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Departemen Kardiologi FK USU

RSUP. H. Adam Malik


Medan

SA node
Sumber impuls normal/
alamiah , 60 100

AV node
Bisa mengeluarkan
impuls 40-60x/menit

Berkas His
Serabut Purkinje

Ventrikel
Bisa mengeluarkan impuls
20-40 x/menit

CAUSE OF CARDIAC ARRHYTHMIAS :


Disturbances in automaticity : bertambah cepat
atau bertambah lambatnya suatu daerah otomatisitas.
Misal di sinus node, AV node, abnormal beats/
depolarisasi atrium, AV junction, ventrikel, VT, dll.
Disturbances in conduction : konduksi terlalu cepat
(WPW) atau terlalu lambat (blok AV).
Combinations of altered automaticity and
conduction.

Tachyarrhythmia
(rate >100 x/min)

Bradyarrhytmia
(rate < 60 X/min)

QRS sempit (<0.12 ms)

AV blok derajat 1, 2 & 3

QRS lebar (>0.12 ms)

RBBB & LBBB

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)

Drugs
- anti-arrhytmia
- sympathomimetic.
- B2 agonis, cocaine, anti depresants
(tricyclic), Aminophylline, caffeine.
- alcohol.

Metabolic abnormalities.
- Electrolyte (low K, Na, Ca, Mg )
- Hypoximia, Hypercarbia.
- Acidosis
0 Endocrine abnormalities
-Thyrotoxicosis, Phaeochrocytoma.

Miscellaneous.
Febrile illness
Emotional stress
Smoking
Fatigue.

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

Chest discomfort
Syncope; nearly blacked out; syncope with spell

Polyuria
Cardiac arrest

Signs
Heart rate and pulses: regularity; amplitude; deficit
Hypotension
Hypoperfusion

Failure of impulse
formation
Sinus Bradycardia
Sick Sinus Syndrome

AV conduction
abnormalities
1st and 2nd AV Block
Total AV Block
BBB (Bundle Branch
Block)

Junctional rhythm:
-AV junction can function as a pace maker

(40-60 x/min).
-due to the failure of sinus node to initiate
time impulse or conduction problem.
-normal-looking QRS.
-retrograde P wave.
-P wave may preceede, coincide with, or
follow the QRS

First-degree AV block
Rhythm : Regular
Rate
: Usually normal
P wave : Sinus P wave present; one P wave to each QRS
PR
: Prolonged ( greater than 0.20 seconds )
QRS
: Normal

Second -degree AV block, Mobitz I


Rhythm : Irregular
Rate
: Usually slow but can be normal
P wave : Sinus P wave present;
some not followed by QRS complexes
PR
: Progressively lengthens
QRS
: Normal

Second-degree AV block, Mobitz II


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

Third-degree AV block
Rhythm : Regular
Rate
: 40 60 if block in His bundle;
30 40 if block involves bundle branches
P wave : Sinus P wave present; bear no relationship to QRS;
can be found hidden in QRS complexes and T waves
PR
: Varies greatly
QRS : Normal if block in His bundle;
wide if block involves bundle branches

Inj Sulfas Atropin/SA 0,5 mg IV


Dopamin drips
Temporary Pace Maker/TPM
Permanent Pace Maker/PPM pada kasus2
bradiaritmia yang berat