ARITMIA

Faisal Sommeng
FK – UMI
RS. Ibnu Sina Makassar
 ANATOMI JANTUNG

 Keterangan Gambar:
1. Right coronary 9. atrium kanan 17. katup pulmonaris
2. Left anterior 10. ventrikel kanan
3. Left circumflex 11. atrium kiri
4. vena cava superior 12. ventrikel kiri
5. vena cava inferior 13. muskulus papillaris
6. aorta 14. chorda tendinae
7. arteri pulmonalis 15. katup trikuspidalis
8. vena pulmonalis 16. katup mitralis
SA node
Sumber impuls normal/
alamiah , 60 – 100 / menit

AV node
Bisa mengeluarkan
impuls 40-50x/menit

Berkas His
Serabut Purkinje

Ventrikel
Bisa mengeluarkan impuls
30 x/menit
Atrial Depolarization
Ventricle
Depolarization

0.12 second
Terminologi morfologi QRS
R
qRs Rs rS

QR Q/QS rSr’
RsR’
 5 kotak kecil
= 1 kotak sedang
= 0.2 detik Paper speed : 25 mm/second
1 kotak kecil
= 0.04 detik

5 kotak sedang
= 1 kotak besar
= 1 detik
MENGHITUNG LAJU JANTUNG :
A. Jarak R – R :

-1 kotak sedang = 300 x / menit

-2 kotak sedang = 150 x / menit
-3 kotak sedang = 100 x / menit
-4 kotak sedang = 75 x / menit
-5kotak sedang = 60 x / menit
-6 kotak sedang = 50 x / menit

B. Hitung jumlah R- R dalam 6 kotak besar = 6 detik

Jumlah R x 10 = heart rate / menit

C. 1500 / jarak R-R ( dlm mm ) = heart rate / menit

Aritmia
Aritmia
CAUSE OF CARDIAC ARRHYTHMIAS :

• Disturbances in automaticity : bertambah cepat

atau bertambah lambatnya suatu daerah otomatisitas.
Misal di sinus node, AV node, abnormal beats/
depolarisasi atrium, AV junction, ventrikel, VT, dll.

• Disturbances in conduction : konduksi terlalu cepat

(WPW) atau terlalu lambat (blok AV).

• Combinations of altered automaticity and conduction.

Pacemeker Cells
How to identify arrhythmias ?
 QRS complex
Regular / irregular ?

QRS complex
Normal-looking QRS complex?
Wide / narrow ?

P wave ?

Relationship between P and QRS ?

Bagaimana cara membaca irama EKG?
NORMAL SINUS RHYTHM
Taki-Aritmia
Takikardia
PSVT :
-due to re-entry mechanism
-narrow QRS complex
-regular
-retrograde atrial depolarization
-P wave ?
PSVT
Atrial Fibrillation :

-from multiple area of re-entry within atria

-or from multiple ectopic foci
-irregular, narrow QRS complex
-very rapid atrial electrical activity
(400-700 x/min).
-no uniform atrial depolarization
Atrial Flutter :
-The result of a re-entry circuit within
the atria
-Irregular / regular QRS rate
-Narrow QRS complex
-Rapid P waves (300x/min), “sawtooth”
Junctional rhythm:
-AV junction can function as a pace maker
(40-60 x/min).
-due to the failure of sinus node to initiate
time impulse or conduction problem.
-normal-looking QRS.
-retrograde P wave.
-P wave may preceede, coincide with, or
follow the QRS
 VENTRIKEL EXTRA SYSTOLE

SR

VES
 Sinus rhythm
with
Multifocal VES

VES VES

SR SR
SR SR SR SR
Sinus rhythm with VES couplet
Sinus Rhythm with VES, R on T
Ventricular Tachycardia
Torsade de Pointes
Ventricular Fibrillation
Bradikardia
Bradikardia
 1st degree AV block

Prolonged PR interval
 2nd degree AV block, type 1

Missing QRS Missing QRS

2nd degree AV block, type 2

Missing QRS
 Total AV Block /
3rd degree AV block

QRS QRS QRS

P P P P P P P
Treat the patient,
not the monitor . . . . .!!!

SELESAI