skill arytmia

8/15/2019 Skill Arytmia

http://slidepdf.com/reader/full/skill-arytmia 1/71

LOGO

A R R H Y T M I A

HARVI PUSPA WARDANIHARVI PUSPA WARDANIFAKULTAS KEDOKTERAN UNISBAFAKULTAS KEDOKTERAN UNISBA

21 MEI 201321 MEI 2013



Sistem Konduksi Jantung



Pacemaker cell action potential



Your Subtopics Go Here



&nalisis Gambaran 'KG

- Irama : reg !er " #reg !er- Fre$ e%&# : %'rma! " (e)a* " !am+a*- ,e!'m+a%g P : a-a " *#-a$ a-a

- I%*er.a! PR : %'rma! " mema%/a%g "meme%-e$

- ,e!'m+a%g RS : !e+ar " &em)#*



Irama dan (egularitas

()( inter*al! P)P inter*al+eratur #reguler$ : inter*al sama+idak teratur #ireguler$ : inter*altidak sama



,rekuensi - H( #+eratur$

,rekuensi

.//000000

1 kotak besar ()(

00 0023//0 0000

1 kotak kecil ()(

Kecepatan standar 43mm5detik



,rekuensi - H( #+idak +eratur$

,rekuensiStrip 6 detik :

1 komp7 8(S 9 2/Strip 24 detik :

1 komp7 8(S 9 3



N'rma! S#% & R * m NSR4

Irama S#% & N'rma!



,a%gg a% )em+e%* $a% #m) !&E% a%(e- a *'ma*#(#* :5 I%(rea&e- a *'ma*#(#* '6 SA %'-e5 I%(rea&e- a *'ma*#(#* '6 !a*e%* )a(ema$er&

5 A+%'rma! a *'ma*#(#*Tr#ggere- a(*#.#*De(rea&e- a *'ma*#(#* '6 SA %'-e



Figure 11.8. Triggered acti ity. A delayed afterdepolarization (arrow) arisesafter the cell has fully repolarized. )f the delayed afterdepolarization reachesthe threshold voltage' a propagated action potential (A0 is triggered (dashedcurve) .



Gangguan peng antaran impuls

Blok(eentry



LOGO

S I ; S ( H Y + <



Sinus Bradycardia #SB$



Sinus +ac ycardia #S+$



Sinus &rr yt mia



LOGO

SUPRAVENTRI7ULARARRHYTMIAS



A*r#a! Prema* re Bea*&8A*r#a! E9*ra& &*'!e

,e!'m+a%g P : )rema* re a+%'rma!R * m : #rreg !ar

RS : &em)#*



&trial ,ibrillation #&,$



&trial ,lutter #&=$



&trial ,ibrillation - &trial ,lutter

Fre$ e%&#; <0 98m : &!'= re&)'%&e SVR4

<05100 98m : %'rm' re&)'%&e NVR4>100 98m : ra)#- re&)'%&e RVR4



&trial +ac ycardia #&+$



<ulti=ocal &trial +ac ycardia

Ra*e 10052?08+)mP =a.e *=' 'r m're e(*')#( P =a.e& =#* -#66ere%*m'r) '!'g#e& m#% 3 -#66ere%* P =a.e m'r) '!'g 4

RS %'rma!7'%- (*#'% P5R #%*er.a!& .arR * m #rreg !ar



Ve%*r#( !ar Pree9(#*a*#'% S %-r'mW'!665Par$#%&'%5W #*e8WPW

PR #%*er.a! meme%-e$De!*a =a.eW#-e RS ('m)!e9



Par'9 &ma! S )ra.e%*r#( !ar Ta( (ar-#aPSVT4

Irama *era* r HR > 1?098m,e!'m+a%g P $e(#!$a-a%g 54I%*er.a! PR meme%-e$a*a 54K'm)!e$& RS @ 0 12

-e*#$ &em)#*4Se+ag#a% +e&arAVNRT

Impulse fromSA node Fast pat hway

Compactnode

Tobundle o f His

Atrialpremature

beat

Tobundle o f His

Unidirectionalblock

Retrogradeconduction

Slow pathway



S )ra.e%*r#( !ar Ta( (ar-#a SVT4



ATRIOVENTRI7ULAR REENTRANT TA7HY7ARDIA AVR



%(*#'%a! E9*ra& &*'!e

,e! P : #%.er*e- *#-a$ a-a &e*e!a $'m)!e$ RS



Junctional ( yt m #J($



A((e!era*e- %(*#'%a! R * m A(( R4

LOGO



LOGO

>' +(I?;L&(&((HY+H<I&S



I-#'.e%*r#( !ar R * m IVR4



A((e!era*e- I-#'.e%*r#( !ar R * m A(( IVR 5 AIR4



Ve%*r#( !ar E9*ra& &*'!e VES4

Prema* re Ve%*r#( !ar 7'%*ra(*#'% PV74Irama *#-a$ *era* r $are%a a-aextrasystoleHR *erga%* %g #rama -a&ar

,e!'m+a%g P 54 I%*er.a! PR 54K'm)!e$& RS > 0 12 -e*#$ !e+ar4VES %#6'(a! m !*#6'(a!

VES (' )!e* *r#)!e* ('%&e( *#.e Sa!.'4VES +#gem#%# *r#gem#%# a-r#gem#%#VES R '% T



Ve%*r#( !ar E9*ra& &*'!e VES4M !*#6'(a!



