ARRHYTHMIA

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
Tachyarrhythmia Bradyarrhytmia
(rate >100 x/min) (rate < 60 X/min)

• QRS sempit (<0.12 ms) • AV blok derajat 1, 2 & 3

• QRS lebar (>0.12 ms) • RBBB & LBBB
 QRS complex
Teratur / tidak teratur ?

QRS complex
Sempit / lebar ?

P wave ?

Hubungan antara P and QRS ?

QRS sempit : Supraventricular origin

QRS sempit

Irama
Irama Teratur
Tidak teratur

Sinus Supraventricular Atrial

Tachycardia Tachycardia Fibrillation Atrial Flutter

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
Electrical
Activity)
A systole
Thank You