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SA nodeSumber impuls normal/

alamiah , 60100 x/m

AV nodeBisa mengeluarkan

impuls 40-50x/menit

Berkas His

Serabut Purkinje

VentrikelBisa mengeluarkan impuls

30 x/m

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Atrial Depolarization

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Ventricle

Depolarization

0.12 second

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Terminologi morfologi QRS

qRs RsR

rS

QR Q/QS RsR rSr

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1 kotak kecil

= 0.04 detik

5 kotak kecil

= 1 kotak sedang

= 0.2 detik

5 kotak sedang

= 1 kotak besar

= 1 detik

Paper speed : 25 mm/second

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Cause of cardiac arrhythmias :

Disturbances in automaticity: bertambah cepatatau bertambah lambatnya suatu daerah otomatisiti.

Misal di sinus node, AV node, abnormal beats/depolarisasi dari atrium, AV junction, ventrikel, VT, dll.

Disturbances in conduction: konduksi terlalu cepat(WPW) atau terlalu lambat (blok AV).

Combinations of altered automaticity andconduction.

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How to identify arrhythmias ?

Treat the patient, not the monitor

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QRS complex ?

QRS complex

Cepat /lambat ?

QRS complex

Teratur / tidak ?

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QRS complex

Normal-looking QRS complex?

Wide / narrow ?

P wave ?

Relationship between P and QRS ?

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IRAMA SINUS

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PSVT :

-due to re-entry mechanism

-narrow QRS complex-regular

-retrograde atrial depolarisation

-P wave ?

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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).

-no uniform atrial depolarisation

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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

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Junctional rhythm:

-AV junction can function as a pace maker

(40-60 x/min).

-due to the failure of sinus node to initiate

timed impulse or conduction problem.

-normal-looking QRS.

-retrograde P wave.

-P wave may precede, coincide with, orfollow the QRS

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VES

SR

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SR SR SR SR SR SR

VES VES

Sinus rhythm with multifocal VES

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Sinus rhythm with VES couplet

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VENTRICULAR TACHYCARDIA

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TORSADE DE POINTES

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VENTRICULAR FIBRILLATION

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Prolonged PR interval

1st degree AV block

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2nd degree AV block, type 2

Missing QRS

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P PP P P P P

QRS QRS QRS

Total AV Block / 3rd degree AV block

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Treat the patient,not the monitor . . . . . . . . . .!!!

SELESAI

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LATIHAN

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Sinus Rhytm (Sinus Arrhythmia)

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Second Degree AV Block Type 1

(Mobitz type 1)

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Premature Ventricular Contraction

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Gangguan Perekaman

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Ventricular Tachycardia

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TAVB with Idioventricular escape rhythm

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Atrial Flutter

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Supra Ventricular Tachycardia

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Ventricular Tachycardia

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MATUR NUWUN

TERIMA KASIH

THANK YOU

SAKALANGKONG

Mba Marijan

KASOON

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