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Aritmia dan Kegawatan Jantung
Zulfikri MukhtarZulfikri MukhtarDepartemen Kardiologi dan Kedokteran Vaskuler Departemen Kardiologi dan Kedokteran Vaskuler
Fakultas Kedokteran USU Fakultas Kedokteran USU MedanMedan
Arrhythmia.
Definition : Lack of rhythm or abnormal rhythm.
- Frequency ( bradycardia or tachycardia)
(Normal sinus rhythm 60 – 100 x /min.)- Irregularity- Source of impuls- Sequence of activation
Precipitating factors
Underlying cardiac disease- Ischemic heart disease- Valvular heart disease- Hypertensive heart disease- Congenital heart disease- Pre excitation (short of PR interval)- Long QT (congenital or acquired)
Precipitating factors
Drugs- anti-arrhytmia- sympathomimetic.- B2 agonis, cocaine, anti depresants
(tricyclic), Aminophylline, caffeine.
- alcohol.
Precipitating factors
Metabolic abnormalities.- Electrolyte (low K, Na, Ca, Mg )- Hypoximia, Hypercarbia. - Acidosis
0 Endocrine abnormalities
-Thyrotoxicosis, Phaeochrocytoma.
Precipitating factors
Miscellaneous.- Febrile illness- Emotional stress- Smoking- Fatigue.
Investigation for arrhytmias1. 12 lead ECG and rhythm strip.
2. Blood test : routine blood, electrolyte , glucose, cardiac enzyme, thyroid level,
drug level (digoxin), arterial blood gas.
3. Chest x ray : heart size , pulmonary edema, lung cancer, pericardial effusion.
I. Sebutkan iramanya :Normal Sinus Rhythm
EKG
The Heartbeat.Electromechanical association
II. MENGHITUNG DENYUT JANTUNG :
PJK
SCHEMIA : ST depresi atau T inverted
INFARCT : ST Elevasi
NECROSIS (OLD INFARCT) :
gel. Q patologis atau QSI
Early Repolarisasi
RBBB
Acute Anterior MI
Acute Inferoposterior MI
Arrhytmia
Tachyarrhythmia (rate >100 x/min)
Bradyarrhytmia(rate < 60 X/min)
• QRS sempit (<0.12 ms)• QRS lebar (>0.12 ms)
• AV blok derajat 1, 2 & 3• RBBB & LBBB
Diagnostic Tachyarrhytmia
Lebar gel. QRS
Keteraturan gel. QRS
P wave ??
QRS complex Teratur / tidak teratur ?
QRS complexSempit / lebar ?
P wave ?
Hubungan antara P and QRS ?
QRS sempit : Supraventricular origin
QRS Lebar : Ventricular origin
QRS lebar
Irama TeraturIrama
tidak teratur
Ventricular Tachycardia
Ventricular Fibrillation
VES (Ventricular extrasystole)- VPB (ventricular prematur beat)- begemini -bifocal.
VES couplet
VT-ventricular tachycardia
AF-atrial fibrillation, course P wave , RR interval irregular
SVTRR interval regular, P or T wave not identified
AF rapid
VT , wide qrs , fixed axis
VF, ventricular fibrillation, changed axis
VT
VT
VF
Torsade de Pointes
Bradyarrhytmia(rate < 60 x/min)
Failure of impulse formation
Sinus Bradycardia Sick Sinus Syndrome
AV conduction abnormalities
1st and 2nd AV Block Total AV Block BBB (Bundle Branch
Block)
Sick Sinus Syndrome
LBBBLBBB
Treatment
Atrial Fibrillation.- Rate control :
1. Digoxin.
Digitalization dose : 0,03 x BW (Kg)
Maintenance dose : 0,125 – 0,25 mg /day, depends on – renal function.
Route :oral tablet 0,25 mg or
Injection ampule 0,5 mg
The Deadly
Rhythms
VT VFPEA
(Pulse less ElectricalActivity)
A systoleVF
2. Beta blocker
- Propranolol- Metoprolol- Atenolol- Bisoplrolol- Carvedilol
2. Rhythm control Main purpose is conversion to sinus rhythm.
Amiodaron
Tablet : 200 mg.
Injection : 150 mg
Loading dose : 3 x 200 mg ( 5 days)
Maintenance dose : 100 – 200 mg / day.
Contraindication : Thyroid and Lung (fibrotic) dysfunction.
SVT-supraventricular Tachycardia
1. ADP injection ( 8 mg – 20 mg )
2. Verapamil injection ( 2,5 – 10 mg)
3. Amiodaron injection.
Loading dose : 300 mg / 250 cc in 30 – 60 minutes.
Maintenance dose : 450 – 600 mg /day
4. Cardioversion : DC shock synchronize
5. Ablation : radiofrequency or laser.
VES.
Amiodaron
oral or injection : depends on benign or malignant extrasystole.
VT
Amiodaron : if patients hemodynamic: good (conscious, BP )
DC shock synchronize : if instability hemodynamic.
100 – 300 Joule.
VF – ventricular fibrillation.
DC shock asynchronized
300- 350 joule.
ICD – intracardiac defibrillation.
EMD-electromechanical dissociation.