• COPD
• Hypoxia, acidotic, intoxicated, etc.

22
ARITMIA

Takikardia

6. VT
Reguler
7. SVT + aberancy
Wide QRS 8. SVT +preeksitasi (WPW)
(≥0,12 sec)

23
 Wide QRS Tachycardias
• Ventricular Tachycardia
• SVT + aberrancy
• SVT + pre-excitation (WPW)

In patients with IHD….….

90% of broad complex
tachycardias will be
ventricular in origin

24
AV dissociation 6. VT

Capture beat

Fusion beat

25
VT (Monomorphic)

26
27
ARITMIA

Takikardia

Wide QRS
(≥0,12 sec)
9. Torsades de Pointes
Ireguler 10. AF + aberancy
11. AF + preeksitasi (WPW)
28
 9. Torsades de Pointes (VT Polymorphic)

Note the
“twisting of the points”

This rhythm pattern

looks like
ribbon in it’s fluctuations
29
R on T PVC’s

30
 1. Sinus Takikardi gel P(+)
umumnya HR<150
Reguler

Narrow QRS 2. SVT  gel P (-)/ tdk jelas

Umumnya HR>150
(<0,12 sec)
3. AF gel P tidak jelas (fibrilasi)
Ireguler 4. A. Flutter gel P spt gergaji
Takikardia 5. MAT gel P tidak sama

Reguler 6. VT  90%, rw PJK, HF

7. SVT + aberancy
Wide QRS 8. SVT +preeksitasi (WPW)
(≥0,12 sec)
9. Torsades de Pointes
Ireguler ribbon fluctuation
10. AF + aberancy
11. AF + preeksitasi (WPW)
32
33
34
35
36
37
38
39
40
41
42
43
44