aritmia cordis

7/25/2019 Aritmia Cordis

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Aritmia Cordis

Yudistira Panji Santosa


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Important aspects in understanding arrhythmias1. The mechanism:

- problems of impulse formation(automaticity)

- problems of impulse conduction (block orreentry)

2. The site of origin: - supraventricular

- ventricular

I


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The parts of Supraventricular and Ventricular Areas


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Sino-atrialnode (SAnode)

Atrio-ventricularnode (AV node)

Left bundlebranch

Right bundlebranch

Hisbundle

Purkinje


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(SAN

)

(AVN)

()

(H)

RA

LA

V

V

SAN

LA

H

V

RA

AVN


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!"#HAN$S! AN%R!AL $!P&LS'%R!A$%N

* +e,ressed

autoaticit.

/* "nhanced

autoaticit.

0* riggered

autoaticit.


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+e,ressed autoaticit.

$ntrinsic

rate


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"nhanced autoaticit.

Atrial or junctional or ventricular

rate e2ceed sinus rate(tach.cardia)


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A #

+ "

riggered activit.


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AVR

AVNR-t.,ical

- at.,ical

R"-"NR3


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Ventricular as.stole


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Sinus tach.cardia


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Sinus tach.cardia

normal physiologic response to exerciseor emotional stress or may bepharmacologically induced by such drugs

as epinephrine, ephedrine, or atropine. Exposure to alcohol, cafeine, or nicotine. Persistence o sinus tachycardia usually

signals an underlying disorder such asheart ailure, pulmonary embolism,hypo!olemia, or hypermetabolic states"


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Preature Atrial $,ulsesAtrial e2tras.stoles or ,reature atrial

contractions (PA#s)

#ound in normal indi!iduals$ myocardial ischemia,rheumatic heart disease, myopericarditis, congesti!eheart ailure, and a !ariety o systemic abnormalitiesincluding acid%base&electrolyte disturbances and

pulmonary diseases. Cafeine, tobacco, or alcohol use as 'ell as

emotional stress may initiate or exacerbatepremature atrial contractions.

Asymptomatic patients 'ith no underlying heartdisease re(uire no treatment other than remo!al othe underlying or precipitating actors.

) patients are symptomatic, beta%adrenergic

bloc*ing agents may pro!ide relie.


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su,raventricular tach.cardia (SV)


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Su,raventricularach.arrh.thias

All tachyarrhythmias that originate abo!ethe biurcation o the bundle o +is

he atrial rate must be - or more beats

per minute or a diagnosis, but the!entricular

rate may be less 'hen A/ conduction isincomplete.

classi0ed asparoxysmal (lasting secondsto hours), persistent (lasting days toweeks), or chronic (lasting weeks to

years).


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AN$ARRH3H!$# +R&4S


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AN$ARRH3H!$# +R&4S


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V"NR$#&LARA#H3#AR+$A


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Ventricular tach.cardia


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Ventricular tach.cardia and the diagnostic signi5cance of

ventricular e2tras.stole


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V is triggered b. 6R on 7 ventricular,reature beat

6R on7


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AR$AL 'L&"R

broad, atrial de1ections23#4 or 1utter'a!es2'hich ha!e a sa'toothcon0guration in leads )), ))), and a/#.

t'o types o atrial 1utter5 type ), orclassic, and type )) ype ) 1utter can be entrained and

interrupted 'ith atrial pacing

techni(ues.)t has an atrial rate o 67 to86 per minute ype )) 1utter has an atrial rate aster

than 89 per minute and cannot be

terminated by pacing


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usual atrio!entricular conduction ratio is 65- or95-

:ost commonly it is associated 'ith some ormo chronic heart disease, such as !al!ular

disease, congenital heart disease, orcardiomyopathy

reatment o choice in hemodynamicallycompromising atrial 1utter is lo' energy - to;


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AR$AL '$R$LLA$%N

disorgani=ed atrial de1ections and anirregular A/ conduction se(uenceresulting in a grossly irregular pattern o

the >?S complexes. Atrial 0brillatory 'a!es are best seen in

standard lead /- and are usually e!identin )), ))), and a/#.

