You are on page 1of 59

Elektrokardiograf

Oleh : PROF. DR. PETER KABO. PHD. SPJP. SPFK. FIHA


Langkah-langkah Pembacaan EKG
1. Irama : Sinus 60-100 x/menit (normal)
Bukan Sinus Atrial Fibrilasi
SVT
Irama JUNSION
2. Laju QRS : HR?
Regularitas
3. Aksis : Normal
RAD/LAD
Superior Aksis
4. Interval PR : 0.20 Detik (Normal)
5. Morfologi
a. Gelombang P : Normal P.Pulmonal P.Mitral
b. Kompleks QRS : Q patologis
RSR pattern di V1&V2
Interval-QRS (0.08 detik)
c. Segmen ST : ST-elevasi, ST-depresi
d. Gel.T : Flat-T, Inverted-T, tall-T
PA interval : 0.01-0.45 detik
P dur : 0.06 0.2 detik
Max : 0.1 detik
AH interval : 0.05-0.13 detik
PR-interval : 0.2 detik
Max : 0.24 detik
HV interval : 0.03-0.05 detik
PRS dur : 0.08 detik
Max : 0.1 detik
6.7 x 20 = 134x/menit

300 : 5.8 = 52x/menit

3.3 x 50 = 165x/menit
Gambar 3.2. Perhitungan aksis
A. Aksis Normal : Lead I: I= +4.5; lead aVF : +12.5; aksis = 72
B. Deviasi aksis ke kanan : Lead I = -10; lead aVF : +8; aksis = +140
C. Deviasi aksis ke kiri : Lead I = +5; lead aVF : -10; aksis = - 60
CARDIAC ARRHYTHMIAS
CLASSIFICATION :

1. Sinus Node diseases :


Sinus tachycardia / bradycardia
SA block
Wandering pace maker
Hypersensitive carotid sinus syndrome (SSS)
2. Disturbance of atrial rhytim :
Atrial fibrilation
Atrial flutter
3. Disturbance of AV junction rhytim :
Supraventricular tachycardia
4. Pre-excitation syndrome :
Woeff Parkinson White syndrome (S-wave)
5. Disturbance of ventricular rhytim :
Ventricular extra systole
Ventricular tachycardia
6. Heart Block :
1 o HB
2 o HB : - Wenckebach ( Mobits type I)
- Mobitz type II
3 HB (total AV block) : - Temporary pace-maker
o

- Permanent pace-maker
R/ : - Simpatomimetik : Ephedrin
- Anti cholinergic: Atropine
Sekian
dan
Terima Kasih
COMMON UNDERLYING DISEASES
CAUSING ARRHYTHMIAS
1. Ischemic Heart Disease :
Acute myocardial infarction
Myocardial ischemia ( HHD, LVH, CAD)
Left ventricle aneurysma
2. CARDIOMYOPATHY
3. Valvular Heart disease
4. Myocarditis
5. Congenital Hearth disease
6. Conduction system abnormalities :
Sinus R AV-node disease
By pass tract
7. Chronic pulmonary disease : Hypokemia
8. Endocrine : Thyrotoxicosis
9. Electrolide imbalance
10. Drug-induce : Sympathomimetic, caffeine
11. Increase Symphatetic / vagal activity
DRUG O P BIO T Doses Doses Maintenance
(%) (hari) Loading

Quinidine + 4-10 300-600


Procamamide + 3-4 750
Disopyramide + 4-10 400-800
Lidocaine + 2 1 mg/kg BB 4-3-2-1mg/kg BB
Propafenone + + 2-32 450-900
Amiodarone + + 40 % 25-60 800-1600 100-400
(2 weeks)
Sotalol + 100% 10 80-320
DRUGS INDICATIONS ADVERSE EFFECTS

Quinidine AF Cinchronism, Long QT


syndrome, Hypotension,
Diarrhea/Hepatitis,
Thrombocytopenia
Procamamide VES
Hypotension, Nausea, Lupus
Disopyramide VES
(-) miotropic, Anti cholinergic :
Lidocaine VES,VT dry mouth
Constipation, urine retention,
Propafenone VES,VT,AF,SVT Glaukoma attack
Amiodarone VES,VT,AF,SVT Hypotension, nystagmus,
Seizure

Sotalol VT,VES Hypotension, Hepatic


disfunction, Pulmonary fibrosis,
Hypo/Hyper thyroidism, Cornea
microdeposit
Heart failure, Bradycardia
Tachycardia

Stable Unstable

Serious sign or symptoms


prepare for immediate
cardioversion

Atrial fibrillation Narrow-complex Stable monomorphic


Atrial flutter tachycardias VT or Polymorphic VT
Narrow-complex Supra Ventricular Tachycardia (SVT)

Vagel Stimulation
Adenosine
Heart function Amiodarone, B-blokers,
preserved Verapamil
Juctional
tachycardia EF < 40% Amiodarone

Heart function
preserved Verapamil, B-blokers,
Digoxin, Cardioversion,
Paroxysmal SVT Amiodarone, Sotalol,
Adenosine
EF < 40%
Digoxin, Amiodarone

Heart function
Verapamil, B-blockers,
Ectopic / multifocal preserved
Amiodarone
atrial tachycardia
EF < 40% Amiodarone
ATRIAL FIBRILLATION / FLUTTER
CONTROL RATE CONVERT RHYTIM
Normal Cardiac Verapamil
Function B-Blocker Amiodarone
Propafenone

Impaired Heart Digoxin Sulfas quinidine


(EF < 40% or CHF ) DC Cardioversion

If AF > 48 hours duration : use anti arrithmic agents with extreme


caution patients not receiving adequate anti coagulation because of
possible embolic complication.
Delayed cardioversion :
Anti coagulation 3 weeks cardioversion anti coagulation 4 weeks
CLASSIFICATION OF ANTIARRHYTMIC
DRUGS
I. Sodium channel blockers
A. Sodium channel (++) Disopyramide
Blocks K+ effluks (+) Quinidine
Procainamide
B. Sodium Channel (+) Lidocaine
Mekiletine
Tocainide
C. Sodium Channel (+++) Flecamide, Encamide,
Propafenone

II. Anti adrenergic Beta blockers

III. K+ channel effluks blockers Amiodarone


also Na+ Blockers Sotalol
IV. Ca++ channel blockers Verapamil, Diltiazem
V. Autonomic effects
Vagal stimulation Digoxin
Adenosine receptor activation Adenosine
Mechanisms of Antiarrhytmic Drug Action

Decreased Phase 4 Slope B-blocker

Na+ channel
Increased Threshold blocker
Ca++ channel
blocker

Increased Max-diastolic Adenosine


potential Acetylcholine

Increased action potential K+ channel


duration blocker
Antiarrhytmic drugs can cause
arrhytmias

Some arrthythmias should not be treated


Mechanisms of Cardiac Arrhytmias
1. Enhanced Automaticity : Sinus tachycardia
2. Triggered Automaticity : Multifocal atrial tachycardia. VES VT. Torsade de pointes

Delayed after depolarization

Early after depolarization

3. Reentry
Atrial fibrillation (AF)
Atrial Flutter
Supraventricular tachycardia (SVT)
Ventricular tachycardia (VT)
Woeff-Parkinson-White Syndrome

4. Block
1o AV block
2o AV block
3o AV block (Total AV Block)
Narrow QRS Complex
Retrograde P
Vent-rate : 140 200 x / min
Vagal Maneuver Response
Wide QRS Complex, V1(+), LAD/Superior
AV dissociation / fusion beat
Vent-rate : 150 250 x / min
Vagal Maneuver No Response

You might also like