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    Elektrokardiograf: Prof. Dr. Peter Kabo

    Uploaded by

    Achmad Damnhuri
    This document discusses electrocardiography (EKG/ECG) and cardiac arrhythmias. It covers topics such as EKG waveform morphology, intervals, axes, heart rates, arrhythmia classifications including sinus node diseases, atrial and junctional rhythms, pre-excitation syndromes, ventricular rhythms, and heart block. It also discusses underlying diseases that can cause arrhythmias, pharmacological treatments for different arrhythmias, and antiarrhythmic drug classifications and mechanisms of action. The document provides an overview of EKG interpretation and management of common cardiac arrhythmias.

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    Elektrokardiograf: Prof. Dr. Peter Kabo

    Uploaded by

    Achmad Damnhuri
    18 views56 pages
    This document discusses electrocardiography (EKG/ECG) and cardiac arrhythmias. It covers topics such as EKG waveform morphology, intervals, axes, heart rates, arrhythmia classifications including sinus node diseases, atrial and junctional rhythms, pre-excitation syndromes, ventricular rhythms, and heart block. It also discusses underlying diseases that can cause arrhythmias, pharmacological treatments for different arrhythmias, and antiarrhythmic drug classifications and mechanisms of action. The document provides an overview of EKG interpretation and management of common cardiac arrhythmias.

    Original Description:

    EKG presentasi

    Original Title

    Kuliah EKG

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    This document discusses electrocardiography (EKG/ECG) and cardiac arrhythmias. It covers topics such as EKG waveform morphology, intervals, axes, heart rates, arrhythmia classifications including sinus node diseases, atrial and junctional rhythms, pre-excitation syndromes, ventricular rhythms, and heart block. It also discusses underlying diseases that can cause arrhythmias, pharmacological treatments for different arrhythmias, and antiarrhythmic drug classifications and mechanisms of action. The document provides an overview of EKG interpretation and management of common cardiac arrhythmias.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    18 views56 pages

    Elektrokardiograf: Prof. Dr. Peter Kabo

    Uploaded by

    Achmad Damnhuri
    This document discusses electrocardiography (EKG/ECG) and cardiac arrhythmias. It covers topics such as EKG waveform morphology, intervals, axes, heart rates, arrhythmia classifications including sinus node diseases, atrial and junctional rhythms, pre-excitation syndromes, ventricular rhythms, and heart block. It also discusses underlying diseases that can cause arrhythmias, pharmacological treatments for different arrhythmias, and antiarrhythmic drug classifications and mechanisms of action. The document provides an overview of EKG interpretation and management of common cardiac arrhythmias.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 56

    Elektrokardiograf

    Prof. dr. Peter Kabo

    1. Irama

    : Sinus
    Bukan Sinus

    2. Laju QRS
    3. Aksis

    Atrial Fibrilasi
    SVT
    Irama JUNSION
    60-100 x/menit (normal)

    : HR?
    Regularitas
    : Normal
    RAD/LAD
    Superior Aksis
    : 0.20 Detik (Normal)

    4. Interval PR
    5. Morfologi
    a. Gelombang P
    b. Kompleks QRS

    c. Segmen ST
    d. Gel.T

    : Normal P.Pulmonal P.Mitral


    : Q patologis
    RSR pattern di V1&V2
    Interval-QRS (0.08 detik)
    : ST-elevasi, ST-depresi
    : Flat-T, Inverted-T, tall-T

    PA interval : 0.01-0.45 detik


    P dur
    : 0.06 0.2 detik
    Max
    : 0.1 detik
    AH interval
    : 0.05-0.13 detik
    PR-interval
    : 0.2 detik
    Max
    : 0.24 detik
    HV interval
    : 0.03-0.05 detik
    PRS dur
    : 0.08 detik
    Max
    : 0.1 detik

    6.7 x 20 = 134x/menit

    300 : 5.8 = 52x/menit

    3.3 x 50 = 165x/menit

    Gambar 3.2. Perhitungan aksis


    A. Aksis Normal
    : Lead I: I= +4.5; lead aVF : +12.5; aksis = 72
    B. Deviasi aksis ke kanan : Lead I = -10; lead aVF : +8; aksis = +140
    C. Deviasi aksis ke kiri : Lead I = +5; lead aVF : -10; aksis = - 60

    TERIMA KASIH

    CARDIAC ARRHYTHMIAS
    CLASSIFICATION :
    1. Sinus Node diseases :
    Sinus tachycardia / bradycardia
    SA block
    Wandering pace maker
    Hypersensitive carotid sinus syndrome (SSS)

    2. Disturbance of atrial rhytim :


    Atrial fibrilation
    Atrial flutter

    3. Disturbance of AV junction rhytim :


    Supraventricular tachycardia

    4. Pre-excitation syndrome :
    Woeff Parkinson White syndrome (S-wave)

    5. Disturbance of ventricular rhytim :


    Ventricular extra systole
    Ventricular tachycardia
    6. Heart Block :
    1 o HB
    2 o HB : - Wenckebach ( Mobits type I)
    - Mobitz type II
    o
    3 HB (total AV block) : - Temporary pace-maker
    - Permanent pace-maker
    R/ : - Simpatomimetik : Ephedrin
    - Anti cholinergic: Atropine

