ARRHYTH

MIA
 Arrhythmia

Definition : Lack of rhythm or abnormal

rhythm.
- Frequency ( bradycardia or tachycardia)
(Normal sinus rhythm 60 100 x /min.)
- Irregularity
- Source of impuls
- Sequence of activation
 Precipitating factors
Underlying cardiac disease
- Ischemic heart disease
- Valvular heart disease
- Hypertensive heart disease
- Congenital heart disease
- Pre excitation (short of PR interval)
- Long QT (congenital or acquired)
 Precipitating factors
Drugs
- anti-arrhytmia
- sympathomimetic
- B2 agonis, cocaine, anti depresants
(tricyclic), Aminophylline, caffeine
- alcohol
 Precipitating factors
Metabolic abnormalities.
- Electrolyte (low K, Na, Ca, Mg )
- Hypoxemia, Hypercarbia.
- Acidosis
- Endocrine abnormalities
- Thyrotoxicosis, Phaeochrocytoma.
 Precipitating factors
Miscellaneous.
- Febrile illness
- Emotional stress
- Smoking
- Fatigue
 Investigation for arrhytmias
1. 12 lead ECG and rhythm strip.
2. Blood test : routine blood, electrolyte ,
glucose, cardiac enzyme, thyroid level,
drug level (digoxin), arterial blood gas.
3. Chest x ray : heart size , pulmonary edema,
lung cancer, pericardial effusion.
 Arrhytmia
Tachyarrhyth Bradyarrhytmi
mia (rate a
>100 x/min) (rate < 60
X/min)
QRS sempit AV blok derajat
(<0.12 ms) 1, 2 & 3
QRS lebar RBBB & LBBB
(>0.12 ms)
 QRS complex
Teratur / tidak teratur ?

QRS complex
Sempit / lebar ?

P wave ?

Hubungan antara P and QRS ?

QRS sempit : Supraventricular origin

Atrial Flutter
Supraventricular Tachycardia
Sinus Takikardia
Atrial Flutter
Atrial Fibrillation
Atrial Flutter
 QRS Lebar : Ventricular origin

QRS lebar

Irama
Irama Teratur
tidak teratur

Ventricular Ventricular
Tachycardia Fibrillation
Ventricular tachycardia
Torsades de pointes
Ventricular fibrillation
VES
 VES VES

SR SR
SR SR SR SR

Sinus rhythm with multifocal VES

Sinus rhythm with VES couplet
Sinus rhythm with VES, R on T
First-degree AV block
Second-degree AV block type 1
Second-degree AV block type 2
 QRS QRS QRS

P P P P P P P

Third-degree AV block / Total AV block

 Treatment

Atrial Fibrillation.
- Rate control :
1. Digoxin.
Digitalization dose : 0,03 x BW (Kg)
Maintenance dose : 0,125 0,25 mg /day,
depends on renal function.
Route :oral tablet 0,25 mg or
Injection ampule 0,5 mg
 2. Beta blocker

- Propranolol
- Metoprolol
- Atenolol
- Bisoplrolol
- Carvedilol
 2. Rhythm control
Main purpose is conversion to sinus rhythm.

Amiodaron
Tablet : 200 mg.
Injection : 150 mg
Loading dose : 3 x 200 mg ( 5 days)
Maintenance dose : 100 200 mg / day.
Contraindication : Thyroid and Lung
(fibrotic) dysfunction.
 SVT-supraventricular Tachycardia

1. ADP injection ( 8 mg 20 mg )
2. Verapamil injection ( 2,5 10 mg)
3. Amiodaron injection.
Loading dose : 300 mg / 250 cc in 30 60
minutes.
Maintenance dose : 450 600 mg /day
4. Cardioversion : DC shock synchronize
5. Ablation : radiofrequency or laser.
 VES.
Amiodaron
oral or injection : depends on benign or
malignant extrasystole.
 VT

Amiodaron : if patients hemodynamic: good

(conscious, BP )
DC shock synchronize : if instability
hemodynamic.
100 300 Joule.
 VF ventricular fibrillation.

DC shock asynchronized
300- 350 joule.
ICD intracardiac defibrillation.

EMD-electromechanical dissociation.
 The
Deadly
Rhythms

PEA
VT VF (Pulse less A
Electrical
Activity)
systole
Thank You