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Cardiac arrhythmias Abnormal of Cardiac Rhythm Prof. dr. Peter Kabo PhD, MD, SpJP, SpFK, FIHA

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Cardiac arrhythmias Abnormal of Cardiac Rhythm

Prof. dr. Peter Kabo PhD, MD, SpJP, SpFK, FIHA

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Cardiac conduction system

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Normal cardiac rhytm

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Classification

Sympathomimetics : EphedrineAnticholonergic : Atrophine

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Mechanism of Cardiac Arrhytmias

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Trigger automaticityAfterdepolarization

Early Afterdepolarization

Delayed Afterdepolarization

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Reentry

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MacroreentryMacroreentry MicroreentryMicroreentry

Atrial Flutter Atrial Fibrillation

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The commonly found arrthymias Sinus tachycardia/ sinus bradycardia Atrial-/ ventricular- extrasystole Supra-ventricular tachycardia Atrial fibrilation/flutter

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Common underlying diseases causing arrhythmias

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Parasimpatomimetik (Kolinergik) Simpatomimetik (Adrenergik)Parasimpatolitik (antikolinergik) Simpatolitik (Antiadrenergik)

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FAAL SSO

Transmisi Neurohormonal

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Ion Channel in Cell Membrane

Ca+2 ↓

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Functional Consequences of The Arrhythmias

Palpitation Dizziness Syncope/ pre-syncope Fatigue Dyspnea Chest pain

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The Physical Examination (ECG are complemantery)

Jugular venous pulse Arterial pulse Heart sound

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Mechanism of anti arrhythmias drug action

Ant arrhythmic drugs can cause arrhythmiasSome arrhythmias should not be treated

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Classification of anti arrhythmia drugs

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O P Dosis Kadar puncak

Metab Eks Indikasi Efek samping

KINIDIN + + 3 X 200 mg 60 – 90’ H G/H AF, SVT

PROKAINAMID + + 3X (250000 – 500) mg

45 – 70’ H G VES, SVT Lupus like syndrome, leukopeni

DIISOPIRAMID + - 3X 100 mg 60 – 120’ H G VES, SVT Mulut kering, konstipasi, penglihatan kabur

LIDOKAIN - + 1 MG/ KG bb =1mg/ jam

H VT (pasca miokard infark)

hipotensi

PROPAFENON + + 3 x(150 -300) mg

60 – 180’ VES

Cinchonism

•Demam•Tinitus•Penglihatn kabur•Diplopia•Sakit kepala•Delirium•Prikosis•Gangguan GIT

Farmakokinetik

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AmiodaronFarmakokinetik indikasi Efek samping

O P T1/2 Dosis VT, AF Pro aritmik,Hipotensi, gangguan fungsi: hati, tiroid, paru & mata+ + 25 – 60 jam Loading 600

s/d 800 mg/ hariMaintenance 300mg/ hari

Farmakokinetik indikasi Efek samping

O P T1/2 Dosis SVT, VT Gagal jantung

+ - 11 jam 800 s/d 320 mg/hari

Sotalol

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Bradicardy

Heart Block1. Atropine (I.V.)2. Temporary Pacemaker3. Permanent Pacemaker

Sinus Bradicardy1.Ephedrine2.Aminophyline3.Atropine (I.V.)

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Permanent Pacemaker

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