Ve%*r#( !ar E9*ra& &*'!e VES47' )!e-



Ve%*r#( !ar E9*ra& &*'!e VES4Tr#)!e*



Ve%*r#( !ar E9*ra& &*'!e VES4B#gem#%a!



V %* #( ! E9* & &*'! VES4



Ve%*r#( !ar E9*ra& &*'!e VES4R '% T



>entricular ,ibrillation #>,$



>entricular +ac ycardia #>+$

Irama *era* r HR >100 98m,e!'m+a%g P 54 I%*er.a! PR 54K'm)!e$& RS > 0 12 -e*#$ !e+ar4M'%'m'r) #( Torsade de Pointes



+orsade de Pointes



LOGO



7 O N D U 7 T I O ND I S T U R B A N 7 E S



7LASSIFI7ATION OF 7ONDU7TIONDISTURBAN7ES

1C SINOATRIAL BLO7K2C ATRIOVENTRI7ULAR BLO7K

aC I%('m)!e*e AV B!'($5 1&* -egree AV B!'($

5 2%- -egree AV B!'($ :M'+#* * )e I We%($e+a( 4M'+#* * )e II

+C T'*a! AV B!'($ :

5 3r- -egree AV B!'($3C INTRAVENTRI7ULAR BLO7K

RBBB LBBB Fa&(#( !ar B!'($



,irst @egree &> Block

Irama *era* r HR m m% a <05100 98m,e!'m+a%g P %'rma! P : RS 1 : 1I%*er.a! PR mema%/a%g > 0 20 -e*#$ $'%&*a%K'm)!e$& RS @ 0 12 -e*#$ &em)#*4



Second @egree &> Block

Se+ag#a% #m) !& -ar#a*r# m *er am+a* &e(ara*'*a! )a-a AV %'-e -a%gaga! %* $ -#*er &$a% $e.e%*r#$e!Se+ag#a% ge!'m+a%g P*#-a$ -##$ *# $'m)!e$&

RS

S ('% D AV B!'($



Se('%- Degree AV B!'($M'+#* T )e 1 We%($e+a($

Se(ara a%a*'m#&m m% a am+a*a%

+era-a )a-a -aera-# a*a&G AV / %(*#'%



Se('%- Degree AV B!'($M'+#* T )e 1 We%($e+a( 4

S ('% D AV B!'($



Se('%- Degree AV B!'($M'+#* T )e 2

Se(ara a%a*'m#&m m% a am+a*a%

+era-a )a-a -aera-# +a=a G AV / %(*#'%



Se('%- Degree AV B!'($T )e 2

Irama a*r#a! *era* r #rama .e%*r#$e! *#-a$ *era* r,e!'m+a%g P %'rma! a-a &a* a*a !e+# ge!'m+a%g P*#-a$ -##$ *# $'m)!e$& RSI%*er.a! PR %'rma! a*a mema%/a%g %am % $'%&*a%K'm)!e$& RS &em)#*8!e+ar



+ ird @egree &> Block

Ha%*ara% #m) !&*er am+a* &e(ara *'*a!

-ar# a*r# m $e .e%*r#$e!L'$a&# :

5 AV junction - Bundle of His



+ ird @egree &> Block #+&>B$

Irama *era* r,e!'m+a%g P +e%* $ -a% $ ra% %'rma! *#-a$+er + %ga% -e%ga% $'m)!e$& RSI%*er.a! PR *#-a$ -a)a* -# $ r $are%a *#-a$ a-a + %ga%a%*ara ge!'m+a%g P -e%ga% $'m)!e$& RSK'm)!e$& RS &em)#* 8 !e+ar *erga%* %g -ar# ma%aa$*#.#*a& +era&a!

Le+ar : -ar# .e%*r#$e! &em)#* : -ar# AVnode



+ ird @egree &> Block #+&>B$



I +(&>' +(I?;L&( BLA?K

Block in t e intra*entricular conductionsystem :

27 Bundle Branc Blocka7 (BBB #complete5incomplete$

b7 LBBB #complete5incomplete$47 ,ascicular Block

a7 L&,B #L&HB$b7 LP,B #LPHB$

.7 onspeci=ic Intra*entricular Block



(BBB

"RSR -# V1 V2"W#-e &! rre- S -#V? V< I aVL

"T #%.er*e- -# V1 V2"7'm)!e*e -a%#%('m)!e*e RBBB :!# a* - ra&# RS



LBBB

"RSR -# V? V< I aVL"W#-e &! rre- S -#V1 V2

"T #%.er*e- -#V? V< I aVL"7'm)!e*e -a%#%('m)!e*e RBBB :

!# a* - ra&# RS



Kega%atdaruratan 'KG

LAMBAT HR ; <0 J8m4S#% & +ra-#(ar-#a A*r#a! F#+r#!!a*#'% " SVR

A*r#a! F! **er " SVR%(*#'%a! r * m

I-#'.e%*r#( !ar r * m

T'*a! AV +!'($

7EPAT HR > 100 J8m4S#% & *a( (ar-#a A*r#a! F#+r#!!a*#'% " RVR

A*r#a! F! **er " RVRS )ra Ve%*r#( !arTa( (ar-#a SVT4

Ve%*r#( !ar F#+r#!!a*#'%Ve%*r#( !ar Ta( (ar-#a

skill arytmia

Documents