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8/19/2019 4 Pathofisiologi Palpitation.4.1
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© 2012 Pearson Education, Inc.
PathophyisioloPalpitation
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Capaian Pembelajaran
1. Mahasiswa mampu menjelaskan irama dan frekuensi de
jantung yang normal dan tidak normal2. Mahasiswa mampu menjelaskan macam-macam gangg
irama dan frekuensi denyut jantung
3. Mahasiswa mampu menjelaskan etiologi dada berdebar
debar
4. Mahasiswa mampu menjelaskan patofisiologi dada
berdebar-debar
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!"#$%"&! "'()*"#%'( +,&
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+engaturan %rama /antung
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+engaturan %rama /antung
• +usat0
• Medulla 'blongata0 cardioacceleratory center cardioinhibitorycenter
• &fferen0 hipotalamus baroreseptor kemoreseptor resep
regang atrial
• Mekanisme0
• (eural
• #onus simpatis
• #onus parasimpatis
• $efleks atrial
• ,ormonal
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+arasympathetic ympathetic
• parasympathetic
• inhibits & node depolarisation & conduction• Muscarinic receptor
• ympathetic
• &ccelerate & node depolarisation
• #erutama 51 reseptor
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Palpitation
• is a common unpleasant and often alarming awareness
heartbeats.• %s sensations of a rapid or irregular heartbeat6are most
caused by cardiac arrhythmias or an7iety.
• %t may result from0
• increased conscious perception of the normal cardiac rhythm
• any cardiac arrhythmia producing changes in heart rate rhythm
contraction pattern
• may be reported as a skipping pounding fluttering or similar sen
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#ypes of palpitations and their clinical presentations
Type of
palpitation
Subjective
description Heartbeat
Onset and
termination Trigger situat
7trasystolic8kipping9missing abeat8
%rregular interspersedwith periods of normalheartbeat
udden $est
#achycardiac8:eating wings8 in thechest
$egular or irregularmarkedly accelerated
udden+hysical effortcooling down
&n7iety-related &n7iety agitation$egular slightlyaccelerated
;radualtress &n7ietyattacks
+ulsation ,eart pounding$egular normalfre
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tiology
• "ardiac
• "onducting system disorders0 cardiac arrhythmia
• ") = ",)9%,) M% ",> $,) etc.?• "ardiac anatomic defect
• aortic or mitral regurgitation patent ductus arteriosus and septal d
• 7tra cardiac
• &n7iety
• orthostatic hypotension0 sense palpitations caused by sinus tachon standing.
• hyperkinetic circulatory states
• anemia fe@er
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tiology
• 7tra cardiac
• lectrolyte imbalances
• eg hypokalemia hypocalcemia and hypomagnesemia• )rug9 substance
• ympathomimetic0 "hatecholamin betha agonist caffein pseudo
pheniphenylpropanolamine
• illicit drugs0 methamphetamine or cocaine
• )rug to7icity0 antiarrhythmic agents cardiac glycosides
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Mechanism
• sensory mechanisms responsible for palpitation are unk
• %n general palpitations reflect changes in0• cardiac rate rhythm or both
• changes in contractility and9or @entricular contraction pattern.
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cardiac arrhythmia
• :radycardias
• #achycardias
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:radycardias
• sinus bradycardia= normal A; pattern? BCD :+M
• sinoatrial heart block• atrio@enticular heart block = &-123 degrees?
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#achycardias
• sinus tachycardia = E1DD per minute?
• atrial tachycardia = E1FD-2DD per minute?• atrial flutter = E22D-3CD per minute?
• atrial fibrillation = E4DD-CFD per minute?
• @entricular tachycardia or @entricular fibrillation =>? = 3 o
more at E1DD per minute?
• paro7ysmal supra@entricular tachycardia
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Alarm
paro7ysmal supra@entricular tachycardia
Myocardial scarring
electrical reentrant circuits
'ld myocardial infarction
+aro7ysmal upra@entricular #achycardia
Palpitation
hyperthyroidism
polyuria
Gatrial natriuretic peptide =&(and Harginine @asopressin =&
timulants0
caffeine drugs alcohol
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Alarm
#
Myocardial scarring
electrical reentrant circuits
'ld myocardial infarction
entricular #achycardia
Palpitation
myocardial %schemic or infarction
"ardiac &rrest
death
hemodynamic collapse
ymphatic acti@ity
uddent death
opens A + channels
acidosis
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ffect of palpitation
• $elated to underlying problem0
•+olyuria may follow paro7ysmal supra@entricular tachycardia
• yncope following an episode sinus node dysfunction with o@er
suppression of normal pacemaker function after a bout of atrial
tachyarrhythmia.
• +alpitations immediately preceding syncope are classic sympto
sick sinus syndrome.
• hemodynamic collapse
• "ardiac &rrest
• uddent death0 >
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$eference
I !u eh / !ee ,ung / u ). 1LJ. Mechan
of polyuria and natriuresis associated with paro7ysmal supra@entricular tachycardia. /pn,eart /. 1LJ MarK2=2?02D3-L.
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