ARHYTHMIA TACHYCARDIA

pembimbingDr. Setyo Utomo Sp. Jp FIHA

Fahmi Afif Alboneh

PENYEBAB TAKIARITMIAINTRA-CARDIACEXTRA-CARDIAC

IskhemiaPenyakit katub jantungGagal jantungKardiomiopati

Obat-obatanAlkoholStimulan (contoh: caffeine)StressHipertiroidismeInfeksi/ sepsisMetabolik (contoh: Hiperkalemia)

AritmiaGangguan irama jantung berupa segala jenisirama jantung selain IRAMA SINUSSupraventrikularQRS sempit seperti normal(kecuali beberapa hal:BBB, WPW,aberans)VentrikularQRS lebar > 0,12 dt

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

DyspneaChest discomfortSyncope; nearly blacked out; syncope with spellPolyuriaCardiac arrestSignsHeart rate and pulses: regularity; amplitude; deficitHypotensionHypoperfusion

PEMBAGIAN TAKIARITMIA

KOMPLEKS LUASKOMPLEKS SEMPITVentricular TakikardiaTorsades de PointesVentrikel fibrilasi Sinus takikardiaAtrial takikardia Takikardia re-entrant (AVNRT dan AVRT)Atrial fibrillasiAtrial flutter

Atrial fibrillation

Atrial flutter

AVRT AVNRTV TachV FibrillationSNRTATJTTACHYCARDIA

Aritmia SupraventrikularPremature beat/ ekstra sistolikTakikardi aritmiaAtrial FlutterAtrial fibrilasiSupra Ventrikel Takikardi/Paroksismal Atrial Takikardi150 - 250 x/mnt

ARRHYTHMIAS (ATRIAL RHYTHMS)Gambaran premature atrial complex (tanda panah).Gambaran EKG atrial tachycardia/SVT.

SVT

Treatment strategies of SVT:PharmacologicalAcute Tx (Adenosine iv, Verapamil iv)Chronic Tx (Verapamil, Betablocker, Digoxin)Non-pharmacology1980s sharp dissection or cryosurgical modificationHis bundle ablation using DC shockRadiofrequency catheter ablation

Gambaran delta wave pada sindroma WPW Atrial flutter dengan gambaran gigi gergaji.

Wolff-Parkinson-White syndrome

Gambaran fibrilasi atrial dengan rapid ventricular response

Approaches to Treatment of atrial fibrillation

Ventricular rate controlMaintenance of sinus rhythmAnticoagulation (acute and chronic)

Aritmia VentrikularPremature beat/ ekstra sistolikTakikardi aritmiaVentrikel FibrilasiN> 350 x/mnt Ventrikel TakikardiN100-250 x/mnt

VENTRICULAR RHYTHMSGambar A menunjukkan sinus takikardi dengan frequent uniform PVC dan B menunjukkan sinus takikardi dengan multiform PVC.VES

Sinus ritme dengan dua R on T PVCsSinus ritme dengan run VT dan satu episode couplets

Gambaran Ventricular Tachycardia (VT)Gambaran Ventricular Fibrillation (VF)

Torsade de pointes

Management of Malignant Ventricular arrhythmiasPharmacologicalClass IClass IIIClass II, Beta blockerNon-pharmacologicalSurgical arrhythmiasCatheter ablationDevice : AICD

Class I

Class IILignocain untuk aritmia ventrikel akibat iskemia miokard, ventrikel takikardia.Mexiletine untuk aritmia entrikel dan VT

Class III

GANGGUAN KONDUKSI DI SA NODEGambaran sinus ritme dengan episode sinoatrial block.Gambaran sinus ritme dengan episode sinus arrest

First-degree AV block

Rhythm : RegularRate : Usually normalP wave : Sinus P wave present; one P wave to each QRSPR : Prolonged ( greater than 0.20 seconds )QRS : NormalGANGGUAN KONDUKSI DI AV NODE

Second -degree AV block, Mobitz I

Rhythm : IrregularRate : Usually slow but can be normalP wave : Sinus P wave present; some not followed by QRS complexesPR : Progressively lengthensQRS : Normal

Second-degree AV block, Mobitz II

Rhythm : Regular usually; can be irreguler if conduction ratios varyRate : Usually slowP wave : Two, three, or four P waves before each QRSPR : PR interval of beat with QRS is constant; PR interval may be normal or prolongedQRS : Normal if block in His bundle; wide if block involves bundle branches

Third-degree AV block

Rhythm : RegularRate : 40 60 if block in His bundle; 30 40 if block involves bundle branchesP wave : Sinus P wave present; bear no relationship to QRS; can be found hidden in QRS complexes and T wavesPR : Varies greatlyQRS : Normal if block in His bundle; wide if block involves bundle branches

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VES

SVT

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