    COMMON UNDERLYING DISEASES CAUSING


    ARRHYTHMIAS
    1. Ischemic Heart Disease :
    Acute myocardial infarction
    Myocardial ischemia ( HHD, LVH, CAD)
    Left ventricle aneurysma
    2. CARDIOMYOPATHY
    3. Valvular Heart disease
    4. Myocarditis
    5. Congenital Hearth disease
    6. Conduction system abnormalities :
    Sinus R AV-node disease
    By pass tract
    7. Chronic pulmonary disease : Hypokemia
    8. Endocrine : Thyrotoxicosis
    9. Electrolide imbalance
    10. Drug-induce : Sympathomimetic, caffeine
    11. Increase Symphatetic / vagal activity

    DRUG

    Quinidine
    Procamamide
    Disopyramide
    Lidocaine
    Propafenone
    Amiodarone

    +
    +
    +

    Sotalol

    +
    +

    +
    +
    +

    BIO
    (%)

    T
    (hari)

    40 %

    4-10
    3-4
    4-10
    2
    2-32
    25-60

    100%

    10

    Doses
    Loading

    1 mg/kg BB
    800-1600
    (2 weeks)

    Doses Maintenance
    300-600
    750
    400-800
    4-3-2-1mg/kg BB
    450-900
    100-400
    80-320

    DRUGS

    INDICATIONS

    Quinidine

    AF

    Procamamide
    Disopyramide
    Lidocaine

    VES
    VES
    VES,VT

    Propafenone
    Amiodarone

    VES,VT,AF,SVT
    VES,VT,AF,SVT

    Sotalol

    VT,VES

    ADVERSE EFFECTS
    Cinchronism, Long QT
    syndrome, Hypotension,
    Diarrhea/Hepatitis,
    Thrombocytopenia
    Hypotension, Nausea, Lupus
    (-) miotropic, Anti cholinergic :
    dry mouth
    Constipation, urine retention,
    Glaukoma attack
    Hypotension, nystagmus,
    Seizure
    Hypotension, Hepatic
    disfunction, Pulmonary fibrosis,
    Hypo/Hyper thyroidism, Cornea
    microdeposit
    Heart failure, Bradycardia

    Tachycardia
    Unstable

    Stable

    Serious sign or symptoms


    prepare for immediate
    cardioversion

    Atrial fibrillation
    Atrial flutter

    Narrow-complex
    tachycardias

    Stable monomorphic
    VT or Polymorphic VT

    Narrow-complex Supra Ventricular Tachycardia (SVT)


    Vagel Stimulation
    Adenosine

    Juctional
    tachycardia

    Heart function
    preserved

    Amiodarone, B-blokers,
    Verapamil

    EF < 40%

    Amiodarone

    Heart function
    preserved
    Paroxysmal SVT
    EF < 40%

    Ectopic / multifocal
    atrial tachycardia

    Heart function
    preserved
    EF < 40%

    Verapamil, B-blokers,
    Digoxin, Cardioversion,
    Amiodarone, Sotalol,
    Adenosine
    Digoxin, Amiodarone
    Verapamil, B-blockers,
    Amiodarone
    Amiodarone

    ATRIAL FIBRILLATION / FLUTTER


    CONTROL RATE
    Normal Cardiac
    Function

    Verapamil
    B-Blocker

    Impaired Heart
    (EF < 40% or CHF )

    Digoxin

    CONVERT RHYTIM
    Amiodarone
    Propafenone
    Sulfas quinidine
    DC Cardioversion

    If AF > 48 hours duration : use anti arrithmic agents with extreme


    caution patients not receiving adequate anti coagulation because of
    possible embolic complication.
    Delayed cardioversion :
    Anti coagulation 3 weeks cardioversion anti coagulation 4 weeks

    CLASSIFICATION OF ANTIARRHYTMIC
    DRUGS
    I. Sodium channel blockers
    A. Sodium channel (++)
    Blocks K+ effluks (+)
    B. Sodium Channel (+)

    C. Sodium Channel (+++)

    Disopyramide
    Quinidine
    Procainamide
    Lidocaine
    Mekiletine
    Tocainide
    Flecamide, Encamide,
    Propafenone

    II. Anti adrenergic

    Beta blockers

    III. K+ channel effluks blockers


    also Na+ Blockers

    Amiodarone
    Sotalol

    IV. Ca++ channel blockers

    Verapamil, Diltiazem

    V. Autonomic effects
    Vagal stimulation
    Adenosine receptor activation

    Digoxin
    Adenosine

    Mechanisms of Antiarrhytmic Drug Action


    Decreased Phase 4 Slope

    B-blocker

    Increased Threshold

    Na+ channel
    blocker
    Ca++ channel
    blocker

    Increased Max-diastolic
    potential

    Adenosine
    Acetylcholine

    Increased action potential


    duration

    K+ channel
    blocker

    Antiarrhytmic drugs can cause


    arrhytmias
    Some arrthythmias should not be treated

    Mechanisms of Cardiac Arrhytmias


    1. Enhanced Automaticity :
    2. Triggered Automaticity :

    Sinus tachycardia
    Multifocal atrial tachycardia. VES

    Delayed after depolarization

    Early after depolarization

    3. Reentry
    Atrial fibrillation (AF)
    Atrial Flutter
    Supraventricular tachycardia (SVT)
    Ventricular tachycardia (VT)
    Woeff-Parkinson-White Syndrome

    4. Block
    1o AV block
    2o AV block
    3o AV block (Total AV Block)

    VT. Torsade de pointes

    Narrow QRS Complex


    Retrograde P
    Vent-rate : 140 200 x / min
    Vagal Maneuver Response
    Wide QRS Complex, V1(+), LAD/Superior
    AV dissociation / fusion beat
    Vent-rate : 150 250 x / min
    Vagal Maneuver No Response

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