Aritmia Dan Bradiaritmia 5i5v5v

Departemen Kardiologi FK USU RSUP. H. Adam Malik Medan

SA node Sumber impuls normal/ alamiah , 60 – 100

AV node Bisa mengeluarkan impuls 40-60x/menit

Berkas His Serabut Purkinje

Ventrikel Bisa mengeluarkan impuls 20-40 x/menit

4

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.

Tachyarrhythmia (rate >100 x/min)

Bradyarrhytmia (rate < 60 X/min)

• QRS sempit (<0.12 ms)

• AV blok derajat 1, 2 & 3

• QRS lebar (>0.12 ms)

• RBBB & LBBB

 -

-

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)

Drugs - anti-arrhytmia - sympathomimetic. - B2 agonis, cocaine, anti depresants (tricyclic), Aminophylline, caffeine. - alcohol. 

Metabolic abnormalities. - Electrolyte (low  K, Na, Ca, Mg ) - Hypoximia, Hypercarbia. - Acidosis 0 Endocrine abnormalities -Thyrotoxicosis, Phaeochrocytoma. 

 -

-

Miscellaneous. Febrile illness Emotional stress Smoking Fatigue.

Symptoms Palpitations: nontachycardiac; rapid and regular; rapid and irregular (regularly irregular or irregularly irregular). Abrupt or accelerating onset and termination? Dyspnea

Chest discomfort Syncope; “nearly blacked out”; syncope with spell

Polyuria Cardiac arrest

Signs Heart rate and pulses: regularity; amplitude; deficit Hypotension Hypoperfusion

Failure of impulse formation  Sinus Bradycardia  Sick Sinus Syndrome

AV conduction abnormalities  1st and 2nd AV Block  Total AV Block  BBB (Bundle Branch Block)

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

First-degree AV block Rhythm : Regular Rate : Usually normal P wave : Sinus P wave present; one P wave to each QRS PR : Prolonged ( greater than 0.20 seconds ) QRS : Normal

Second -degree AV block, Mobitz I Rhythm : Irregular Rate : Usually slow but can be normal P wave : Sinus P wave present; some not followed by QRS complexes PR : Progressively lengthens QRS : Normal

Second-degree AV block, Mobitz II Rhythm : Regular usually; can be irreguler if conduction ratios vary Rate : Usually slow P wave : Two, three, or four P waves before each QRS PR : PR interval of beat with QRS is constant; PR interval may be normal or prolonged QRS : Normal if block in His bundle; wide if block involves bundle branches

Third-degree AV block Rhythm : Regular Rate : 40 – 60 if block in His bundle; 30 – 40 if block involves bundle branches P wave : Sinus P wave present; bear no relationship to QRS; can be found hidden in QRS complexes and T waves PR : Varies greatly QRS : Normal if block in His bundle; wide if block involves bundle branches

   

Inj Sulfas Atropin/SA 0,5 mg IV Dopamin drips Temporary Pace Maker/TPM Permanent Pace Maker/PPM pada kasus2 bradiaritmia yang berat