Elektrokardiografi & aritmia

8/18/2019 Elektrokardiografi & aritmia

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Elektrokardiograf

Pro. dr. Peter Kabo


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1. Irama : Sinus

Bukan Sinus Atrial Fibrilasi

SVT

Irama JUNSION60-100 x/mnit !n"rmal#

$. %a&u '(S : )(*

(+ularitas

,. Aksis: N"rmal

(A/%A

Suri"r Aksis

. Intral ( : 0.$0 tik !N"rmal#

2. 3"r4"l"+i

a. 5l"mban+ : N"rmal .ulm"nal .3itral

b. "mlks '(S : ' at"l"+is

(S( attrn 7i V18V$

Intral-'(S !0.09 7tik#

. S+mn ST : ST-lasi; ST-7rsi

7. 5l.T : Flat-T; Inrt7-T; tall-T


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PA interval : 0.01-0.45 detik

P dur : 0.06 ± 0.2 detik

Max : 0.1 detik

AH interval : 0.05-0.13 detik

PR-interval : ± 0.2 detik

Max : 0.24 detik

HV interval : 0.03-0.05 detik

PRS dur : ± 0.0 detik

Max : 0.1 detik


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6.! x 20 " 134x#$enit

300 : 5. " 52x#$enit

3.3 x 50 " 165x#$enit


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%a$&ar 3.2. Per'itun(an ak)i)

A. Ak)i) *+r$al : ,ead : " 4.5/ lead aV : 12.5/ ak)i) " !2

. evia)i ak)i) ke kanan : ,ead " -10/ lead aV : / ak)i) " 140

. evia)i ak)i) ke kiri : ,ead " 5/ lead aV : -10/ ak)i) " - 60


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?tim : Atrial ;i&rilati+n

Atrial ;lutter

,. isturban "4 AV &unti"n r>?tim :Su8raventriular ta'ardia

. r-xitati"n s?n7r"m :7+e;; < Parkin)+n < 7'ite )ndr+$e 9S-=ave

2. isturban "4 ntriular r>?tim :

Ventriular extra ))t+le

Ventriular ta'ardia>6. )art Bl"k :1 + H

2 + H : - 7enke&a' 9 M+&it) t8e

- M+&it? t8e

3 + H 9t+tal AV &l+k : - @e$8+rar 8ae-$aker

- Per$anent 8ae-$aker

R# : - Si$8at+$i$etik : 8'edrin

- Anti '+liner(i: Atr+8ine


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Beni) Arit$iaBeni) Arit$ia

C Sinu) takikardi#)inu) &radikardiSinu) takikardi#)inu) &radikardi

C Ventiular -#Atrial < extra))t+leVentiular -#Atrial < extra))t+le

C Su8ra-ventriular ta'ardiaSu8ra-ventriular ta'ardiaC Ventriular ta'ardiaVentriular ta'ardia

C Atrial ;i&rillati+n Atrial ;i&rillati+n

C l+kl+k


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P'a)e) +; ati+n 8+tential +;P'a)e) +; ati+n 8+tential +;

ardia ell)ardia ell)

C Phase 0 Phase 0 ra8id de8+lari)ati+nra8id de8+lari)ati+n

9in;l+= +; *a9in;l+= +; *a.:.:

C Phase 1Phase 1 8artial re8+lari)ati+n8artial re8+lari)ati+n

9in=ard *a9in=ard *a.. urrent deativatedDurrent deativatedD

+ut;l+= +; E+ut;l+= +; E..

C Phase 2 Phase 2 8lateau 9)l+= in=ard8lateau 9)l+= in=ardaliu$ urrentaliu$ urrent

C Phase 3Phase 3 re8+lari)ati+n 9aliu$re8+lari)ati+n 9aliu$

urrent inativate)D Eurrent inativate)D E.. +ut;l+=+ut;l+=

C Phase 4Phase 4 8ae$aker 8+tential8ae$aker 8+tential

9Sl+= *a9Sl+= *a..

in;l+=D )l+=in( +; Ein;l+=D )l+=in( +; E..

+ut;l+= Faut+r't'$iit>+ut;l+= Faut+r't'$iit>

C Refractory period Refractory period 98'a)e) 1-398'a)e) 1-3

Phase 4

Phase 0

Phase 1

Phase 2

Phase 3

0 mV

-80mV II

IIII

IV


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Sinu) r't'$Sinu) r't'$

C Sin+atrial n+de i) ardiaSin+atrial n+de i) ardia8ae$aker 8ae$aker

C *+r$al )inu) r't'$ 60-*+r$al )inu) r't'$ 60-100 &eat)#$in100 &eat)#$in

C e8+lari)ati+n tri((er)e8+lari)ati+n tri((er)de8+lari)ati+n +; atrialde8+lari)ati+n +; atrial$+ardiu$ 9F;+re)t ;ire>$+ardiu$ 9F;+re)t ;ire>

C +ndut) $+re )l+=l+ndut) $+re )l+=lt'r+u(' AV n+det'r+u(' AV n+de

C +ndut) ra8idl t'r+u('+ndut) ra8idl t'r+u('Hi) &undle) and PurkinGeHi) &undle) and PurkinGe;i&re);i&re)


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%%

C Re+rdin( +; eletrial ativit +; t'e 'eartRe+rdin( +; eletrial ativit +; t'e 'eart

C *et )u$ +; de8+lari)ati+n and re8+lari)ati+n*et )u$ +; de8+lari)ati+n and re8+lari)ati+n

