DYSRHYTHMIA

DYSRHYTHMIA

• Tachyarrhythmias HR > 100 x/min

• Bradiarrhythmias HR < 60 x/min

 Tachyarrhythmias
• Sinus Tachycardia
• Accelerated Atrial Tachycardia/Paroxysmal Atrial
Tachycardia
• Atrial Flutter
• Atrial Fibrillation
• Reentrant Junctional Tachycardia (Nodal & Bypass)
• Multifocal Atrial Tachycardia
• Ventricular Tachycardia
Macroreentrant and Microreentrant
Tachycardias
 How to identify dysrhythmias ?

“Treat the patient, not the ECG”

 QRS complex
Regular / irregular ?

QRS complex
Normal-looking QRS complex?
Wide / narrow ?

P wave ?

Relationship between P and QRS ?

NORMAL SINUS RHYTHM
PSVT :
-due to re-entry mechanism
-narrow QRS complex
-regular
-retrograde atrial depolarization
-P wave ?
PSVT
Junctional Tachycardia (RJT)
• Reentry within the atrioventriocular (AV) junction can
result in a single junctional premature beat (JPB) or
in sustained junctional tachycardia
• Produces narrow-complex regular tachycardia
without preceding atrial depolarization waves
• RJTs often produce retrograde atrial depolarization
but these waves are usually buried within the QRS
complex
RJT Schematic diagram
Atrial Fibrillation :

-from multiple area of re-entry wi

-or from multiple ectopic foci
-irregular, narrow QRS complex
-very rapid atrial electrical activit
(400-700 x/min).
-no uniform atrial depolarization
Atrial Flutter :
-The result of a re-entry circuit wi
the atria
-Irregular / regular QRS rate
-Narrow QRS complex
-Rapid P waves (300x/min), “saw to
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 precede, coincide
with, or follow the QRS
SR

VES
 Sinus rhythm
with
Multifocal VES

VES VES

SR SR
SR SR SR SR
Sinus rhythm with VES couplet
Sinus Rhythm with VES, R on T
Ventricular Tachycardia
Torsade de Pointes
Ventricular Fibrillation
 1st degree AV block

Prolonged PR interval
 2nd degree AV block, type 1

Missing QRS Missing QRS

 2nd degree AV block, type 2

Missing QRS
 Total AV Block /
3rd degree AV block

QRS QRS QRS

P P P P P P P
THANK YOU
 PACE MAKER ACTIVITY
mVolt
Ca2+
influx K+
0 If efflux
influx
-20

-40 TP
-60 MDP
Phase 4 depolarization

Time

Leonardo S Lilly,Pathophysiology of heart disease, 1998

 PACE MAKER ACTIVITY
mVolt

-20

-40 TP
-60 MDP

-90 Phase 4 depolarization More negatuveMDP

Time

Leonardo S Lilly,Pathophysiology of heart disease, 1998

Macroreentry Microreentry

Atrial Flutter Atrial Fibrillation

A Fib/Flutter spectrum
Types of RJT
Delta Waves
WPW Syndrome types
 BRADIARITMIA

• Blok Nodus AV, meliputi :

Blok derajat I
Blok derajat II
Mobitz type I ( Wenkebach)
Mobitz type II
Blok derajat III (total AV Block)
• Gangguan fungsi nodus SA
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
Mobitz I
Mobitz II atrioventricular block
Atrioventricular dissociation secondary to complete heart block
High-grade atrioventricular block
Incomplete right bundle branch block
Right bundle branch block
Left bundle branch block
Wolff-Parkinson-White syndrome
Wolff-Parkinson-White syndrome