EKG ARITMIA

TAKI-BRADI ARITMIA
 5 kotak kecil
= 1 kotak sedang
1 kotak kecil = 0.2 detik Paper speed : 25 mm/second
= 0.04 detik

5 kotak sedang
= 1 kotak besar
= 1 detik
 MENGHITUNG LAJU JANTUNG :

A. Jarak R – R :

-1 kotak sedang = 300 x / menit

-2 kotak sedang = 150 x / menit
-3 kotak sedang = 100 x / menit
-4 kotak sedang = 75 x / menit
-5kotak sedang = 60 x / menit
-6 kotak sedang = 50 x / menit

B. Hitung jumlah R- R dalam 6 kotak besar = 6 detik

Jumlah R x 10 = heart rate / menit

C. 1500 / jarak R-R ( dlm mm ) = heart rate / 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.

Perbedaan lokal pola potensial aksi
 Physiologic Basis of Pacemaker Cells

Pacemaking &
Conduction System
Macroreentry Microreentry

Atrial Flutter Atrial Fibrillation

Macroreentrant and Microreentrant
Tachycardias
How to identify arrhythmias ?
 NO AF
QRS complex AFL
Regular ? VF
AV Blocko2
YES
QRS complex
NARROW
Normal-looking QRS complex? WIDE

SUPRAVENTRIKULAR P wave (+)? VENTRIKULAR

Relationship between P and QRS constant?

YES NO
VT
SR AV Block
NORMAL SINUS RHYTHM
 Ekstrasistole / premature beat

Supra ventrikuler ekstrasistol

- QRS sempit

atrium

ventrikel

Ventrikuler ekstrasistol
- QRS lebar
Supra ventrikuler ekstrasistol (SVES)

Atrial ekstrasistol

Atrial ekstrasistol

Junctional ekstrasistol
Ventrikuler ekstrasistol (VES)
VES berturutan
VES couplet

VES triplet

VES salvos

VT
VES berselang teratur
VES Bigemini
-1VES diantara 2 QRS

VES trigemini
-1VES diantara 3 QRS

VES quadrigemini
- 1VES diantara 4 QRS
PSVT :
-due to re-entry mechanism
-narrow QRS complex
-regular
-retrograde atrial depolarization
-P wave ?
PSVT
Atrial Fibrillation :

-from multiple area of re-entry within atria

-or from multiple ectopic foci
-irregular, narrow QRS complex
-very rapid atrial electrical activity
(400-700 x/min).
-no uniform atrial depolarization
Atrial Flutter :
-The result of a re-entry circuit within
the atria
-Irregular / regular QRS rate
-Narrow QRS complex
-Rapid P waves (300x/min), “sawtooth”
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
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
Mobitz 2
Atrial Fluter
AF
Treat the patient,
not the monitor . . . . . . . . . .!!!

SELESAI