ARITMIA

Dr. Isman Firdaus

Anatomi Jantung Normal

Sel Autoritmik
Fase
Depolarisasi
Fase
Repolarisasi
Fase Istirahat

Sel Kontraktil
Fase
Depolarisasi
Fase Plateu
Fase
Repolarisasi
Fase Istirahat

Gelombang P

: depolarisasi kedua atrium

Gelombang QRS : Depolarisasi kedua Ventrikel

Gelombang T

: Repolarisasi Kedua Ventrikel

ARITMIA
TAKIARITMIA

HR > 100 x/MNT

BRADIARITMIA

HR < 60 x/MNT

MEMBACA EKG
Bagaimana irama yang mengatur
atrium( nodus sinus, fibrilasi,fluter, dll)
Bagaimana konduksi AV (bila tidak dilaporkan
berarti normal)
Bila pacu jantung subsidier yang bekerja
maka sebutkan subsidier mana (junctional,
idioventrikular dll)
Contoh : Irama sinus dengan laju atrium 80
X/mnt, blok total AV dan irama idioventrikular
dengan laju ventrikel 40 X/mnt

Takiaritmia
Sinus Tachycardia
Accelerated Atrial Tachycardia/Paroxysmal Atrial
Tachycardia
Atrial Flutter
Atrial Fibrillation
Reentrant Junctional Tachycardia (Nodal & Bypass)
Multifocal Atrial Tachycardia
Ventricular Tachycardia

Physiologic Basis of Pacemaker

Cells

Pacemaking &
Conduction System

Perbedaan lokal pola potensial aksi

mVolt

PACE MAKER ACTIVITY

Ca2+

influx

If
influx

K+
efflux

-20
-40

TP

-60

MDP
Phase 4 depolarization

Time
Leonardo S Lilly,Pathophysiology of heart disease, 1998

PACE MAKER ACTIVITY

mVolt
0
-20
-40

TP

-60

MDP

-90

Phase 4 depolarization

More negatuveMDP

Time

Leonardo S Lilly,Pathophysiology of heart disease, 1998

Macroreentry

Atrial Flutter

Microreentry

Atrial Fibrillation

Macroreentrant and Microreentrant

Tachycardias

A Fib/Flutter spectrum

Types of RJT

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

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 QR
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 wav
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