arrhythmia (aritmia)

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ARRHYTHMIA Eko Antono Division of Cardiovascular Department of Internal Medicine Dr. Hasan Sadikin Hospital

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  • ARRHYTHMIA

    Eko Antono

    Division of Cardiovascular

    Department of Internal Medicine

    Dr. Hasan Sadikin Hospital

  • Diagrammatic representation of mechanism of reentry

  • Blood supply of the AV conduction system

  • The resting membrane potential and the action potential of an ordinary working cell from the ventricular myocardium

  • Schematic representation of pacemaker cell action potential

  • Schematic representation of ventricular myocardial working cell action potential

  • Action potentials recorded from isolated pacemaker cells immersed in a saline bath and firing at their own inherent discharge rates

  • Action potentials from different myocardial cells

  • TERMINOLOGY

    ETIOLOGY

    SIGNS AND SYMPTOMS

  • SINUS RHYTHM

  • Relation of an electrocardiogram to the anatomy of the cardiac conduction system

  • Sinus bradycardia.

  • Sinus tachycardia

  • SUPRAVENTRICULAR ARRHYTHMIAS

  • Non-compen-satory

    postextrasystolic pause

  • Short coupling interval in supra-ventricular extra-

    systole

  • Supraven-tricular

    extrasystole

  • Atrial flutter with high-grade AV block.

  • Atrial flutter. The atrial rate is 250 beats per minute, and the rhythm is regular. Every other flutter wave is conducted to ventricles (2:1 block), resulting in regular ventricular rhythm at a rate of 125 beats per minute

  • Atrial flutter with variable AV block.

  • The different appearances of the flutter line in atrial flutter

  • Fig 5.21

    (hal 141 & 142)

    Atrial flutter with an AV conduction ratio (AV-CR) at

    sleep and rest of 6 : 1 or 4 : 1 decreasing to 1 : 1 with

    slight exercise

  • Atrial fibrillation with controlled ventricular response.

  • Atrial fibrillation with rapid ventricular response

  • Atrial fibrillation (A) untreated and (B) after digitalis

  • VENTRICULAR

    ARRHYTHMIAS

  • Premature ventricular complex

  • Unifocal premature ventricular complexes. Note occurrence of wide, premature QRS complexes. Interval between preceding normal QRS and PVC (coupling interval) remains constant, and

    morphology remains the same

  • Multiformed premature ventricular complexes. Note variation in morphology and in coupling interval of PVCs

  • Premature ventricular complex with fully compensatory pause

  • Ventricular bigeminy. Note that every other betas is PVC. Both coupling interval and morphology remain constant; hence they

    are unifocal

  • Pairs of premature ventricular complexes

  • R-on-T phenomenon. Multiple PVCs are present. Mulitple PVCs are present. On right, a PVC falls on downslope of T wave,

    precipitating ventricular fibrillation

  • The QRST complex in ventricular

    arrhythmia

  • The apprearance of

    the QRST complex in ventricular

    extrasystole

  • Regular appearance

    of extrasystole

  • Lowns criteria (1975) for a

    grading system of warning

    arrhythmias in AMI

  • Precipitation of ventricular tachycardia by late-cycle PVC. Note brief salvo of ventricular tachycardia that is initiated by PVC

    occurring well beyond T wave

  • Ventricular tachycardia

  • Ventricular tachycardia and the diagnostic significance of ventricular extrasystole

  • Toardes de pointes

  • Torsade de pontes ventricular tachycrdial in third degree AV block

  • Coarse ventricular fibrillation

  • Fine ventricular fibrillation (coarse asystole)

  • Onset of ventricular fibrillation in the first hours of an acute myocardial infarction

  • Arrhythmogenic right ventricular dysplasia. A 6-

    year-old boy with fainting

    spells

  • Ventricular asystole

  • CONDUCTION

    DISTURBANCES

  • First-degree AV block. The PR interval is prolonged to 0.31 second

  • Second-degree AV block type I

  • Second-degree AV block type II.

  • Third-degree AV block occuring at level of AV node.

  • Third-degree AV block occuring at ventricular level

  • Review of cardiac

    arrhythmias (1) :

    Arrhythmias with extopic

    impulse formation

  • Review of cardiac

    arrhythmias (2) : Arrhythmias with

    disturbances in impulse

    conduction

  • BATAS AKHIR SLIDE

  • P wave polarity and pacemaker site in

    atrial and AV junctional

    arrhythmia

  • Extra-systole in singles (A) and in pairs of couplets

    (B) and brief attacks of

    tachycardial (C)

  • third-degree AV block with ventricular asystole

  • Premature junctional complexes

  • Junctional excape complexes

  • Paroxysmal supraventricular tachycardial (PSVT)

  • Atrial tachycardia with block

  • Survival rates are estimates of probability of survival to hospital discharge for patients with witnessed collapse and with ventricular fibrillation as initial rhythm