Chinen Presentasi Gangguan Irama Cor
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Transcript of Chinen Presentasi Gangguan Irama Cor
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ARHYTHMIA TACHYCARDIA
pembimbingDr. Setyo Utomo Sp. Jp FIHA
Fahmi Afif Alboneh
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PENYEBAB TAKIARITMIAINTRA-CARDIACEXTRA-CARDIAC
IskhemiaPenyakit katub jantungGagal jantungKardiomiopati
Obat-obatanAlkoholStimulan (contoh: caffeine)StressHipertiroidismeInfeksi/ sepsisMetabolik (contoh: Hiperkalemia)
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AritmiaGangguan irama jantung berupa segala jenisirama jantung selain IRAMA SINUSSupraventrikularQRS sempit seperti normal(kecuali beberapa hal:BBB, WPW,aberans)VentrikularQRS lebar > 0,12 dt
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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
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PEMBAGIAN TAKIARITMIA
KOMPLEKS LUASKOMPLEKS SEMPITVentricular TakikardiaTorsades de PointesVentrikel fibrilasi Sinus takikardiaAtrial takikardia Takikardia re-entrant (AVNRT dan AVRT)Atrial fibrillasiAtrial flutter
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Atrial fibrillation
Atrial flutter
AVRT AVNRTV TachV FibrillationSNRTATJTTACHYCARDIA
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Aritmia SupraventrikularPremature beat/ ekstra sistolikTakikardi aritmiaAtrial FlutterAtrial fibrilasiSupra Ventrikel Takikardi/Paroksismal Atrial Takikardi150 - 250 x/mnt
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ARRHYTHMIAS (ATRIAL RHYTHMS)Gambaran premature atrial complex (tanda panah).Gambaran EKG atrial tachycardia/SVT.
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SVT
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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
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Gambaran delta wave pada sindroma WPW Atrial flutter dengan gambaran gigi gergaji.
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Wolff-Parkinson-White syndrome
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Gambaran fibrilasi atrial dengan rapid ventricular response
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Approaches to Treatment of atrial fibrillation
Ventricular rate controlMaintenance of sinus rhythmAnticoagulation (acute and chronic)
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Aritmia VentrikularPremature beat/ ekstra sistolikTakikardi aritmiaVentrikel FibrilasiN> 350 x/mnt Ventrikel TakikardiN100-250 x/mnt
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VENTRICULAR RHYTHMSGambar A menunjukkan sinus takikardi dengan frequent uniform PVC dan B menunjukkan sinus takikardi dengan multiform PVC.VES
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Sinus ritme dengan dua R on T PVCsSinus ritme dengan run VT dan satu episode couplets
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Gambaran Ventricular Tachycardia (VT)Gambaran Ventricular Fibrillation (VF)
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Torsade de pointes
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Management of Malignant Ventricular arrhythmiasPharmacologicalClass IClass IIIClass II, Beta blockerNon-pharmacologicalSurgical arrhythmiasCatheter ablationDevice : AICD
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Class I
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Class IILignocain untuk aritmia ventrikel akibat iskemia miokard, ventrikel takikardia.Mexiletine untuk aritmia entrikel dan VT
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Class III
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GANGGUAN KONDUKSI DI SA NODEGambaran sinus ritme dengan episode sinoatrial block.Gambaran sinus ritme dengan episode sinus arrest
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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
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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
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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
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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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0.04RBBB
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LBBB
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VES
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SVT
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VES R on TVTVF
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**