Download - Arrhythmia (Aritmia)
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ARRHYTHMIA
Eko Antono
Division of Cardiovascular
Department of Internal Medicine
Dr. Hasan Sadikin Hospital
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Diagrammatic representation of mechanism of reentry
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Blood supply of the AV conduction system
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The resting membrane potential and the action potential of an ordinary working cell from the ventricular myocardium
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Schematic representation of pacemaker cell action potential
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Schematic representation of ventricular myocardial working cell action potential
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Action potentials recorded from isolated pacemaker cells immersed in a saline bath and firing at their own inherent discharge rates
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Action potentials from different myocardial cells
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TERMINOLOGY
ETIOLOGY
SIGNS AND SYMPTOMS
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SINUS RHYTHM
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Relation of an electrocardiogram to the anatomy of the cardiac conduction system
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Sinus bradycardia.
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Sinus tachycardia
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SUPRAVENTRICULAR ARRHYTHMIAS
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Non-compen-satory
postextrasystolic pause
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Short coupling interval in supra-ventricular extra-
systole
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Supraven-tricular
extrasystole
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Atrial flutter with high-grade AV block.
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Atrial flutter. The atrial rate is 250 beats per minute, and the rhythm is regular. Every other flutter wave is conducted to ventricles (2:1 block), resulting in regular ventricular rhythm at a rate of 125 beats per minute
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Atrial flutter with variable AV block.
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The different appearances of the flutter line in atrial flutter
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Fig 5.21
(hal 141 & 142)
Atrial flutter with an AV conduction ratio (AV-CR) at
sleep and rest of 6 : 1 or 4 : 1 decreasing to 1 : 1 with
slight exercise
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Atrial fibrillation with controlled ventricular response.
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Atrial fibrillation with rapid ventricular response
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Atrial fibrillation (A) untreated and (B) after digitalis
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VENTRICULAR
ARRHYTHMIAS
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Premature ventricular complex
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Unifocal premature ventricular complexes. Note occurrence of wide, premature QRS complexes. Interval between preceding normal QRS and PVC (coupling interval) remains constant, and
morphology remains the same
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Multiformed premature ventricular complexes. Note variation in morphology and in coupling interval of PVCs
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Premature ventricular complex with fully compensatory pause
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Ventricular bigeminy. Note that every other betas is PVC. Both coupling interval and morphology remain constant; hence they
are unifocal
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Pairs of premature ventricular complexes
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R-on-T phenomenon. Multiple PVCs are present. Mulitple PVCs are present. On right, a PVC falls on downslope of T wave,
precipitating ventricular fibrillation
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The QRST complex in ventricular
arrhythmia
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The apprearance of
the QRST complex in ventricular
extrasystole
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Regular appearance
of extrasystole
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Lowns criteria (1975) for a
grading system of warning
arrhythmias in AMI
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Precipitation of ventricular tachycardia by late-cycle PVC. Note brief salvo of ventricular tachycardia that is initiated by PVC
occurring well beyond T wave
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Ventricular tachycardia
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Ventricular tachycardia and the diagnostic significance of ventricular extrasystole
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Toardes de pointes
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Torsade de pontes ventricular tachycrdial in third degree AV block
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Coarse ventricular fibrillation
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Fine ventricular fibrillation (coarse asystole)
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Onset of ventricular fibrillation in the first hours of an acute myocardial infarction
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Arrhythmogenic right ventricular dysplasia. A 6-
year-old boy with fainting
spells
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Ventricular asystole
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CONDUCTION
DISTURBANCES
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First-degree AV block. The PR interval is prolonged to 0.31 second
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Second-degree AV block type I
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Second-degree AV block type II.
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Third-degree AV block occuring at level of AV node.
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Third-degree AV block occuring at ventricular level
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Review of cardiac
arrhythmias (1) :
Arrhythmias with extopic
impulse formation
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Review of cardiac
arrhythmias (2) : Arrhythmias with
disturbances in impulse
conduction
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BATAS AKHIR SLIDE
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P wave polarity and pacemaker site in
atrial and AV junctional
arrhythmia
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Extra-systole in singles (A) and in pairs of couplets
(B) and brief attacks of
tachycardial (C)
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third-degree AV block with ventricular asystole
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Premature junctional complexes
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Junctional excape complexes
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Paroxysmal supraventricular tachycardial (PSVT)
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Atrial tachycardia with block
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Survival rates are estimates of probability of survival to hospital discharge for patients with witnessed collapse and with ventricular fibrillation as initial rhythm