SUPRAVENTRIKULAR &

VENTRIKULAR ARRHYTMIA
 The EKG must be interpreted in
the clinical context.

• Don’t order a test unless you

know what to do with the
results…
EKG findings in Sentinel Death Events

• Cardiomyopathies: (flipped T waves

plus…)
– Hypertrophic Cardiomyopathy (LVH)
– Dilated (LVH)
– Restrictive cardiomyopathy (low voltage,a-
fib, conduction disturbances)
– Arrhythmogenic Right Ventricular
Dysplasia /Cardiomyopathy (Epsilon
waves, RBBB pattern)
 EKG findings in Sentinel Death Events

• Primary arrhythmic syndromes

– Brugada coved/saddle deformity ST V1 &V2
– WPW Delta waves, short PR interval, RBBB pattern
– Prolonged/shortened QT
– Catecholaminergic Polymorphic Ventricular
Tachycardia: Normal RESTING EKG/ECHO with recurrent syncope
starting in childhood related to exertion/emotions.
 EKG findings in Sentinel Death
Events
• Myocarditis (diffuse flipped T waves)
• Congenital coronary-artery anomalies (large p
waves)
• Coronary artery disease: (Wellen’s Sign, Hyperacute
T waves, Too tall T-waves)
• Valvular disorders (AS: LVH; MVP: normal or flipped
T waves inferiorly)
Gelombang P : depolarisasi kedua atrium
Gelombang QRS : Depolarisasi kedua Ventrikel
Gelombang T : Repolarisasi Kedua Ventrikel
 Normal Sinus Rhythm

Heart Rhythm P Wave PR Interval QRS

Rate (in seconds) (in seconds)

60 – 100 bpm Regular Before each QRS, 0.12 - 0.20 < 0.12
 The Normal Adult EKG

• Majority QRS complexes are positive (have tall R waves)

– Except AVR & V1-2; r-wave progression across the precordium
– T wave in V1 should be small, flat or flipped
 ARRHYTMIA
4 basic types of arrhytmia :
• Sinus origin
• Ectopic Beat
• Conduction Block
• Preexcitation syndromes
 How to identify arrhythmias ?

“Treat the patient, not the monitor”

 QRS complex
Regular / irregular ?

QRS complex
Normal-looking QRS complex?
Wide / narrow ?

P wave ?

Relationship between P and QRS ?

 Arrhytmia…

Sinus Origin

• Sinus Bradikardia
• Sinus Takikardia
• Sinus Aritmia
could be normal rate changes (does not
remain regular)
• Sinus Arrest
Escape beat
 Sinus Arrhytmia
Inspiration

Expiration

Heart Rate Irama Gelombang p PR interval Durasi QRS

Usually 60- irregular Before each 0,12-0,20 s < 0,12

100 bpm QRS,
identical
 Tachycardia classification
• Narrow QRS Complex
– Regular
– Iregular
• Wide QRS Complex
– Regular
– Iregular
Classification?
Kompleks QRS

QRS SEMPIT

QRS LEBAR
+ ABBERANCY
 Arrhytmia…
Ectopic Rhytms
originated outside of the SA Node
• Paroxysmal Supraventricular Tachycardia
- Paroxysmal Atrial Tachycardia (PAT)
- Paroxysmal Junctional Tachycardia
• Atrial Flutter
• Atrial Fibrilation
• Multifokal Atrial Tachycardia
note : If normal rate, then called wandering
pace maker
 Narrow QRS Complex
Tachycardia
– With irregular rhythm :
• Atrial fibrilasi (AF)
• Atrial flutter (Af) with varying block
• Atrial takikardi (AT) with varying block
– With regular rhythm : SVT
• Atrial flutter (Af)
• Atrioventricular Reprocicating Tachycardia (AVRT)
• Atrioventricular Nodal Reentrant Tachycardia (AVNRT)
• AT
• Junctional Tachycardia (JT)
• Narrow complex Ventricle Tachycardia (VT)
Atrial Fibrillation :

-from multiple area of re-entry within atria

-or from multiple ectopic foci
-irregular, narrow QRS complex
-very rapid atrial electrical activity
(400-700 x/min).
- Ventricular beat slow to rapid
-no uniform atrial depolarization
Atrial Flutter :
-The result of a re-entry circuit within
the atria
-Irregular / regular QRS rate
-Narrow QRS complex
-Rapid P waves (300x/min), “sawtooth”
-Ventricular beat : < 300 bpm
Atrial Flutter

Atrial Fibrilasi
PSVT :
-due to re-entry mechanism
-narrow QRS complex
-regular
-retrograde atrial depolarization
-P wave ?
Supraventricular tachycardia
Wide QRS Complex Tachycardia

– VT
– Supraventrikular Takikardi (SVT) dengan
bundle branch block (BBB)
• Aberrancy
• Pre-existing BBB
– SVT dengan pre-eksitasi
SR

VES
 Arrhytmia…

Non Sustained Abnormal Beat

• Premature Ventricular Contraction

- Multifokal
- Couplet
- Bigemini or trigemini
• Ventricular Tachycardia
• Ventricular Fibrilation
 Sinus rhythm
with
Multifocal VES

VES VES

SR SR
SR SR SR SR
Sinus rhythm with VES couplet
Premature ventricular contraction
Nonsustained Monomorphic VT
Ventricular Tachycardia
Ventricular Fibrillation
Torsade de Pointes
Torsades de pointes
CONDUCTION BLOCK
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

ECG
• Delta waves, short PR interval
WPW
• tall R-waves in V1, RBBB pattern
• Pseudoinfarction pattern inferiorly
Wolf Parkinson White
 60 y/o comatose s/p MVA
Low voltage

Simple cifferential of low voltage: air, fat, fluid, no

ECG