aritmia dan kegawatan jantung1
TRANSCRIPT
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Aritmia dan Kegawatan Jantung
Zulfikri MukhtarZulfikri MukhtarDepartemen Kardiologi dan Kedokteran Vaskuler Departemen Kardiologi dan Kedokteran Vaskuler
Fakultas Kedokteran USU Fakultas Kedokteran USU MedanMedan
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Arrhythmia.
Definition : Lack of rhythm or abnormal rhythm.
- Frequency ( bradycardia or tachycardia)
(Normal sinus rhythm 60 – 100 x /min.)- Irregularity- Source of impuls- Sequence of activation
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Precipitating factors
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)
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Precipitating factors
Drugs- anti-arrhytmia- sympathomimetic.- B2 agonis, cocaine, anti depresants
(tricyclic), Aminophylline, caffeine.
- alcohol.
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Precipitating factors
Metabolic abnormalities.- Electrolyte (low K, Na, Ca, Mg )- Hypoximia, Hypercarbia. - Acidosis
0 Endocrine abnormalities
-Thyrotoxicosis, Phaeochrocytoma.
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Precipitating factors
Miscellaneous.- Febrile illness- Emotional stress- Smoking- Fatigue.
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Investigation for arrhytmias1. 12 lead ECG and rhythm strip.
2. Blood test : routine blood, electrolyte , glucose, cardiac enzyme, thyroid level,
drug level (digoxin), arterial blood gas.
3. Chest x ray : heart size , pulmonary edema, lung cancer, pericardial effusion.
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I. Sebutkan iramanya :Normal Sinus Rhythm
EKG
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The Heartbeat.Electromechanical association
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II. MENGHITUNG DENYUT JANTUNG :
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PJK
SCHEMIA : ST depresi atau T inverted
INFARCT : ST Elevasi
NECROSIS (OLD INFARCT) :
gel. Q patologis atau QSI
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Early Repolarisasi
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RBBB
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Acute Anterior MI
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Acute Inferoposterior MI
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Arrhytmia
Tachyarrhythmia (rate >100 x/min)
Bradyarrhytmia(rate < 60 X/min)
• QRS sempit (<0.12 ms)• QRS lebar (>0.12 ms)
• AV blok derajat 1, 2 & 3• RBBB & LBBB
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Diagnostic Tachyarrhytmia
Lebar gel. QRS
Keteraturan gel. QRS
P wave ??
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QRS complex Teratur / tidak teratur ?
QRS complexSempit / lebar ?
P wave ?
Hubungan antara P and QRS ?
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QRS sempit : Supraventricular origin
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QRS Lebar : Ventricular origin
QRS lebar
Irama TeraturIrama
tidak teratur
Ventricular Tachycardia
Ventricular Fibrillation
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VES (Ventricular extrasystole)- VPB (ventricular prematur beat)- begemini -bifocal.
VES couplet
VT-ventricular tachycardia
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AF-atrial fibrillation, course P wave , RR interval irregular
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SVTRR interval regular, P or T wave not identified
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AF rapid
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VT , wide qrs , fixed axis
VF, ventricular fibrillation, changed axis
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VT
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VT
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VF
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Torsade de Pointes
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Bradyarrhytmia(rate < 60 x/min)
Failure of impulse formation
Sinus Bradycardia Sick Sinus Syndrome
AV conduction abnormalities
1st and 2nd AV Block Total AV Block BBB (Bundle Branch
Block)
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Sick Sinus Syndrome
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LBBBLBBB
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Treatment
Atrial Fibrillation.- Rate control :
1. Digoxin.
Digitalization dose : 0,03 x BW (Kg)
Maintenance dose : 0,125 – 0,25 mg /day, depends on – renal function.
Route :oral tablet 0,25 mg or
Injection ampule 0,5 mg
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The Deadly
Rhythms
VT VFPEA
(Pulse less ElectricalActivity)
A systoleVF
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2. Beta blocker
- Propranolol- Metoprolol- Atenolol- Bisoplrolol- Carvedilol
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2. Rhythm control Main purpose is conversion to sinus rhythm.
Amiodaron
Tablet : 200 mg.
Injection : 150 mg
Loading dose : 3 x 200 mg ( 5 days)
Maintenance dose : 100 – 200 mg / day.
Contraindication : Thyroid and Lung (fibrotic) dysfunction.
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SVT-supraventricular Tachycardia
1. ADP injection ( 8 mg – 20 mg )
2. Verapamil injection ( 2,5 – 10 mg)
3. Amiodaron injection.
Loading dose : 300 mg / 250 cc in 30 – 60 minutes.
Maintenance dose : 450 – 600 mg /day
4. Cardioversion : DC shock synchronize
5. Ablation : radiofrequency or laser.
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VES.
Amiodaron
oral or injection : depends on benign or malignant extrasystole.
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VT
Amiodaron : if patients hemodynamic: good (conscious, BP )
DC shock synchronize : if instability hemodynamic.
100 – 300 Joule.
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VF – ventricular fibrillation.
DC shock asynchronized
300- 350 joule.
ICD – intracardiac defibrillation.
EMD-electromechanical dissociation.