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aritimia
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Department of Cardiology and Vascular MedicineFaculty of Medicine University of Indonesia
National Cardiovascular Center Harapan Kita
ARRHYTHMIA
Surya Dharma, MD, FIHA
AritmiaGangguan irama jantung berupa segala jenis
irama jantung selain IRAMA SINUS
SupraventrikularQRS sempit seperti normal
(kecuali beberapa hal:BBB, WPW,aberans)
VentrikularQRS lebar > 0,12 dt
Atrial fibrillation
Atrial flutter
AVRT AVNRT
V Tach
V Fibrillation
SNRT
AT
JT
TACHYCARDIA
Aritmia Supraventrikular
Premature beat/ ekstra sistolik
Takikardi aritmia
Atrial FlutterAtrial fibrilasi
Supra Ventrikel Takikardi/Paroksismal Atrial Takikardi
150 - 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-pharmacology1980’s 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 control• Maintenance of sinus rhythm• Anticoagulation (acute and
chronic)
Aritmia Ventrikular
Premature beat/ ekstra sistolik
Takikardi aritmia
Ventrikel Fibrilasi
> 350 x/mnt
Ventrikel Takikardi
100-250 x/mnt
VENTRICULAR RHYTHMS
Gambar A menunjukkan sinus takikardi dengan frequent uniform PVC dan B menunjukkan sinus takikardi dengan multiform PVC.
VES
Sinus ritme dengan dua R on T PVC’s
Sinus ritme dengan run VT dan satu episode couplets
Gambaran trigeminal PVC.
Gambaran accelerated idioventricular rhythm
Gambaran Ventricular Tachycardia (VT)
Gambaran Ventricular Fibrillation (VF)
Torsade de pointes
Management of Malignant Ventricular arrhythmias
• Pharmacological– Class I– Class III– Class II, Beta blocker
• Non-pharmacological– Surgical arrhythmias– Catheter ablation– Device : AICD
Gambaran asistol
Gambaran ”P wave” asystole.
• BRADYARRHYTHMIA AND CONDUCTION ABNORMALITIES
• SPECIFIC ECG CHANGES
GANGGUAN KONDUKSI DI SA NODE
Gambaran 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 : Normal
GANGGUAN 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
0.04
RBBB
LBBB
Gambaran atrial pacing (tanda panah menunjukkan pacer spikes).
Gambaran ventricular pacing (tanda panah menunjukkan pacer spikes).
Kesimpulan
• EKG pemeriksaan yang sangat sederhana, sangat mobile, segera didapatkan hasil dan sangat bermanfaat di bidang kardiologi
• EKG hanya sebagai alat bantu diagnosis• Sebagian besar aritmia dapat didiagnosis
berdasarkan EKG• Semua dokter umum seyogyanya
menguasai EKG
T H A N K Y O U
VES
SVT
VES R on T
VT
VF