Atrial 0brillation occurring in the absenceo structural heart disease is called loneatrial fbrillation


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Atrial 5brillation 8ith controlled ventricular res,onse*


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Signi0cant mitral or aortic !al!e disease,hypertension, coronary artery disease,cardiomyopathy, atrial septal deect, andmyopericarditis are all disease processesre(uently associated 'ith atrial0brillation.

Pulmonary emboli and thyrotoxicosis are'ell%*no'n causes o atrial 0brillation.

Consumption o cofee, tobacco, oralcohol and extreme stress or atigue alsopredispose to atrial 0brillation.


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)n the absence o underlying heartdisease, rest, sedation, and treatment'ith digitalis is the treatment o choice

or short paroxysms. Chronic therapy is based on the need to

control the !entricular rate duringrecurrences and may be accomplished

'ith digitalis, beta bloc*ers, or calciumchannel bloc*ers, as described or atrial1utter.


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'irst ",isode of Atrial 'ibrillation Paro2.sal Atrial 'ibrillation Persistent Atrial 'ibrillation #hronic Atrial 'ibrillation


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Anticoagulant in A'

anticoagulation is to limit the morbidityand mortality rom systemic andpulmonary emboli=ation

he decision

the balance bet'een therelati!e ris* o an embolic e!ent !ersusthe ris* o a major bleeding complicationsecondary to anticoagulant therapy

)nternational @ormali=ed ?atio )@?" o6. to 8..


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V"NR$#&LARARRH3H!$AS


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he 9RSco,le2 in

ventriculararrh.thia


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he,,rearanceof the 9RSco,le2 in

ventriculare2tras.stole

a,,earance


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a,,earanceof

e2tras.stole


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: /:

#o,lete co,ensator. ,ause

;unctional

interference


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$ntraventricularinterference

'usion beat


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Ventricular 'ibrillation


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Coarse !entricular 0brillation


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#ine !entricular 0brillation 3coarse4 asystole"


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RA+3ARRH3H!$AS

Sinus radycardia Sic* Sinus Syndrome #irst%Begree Atrio!entricular loc* Second%Begree Atrio!entricular loc* Complete Atrio!entricular loc*


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'irst-degree AV block* he PR interval is ,rolonged to


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Second-degree AV block t.,e $


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Second-degree AV block t.,e $$*


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hird-degree AV block occuring at level of AV node*


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i i i i


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+iagnostic criteriafor bundle branch blocks

#o,lete left bundle branchblock

>?S duration -6 msec road, notched ? 'a!es in lateral

precordial leads /;and /D" and usully

leads ) and a/l Small or absent initial r 'a!es in right

precordial leads /-and /6" ollo'ed by

deep S 'a!es Absent se tal 'a!es in let%sided leads

+i i i i


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+iagnostic criteriafor bundle branch blocks

#o,lete right bundle branch block >?S duration -6 msec

road, notched ? 'a!es rsr, rs?, orrS?" pattern in right precordial leads /-

and /6"


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+i ti it i


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+iagnostic criteriafor unifascicular blocks

Left anterior fascicular block #rontal plane mean >?S axis5 %9; to %F

degrees 'ith rS patterns in lead )), ))) and

a/ and a (? pattern in lead a/l >?S duration less than -6 msec

Left ,osterior fascicular block #rontal plane mean >?S axis5 G -6

degrees rS pattern in leads ) and a/l 'ith (?

patterns in inerior leads

>?S duration o less than -6 msec


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rite= co,lete R= LA+=

nterior fasicular heiblock (ifasicular bloc


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Pocket Guide To Basic Dysrhythmias 3rdEd . Robert J Huszar


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hank 3ou

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