8+tential) +; all $+ardial ell)8+tential) +; all $+ardial ell)

C P-IRS-@ 8atternP-IRS-@ 8atternC P - atrial de8+lari)ati+nP - atrial de8+lari)ati+n

C IRS - ventriular de8+lari)ati+nIRS - ventriular de8+lari)ati+n

C @ - ventriular re8+lari)ati+n@ - ventriular re8+lari)ati+n


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M ' i ; di A ' i


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Me'ani)$) +; ardia Arr't$ia)1. @n>an7 Aut"matiit? : Sinu) ta'ardia

$. Tri++r7 Aut"matiit? : Multi;+al atrial ta'ardia. VS V@. @+r)ade de 8+inte)

la?7 a4tr 7"lariCati"n

@arl? a4tr 7"lariCati"n

,. (ntr?

Atrial ;i&rillati+n 9A

Atrial lutter

Su8raventriular ta'ardia 9SV@

Ventriular ta'ardia 9V@

7+e;;-Parkin)+n-7'ite Sndr+$e

. Bl"k

1+ AV &l+k

2+ AV &l+k

3+ AV &l+k 9@+tal AV l+k


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PV 9SVPV 9SV

• Bigeminism


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• Polymorphic

PV 9SVPV 9SV


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• Triplet

PV 9SVPV 9SV


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PV 9SVPV 9SV

• Ischemic• Ventricle irritation

http://www.emedu.or


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(@SUSITASI A(IO - U%3ONA%


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3>anisms "4 Antiarr>?tmi ru+ Ati"n

erea)ed P'a)e 4 Sl+8e -&l+ker

nrea)ed @'re)'+ld

*a 'annel&l+ker

a 'annel&l+ker

nrea)ed Max-dia)t+li8+tential

Aden+)ine

Aetl'+line

nrea)ed ati+n 8+tentialdurati+n

E 'annel&l+ker


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Antiarr>?tmi 7ru+s an aus

arr>?tmias

S"m arrt>?t>mias s>"ul7 n"t b trat7


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RJ%S *A@K*S AVRS @S

Iuinidine

Pr+a$a$ide

i)+8ra$ide

,id+aine

Pr+8a;en+ne A$i+dar+ne

S+tal+l

A

VS

VS

VSDV@

VSDV@DADSV@VSDV@DADSV@

V@DVS

in'r+ni)$D ,+n( I@)ndr+$eD H8+ten)i+nD

iarr'ea#He8atiti)D@'r+$&+t+8enia

H8+ten)i+nD *au)eaD ,u8u)

9- $i+tr+8iD Anti '+liner(i :dr $+ut'

+n)ti8ati+nD urine retenti+nD

%lauk+$a attak

H8+ten)i+nD n)ta($u)DSei?ure

H8+ten)i+nD He8ati

di);unti+nD Pul$+nar ;i&r+)i)DH8+#H8er t'r+idi)$D +rnea$ir+de8+)it

Heart ;ailureD radardia


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Seri+u) )i(n +r )$8t+$)

8re8are ;+r i$$ediate

ardi+ver)i+n

@a'ardia

Sta&le

Atrial ;i&rillati+n

Atrial ;lutter

*arr+=-+$8lex

ta'ardia)Sta&le $+n+$+r8'i

V@ +r P+l$+r8'i V@

Jn)ta&le


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; A 4 '+ur) durati+n : u)e anti arrit'$i a(ent) =it' extre$e

auti+n 8atient) n+t reeivin( adeQuate anti +a(ulati+n &eau)e +;

8+))i&le e$&+li +$8liati+n.

elaed ardi+ver)i+n :

Anti +a(ulati+n 3 =eek) ardi+ver)i+n anti +a(ulati+n 4 =eek)

K*@RK, RA@ K*VR@ RH@M

*+r$al ardia Vera8a$il

unti+n -l+ker

$8aired Heart i(+xin

9 O 40L +r H

A$i+dar+ne

Pr+8a;en+ne

Sul;a) Quinidine

ardi+ver)i+n

A@RA, R,,A@K* # ,J@@R


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RR

• Preoperative: Normal (!"#$ %V&

• New %BBB' poor %V myocardial protection (imperect retrograde

cardioplegia#' incomplete revasculari)ation to %*+' Technical pro,lem with grat (-in$ Twist# to %*+' +ir em,olism in the %*+ ostium ( valve surgery#' 0esion to conduction tissues (tricuspid# http://www.emedu.or


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• Beta ,locers• 1re2uent in elderly

• +V node (valve surgery$ 3I#

11)t)t e(ree AV &l+ke(ree AV &l+k

http://www.emedu.or


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22ndnd e(ree AV &l+k t8e 2e(ree AV &l+k t8e 2

' 0esion to conduction tissues (+V%$ 3V%$ TV%#

http://www.emedu.or


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33rdrd e(ree AV &l+ke(ree AV &l+k

' 0esion to conduction tissues (+V%$ 3V%$ TV%#

http://www.emedu.or

http://www.emedu.org/ecg/images/ans/23rd_1a.jpg


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radiardradiard

Heart l+k1. Atr+8ine 9.V.

2. @e$8+rar Pae$aker

3. Per$anent Pae$aker

Sinu) radiard1.8'edrine

2.A$in+8'line

3.Atr+8ine 9.V.


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Per$anent Pae$aker Per$anent Pae$aker


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Elektrokardiografi & aritmia