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JANTUNG

AV BLOCK VT (Ventricular Tachycardia)


Derajat 1 → PR interval memanjang konstan
> 1 kotak besar

Derajat II → PR interval memanjang perlahan lalu drop beat


Mobitz 1 Weckenbach: rasio gel. QRS 2:3, 3:4, 4:5 VF (Ventricular Fibrillation)

Derajat II → PR interval memanjang konstan lalu drop beat


Mobitz 2

Atrial Fibrillation
→ Antara gel. R ada ≥ 3 gelombang, ireguler

Derajat 3 → Gel. P dan QRS berjalan sendiri-sendiri

Atrial Flutter
→ Antara gel. R ada ≥ 3 gelombang, regular, saw tooth app

TAKIKARDIA
Ax: Palpitasi, sesak napas, nyeri dada, pusing, berkeringat Tx:  Medikamentosa

PF: Nadi > 100 x/mnt, takipneu, hipotensi § Sinus takikardi → Treat underlying disease

PP: EKG § SVT → Vagal maneuver, Adenosin 6 mg lanjut

Sinus Tachycardia 12 mg hingga 2 kali

→ Gel. P membentuk ‘camel hump’ appearance § VT → Amiodaron


§ Atrial fibrilasi, atrial flutter → Diltiazem/digoxin
 Non medikamentosa
QRS sempit
§ Reguler → 50-100 J
Atrial flutter, SVT, sinus takikardi
SVT (Supraventricular Tachycardia)
§ Irreguler → 120-200 J
→ Antara gel. R ada 1 gelombang
Atrial fibrilasi
QRS lebar
§ Reguler → 100 J
VT

JANTUNG
VES / PVC (PREMATURE VENTRICULAR CONTRACTION) TORSADE DE POINTES
Ax: Palpitasi, sinkop, sesak, keringat dingin
Bigemini PP: EKG
→ Normal – PVC – normal - PVC

Tx:  Medikamentosa
§ MgSO4 1-2 g selama 10-15 menit

Trigemini LBBB / LEFT BUNDLE BRANCH BLOCK


→ Normal – normal - PVC – normal - normal - PVC → W shaped block in V1, M shaped block in V6

→ RS Complex (small R wave, deep S wave)

Quadrigemini
→ Normal – normal - normal - PVC – normal - normal -
normal - PVC
RBBB / RIGHT BUNDLE BRANCH BLOCK
→ Typical RSR’ pattern (‘M’-shaped QRS) in V1

→ M shaped in V1, W shaped block in V6

Couplet
→ Normal - PVC – PVC – normal → Wide slurred S wave in lead I

→ Typical pattern of T-wave inversion in V1-3

Triplet
→ Normal - PVC – PVC - PVC - normal

JANTUNG
GAGAL JANTUNG / HEART FAILURE ANGINA PEKTORIS
Ax: Dyspneu d’effort, ortopneu, PND Ax: Stabil → Nyeri dada menjalar, timbul pada saat
PF: JVP ↑, takipneu, kardiomegali, gallop, ronki, beraktivitas, hilang bila istirahat, disertai keringat
hepatomegaly, asites, edema perifer dingin, mual muntah, sesak, pucat
PP: X-ray thoraks → kardiomegali, edema paru Unstable → Timbul saat istirahat maupun aktivitas,
Darah lengkap, EKG → LVH tidak membaik dg istirahat
DD: PPOK, asma, pneumonia, sirosis hepatik PP: EKG, X-ray thoraks → normal
Tx:  Non medikamentosa DD: GERD, gastritis akut, pleuritis
§ Terapi oksigen 2-4 L/mnt Tx:  Medikamentosa
§ Injeksi furosemide 20 mg/jam, max 600 mg R/ISDN 5 mg tab No. I
§ Pembatasan minum 1-1,5 L/hari S 1 dd tab I sublingual
§ Berhenti merokok dan konsumsi alkohol R/Propranolol 40 mg tab No. III
§ Tirah baring S 3 dd tab I
R/Aspirin 80 mg tab No. II

S 1 dd tab II
LVH (LEFT VENTRICULAR HYPERTROPHY)
→ S wave in V2 + R wave in V5 > 35 mm  Non medikamentosa
§ Pasang oksigen 2L/menit
§ Mengontrol emosi
§ Mengurangi konsumsi makanan berlemak
§ Berolahraga teratur
§ Mengontrol tekanan darah
→ LV strain pattern: ST depression and T wave inversion in
INFARK MIOKADIUM
the lateral leads
Ax: Nyeri dada, menjalar, disertai sesak, mual muntah, nyeri
epigastrium, keringat dingin
PF: Murmur ⊕, gallop S3 ⊕, ronki basah ⊕ bila edema paru
PP: EKG, enzim jantung ↑

→ ST elevation in V1-3 is simply in proportion to the very


deep S waves (“appropriate discordance”)
LV strain pattern in all leads with a positive R wave

DD: UAP, diseksi aorta, miokarditis, dispepsia
Tx:  Medikamentosa Tx:  Medikamentosa
R/ISDN 5 mg tab No. I Hipertensi Stage 1
S 1 dd tab I sublingual R/Captopril 12,5 mg tab No. XXI
R/Aspirin 80 mg tab No. IV S 3 dd tab I
S 1 dd tab IV Hipertensi Stage 2
R/Clopidogrel 75 mg tab No. IV R/Captopril 12,5 mg tab No. XXI
S 1 dd tab I S 3 dd tab I
 Non medikamentosa R/HCT 12,5 mg tab No. VII
§ Pasang oksigen 2L/menit S 1 dd tab I
 Non medikamentosa
§ Diet kaya buah, sayuran, rendah lemak
CARDIORESPIRATORY ARREST § Diet natrium 1 sendok teh garam/hari
Ax: 5H (hipovolemia, hipoksia, hydrogen ion/asidosis,
§ Olahraga 30 menit/hari selama 3 kali/minggu
hiper/hypokalemia, hipotermia)
§ Berhenti konsumsi alkohol
5T (tension pneumothorax, tamponade, overdosis obat,
trombosis coroner, trombosis pulmoner)
PP: EKG
Pulseless Electrical Activity (PEA)

Asystole



HIPERTENSI ESENSIAL

Klasifikasi TD Sistolik TD Diastolik


Normal < 120 mmHg < 80 mmHg
Pre-Hipertensi 120-139 mmHg 80-89 mmHg
Hipertensi St. 1 140-159 mmHg 90-99 mmHg
Hipertensi St.2 > 160 mmHg > 100 mmHg

Ax: Nyeri kepala, berdebar-debar, leher kaku, mata kabur


PF: TD ↑, JVP, batas jantung, ronki, status neurologis
PP: UL, GDA, GD2PP, GDP, profil lipid, Ur Cr
X-ray toraks
EKG
Funduskopi