ARRHYTHMIA RECOGNITION DR. JETTY SEDYAWAN SpJP.Bagian Kardiologi FKUI

EKG & ARITMIA

USEFULNESS OF The ECG1. Atrial and Ventricular Hypertrophy2. Myocardial ischemia and infarction3. Arrhythmia4. Pericarditis5. Systemic Disease that effect the heart6. Effect of cardiac drugs, esp Digoxin and Quinidine7. Distribution in electrolyte metabolisme

SA nodeSumber impuls normal/ alamiah , 60 100 AV nodeBisa mengeluarkan impuls 40-50x/menitBerkas HisSerabut PurkinjeVentrikelBisa mengeluarkan impuls30 x/menit

Atrial Depolarization

VentricleDepolarization0.12 second

Terminologi morfologi QRSqRsRsRrSQRQ/QSRsRrSr

JETSED

A. Jarak R R :

1 kotak sedang= 300 x / menit2 kotak sedang= 150 x / menit3 kotak sedang= 100 x / menit4 kotak sedang= 75 x / menit5kotak sedang= 60 x / menit6 kotak sedang = 50 x / menit

B. Hitung jumlah R- R dalam 6 kotak besar = 6 detikJumlah R x 10 = heart rate / menit

C. 1500 / jarak R-R ( dlm mm ) = heart rate / menitMENGHITUNG LAJU JANTUNG :

1 kotak kecil= 0.04 detik5 kotak kecil= 1 kotak sedang= 0.2 detik5 kotak sedang = 1 kotak besar= 1 detikPaper speed : 25 mm/second

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.

Dr. Roy Martin SpJP.KHow to identify arrhythmias ?

Treat the patient, not the monitor

QRS complex Regular / irregular ?QRS complexNormal-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

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 atriaIrregular / regular QRS rateNarrow QRS complexRapid 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

VESSR

SRSRSRSRSRSRVESVESSinus rhythm with Multifocal VES

Sinus rhythm with VES couplet

Sinus Rhythm with VES, R on T

Ventricular Tachycardia

Torsade de Pointes

Ventricular Fibrillation

Prolonged PR interval1st degree AV block

Missing QRSMissing QRS2nd degree AV block, type 1

2nd degree AV block, type 2Missing QRS

PPPPPPPQRSQRSQRSTotal AV Block / 3rd degree AV block

PENGENALAN ARITMIAMONITORINGCEPAT dan TEPATSTATUS KLINIS??

Treat the patient, not the monitor . . . . . . . . . .!!!

MONITOR : VF / VT ?No: PEA,asistolYesUntung gueUdah ikutACLS

VF dan VT pulseless90 % Kematian IMA Terjadi dalam 2 jam pertama IMA Penatalaksanaan: 1. DEFIBRILASI 2. RJP termasuk ETT 3. Farmakologis / obat-obatan* Epinefrin* Lidocaine, Amiodarone

JETSED P E ATERDAPAT AKTIFITAS ELEKTRIK JANTUNG, kecuali VT dan VF , TETAPI TIDAK TERABA PULSASI Obat: EPINEFRIN SULFAS ATROPIN

YOU NEED ACLS !!! Acls PERKIAISSTOL