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ELEKTROKARDIOGRAFI
GANGGUAN ANTARAN, DISRITMIA, GANGGUAN
ELEKTROLIT dan PENGARUH OBAT
Supra ventricle
Junctional
Ventricular
Classification Arrhythmia and Conduction
disturbances
ARRHYTHMIA :
I. SUPRAVENTRCULAR ARRHYTMIA :
1. Atrial Extrasystole or Premature Atrial Contraction (PAC)
2. Sinus Rhythm and Sinus Tachycardia
3. Supraventricular Tachyarrhthmia
a. PSVT due to AV Nodal Reentry
b. PSVT due to Wolff Parkinson White (WPW) Syndrome
c. Other Reentrant SVTS
d. Ectopic atrial Tachycardia
e. Multifocal Atrial tachycardia
f. Atrial flutter
g. Atrial fibrillation
II. AV JUNCTIONAL and ACCELERATED VENTRICULAR RHYTHM :
1. AV Junctional Premature beat or AV nodal extrasystole
2. Accelerated Junctional and Accelerated Ventricular rhythm
3. AV Junctional Tachycardia
III. VENTRICULAR ARRHYTMIA :
1. Premature Ventricular Contraction
Arrhytmia
Tachyarrhythmia Bradyarrhytmia
(rate >100 x/min) (rate < 60 X/min)
P wave ??
QRS complex
Teratur / tidak teratur ?
QRS complex
Sempit / lebar ?
P wave ?
QRS sempit
Irama
Irama Teratur
Tidak teratur
Atrial Flutter
Tachyarrhytmia
QRS Lebar : Ventricular origin
QRS lebar
Irama
Irama Teratur
tidak teratur
Ventricular Ventricular
Tachycardia Fibrillation
Tachyarrhytmia
1. Atrial Extrasystole or Premature Atrial Contraction (PAC)
2. SINUS RHYTHM dan SINUS TACHYCARDIA
Source: Male, 48 years old, Heart Rate: 65bpm, PR: 188ms, QRS: 92ms
heartrhythmguide.com, 2008
Supraventricular Defects
List of Supraventricular Defects
Atrial Fibrillation
Atrial Flutter
Atrial Tachycardia
Premature Atrial Contraction Isolated
Premature Atrial Contraction Paired
Premature Atrial Contraction Atrial
Bigeminy
Premature Atrial Contraction Aberrantly
Conducted
Junctional Rhythm
Junctional Tachycardia
Accelerated Junctional Rhythm
Wandering Pacemaker
Premature Atrial Contraction Isolated
Irregular Rhythm
Heart Rate: None
P Wave: Premature and abnormal or hidden
PR Interval: Less then 200ms
QRS Interval: Less then 120ms
Premature Atrial Contraction Atrial Bigeminy
Irregular Rhythm
Heart Rate: None
P Wave: Premature and abnormal or hidden
PR Interval: Less then 200ms
QRS Interval: Less then 120ms
Wandering Pacemaker
Irregular Rhythm
Heart Rate: Less then 60 beats per minute (BPM)
P Wave: Multiple forms
PR Interval: Variable
QRS Interval: Less then 120ms
Ventricle Extra Systole =
Ventricle Premature Contraction
Premature Ventricular Complexes
Due to a part of the heart depolarizing earlier than it should. Looking at the ECG you'll see that:
Rhythm - Regular
Rate - Normal
QRS Duration - Normal
P Wave - Ratio 1:1
P Wave rate - Normal and same as QRS rate
P-R Interval - Normal
Also you'll see 2 odd waveforms, these are the ventricles depolarising prematurely in response to a signal within
the ventricles.(Above - unifocal PVC's as they look alike if they differed in appearance they would be called
multifocal PVC's, as below)
Ventricular Tachycardia (VT) Abnormal
Looking at the ECG you'll see that:
Rhythm - Regular
Rate - 180-190 Beats per minute
QRS Duration - Prolonged
P Wave - Not seen
Results from abnormal tissues in the ventricles generating a rapid and irregular
heart rhythm. Poor cardiac output is usually associated with this rhythm thus
causing the pt to go into cardiac arrest. Shock this rhythm if the patient is
unconscious and without a pulse
Ventricular Fibrillation (VF) Abnormal
Disorganised electrical signals cause the ventricles to quiver instead of contract in
a rhythmic fashion. A patient will be unconscious as blood is not pumped to the
brain. Immediate treatment by defibrillation is indicated. This condition may occur
during or after a myocardial infarct.
Looking at the ECG you'll see that:
Rhythm - Irregular
Rate - 300+, disorganised
QRS Duration - Not recognisable
P Wave - Not seen
This patient needs to be defibrillated!! QUICKLY
AICD
Automatic Implantable Cardioverter-Defibrillator
AICD stands for Automatic Implantable Cardioverter-Defibrillator
Automatically deliver a shock to your heart in emergencies
The
Deadly
Rhythms
PEA
VT VF
VF (Pulse less
Electrical
Activity)
A systole
ELECTROLYTE DISTURBANCES & DRUG EFFECT
Figure 13.2. ECG
changes associated
with moderate
hyperkalemia. Note that
T waves are tall and
symmetrically peaked,
and that there is mild J
point elevation in
V2 and V3.
TERIMA KASIH