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Paper Case of


1. Nazla syafawani. S
2. Nana khoirunnisa
3. Ulima dwi
4. Utari raodha
5. Imron

Paper Case of Arrhythmia
A 35-year-old woman presents to your office complaining of skipped or “irregular beats” for
the past few weeks. She paid little attention to her symptoms because she had been under
job-related stress and she thought these symptoms would disappear. Instead, her
occasional skipped beats increased in frequency to twice day, lasting up to 2 minutes. Her
father, who suffered from heart disease, urged her to see a doctor. There had been no chest
pain, shortness of breath, or dizziness. She consumes about two cups of coffee a day. She
recently tried some diet pills to lose weight but stopped this medicine when her symptoms
became more frequent. On examination, she is average build. Her blood pressure is 130/85
mmHg, her heart rate is 92 bpm, ear, eyes, nose nad throat (HEENT) examination is normal.
No conjunctival pallor noted. Neck examination is supple. No jugular venous distension.
Thyroid gland is normal size without nodules and is nontender. There are no associated
thyroid bruits. Lung examination is normal. Cardiac examinations are normal. Neurologic
examination no reveals no resting tremor. Reflexes are normal.

1. 35-year-old woman.
2. Irregular beat for the past few weeks.
3. Her occasional skipped beats increased in frequency to twice day, lasting up to 2
4. Her father suffered from heart disease.
5. No chest pain, shortness of breath, or dizziness.
6. She consumes about two cups of coffee a day.
7. She recently tried some diet pills but stopped this medicine when her symptoms
became more frequent.
8. Her blood pressure is 130/85 mmHg, her heart rate is 92 bpm.

Definition Arrhythmia
Heart rhythm disorder or arrhythmia is a common complication in myocardial
infarction. Arrhythmias or dysrhythmias are changes in the frequency and heart rhythm
caused by abnormal electrolyte conduction or automatic (Doenges, 1999). Arrhythmias
arising from electrophysiological changes in the cells of the myocardium. These
electrophysiological changes manifest as changes in the form of an action potential is a
graph recording the electrical activity of cells (Price, 1994). Heart rhythm disorder is not
confined to the irregularity of the heart rate but also including rate and conduction
disturbances (Hanafi, 1996).
Etiology of cardiac arrhythmias in the outline can be caused by:

1. Inflammation of the heart, such as rheumatic fever, myocardial inflammation (myocarditis

due to infection)

2. Impaired coronary circulation (coronary atherosclerosis or coronary artery spasm), such

as myocardial ischemia, myocardial infarction.

3. Because the drug (intoxication), among others by digitalis, quinidine and anti-arrhythmia
drugs other

4. Impaired balance of electrolytes (hyperkalemia, hypokalemia)

5. Disorders of the autonomic nervous system settings that affect the work and heart

6. Psychoneurotic disorder and central nervous system.

7. Metabolic disorders (acidosis, alkalosis)

8. Endocrine disorders (hyperthyroidism, hypothyroidism)

9. Cardiac rhythm disturbance due to cardiomyopathy or heart tumor

10. Cardiac rhythm disturbance due to degeneration (fibrosis of the conduction system of
the heart)

Signs And Symptoms Arrhythmias

There are some signs and symptoms of arrhythmias, namely

a. Change in BP (hypertension or hypotension); The pulse may be irregular; pulse deficit;

irregular heart rhythm sound, extra sound, pulse decreased; pale skin, cyanosis, sweating;
edema; Urine output decreases as weight decreases cardiac output.

b. Syncope, dizziness, throbbing, headache, disorientation, confusion, lethargy, change in


c. Mild to severe chest pain, may be lost or not with antianginal drugs, anxiety

d. Shortness of breath, cough, change of speed / depth of respiration; additional breath

sounds (krekels, crackles, wheezing) may exist indicate respiratory complications such as left
heart failure (pulmonary edema) or pulmonary tromboembolitik phenomena; hemoptysis.
e. Fever; redness of the skin (adverse drug reactions); inflammation, erythema, edema
(thrombosis siperfisial); loss of muscle tone / strength

f. Palpitations

g. Fainting

h. Discomfort in the chest

i. Weakness or fatigue (feeling)

j. Rapid heart rate (tachycardia)

k. Slow heartbeat (bradycardia)

Various Kinds of Arrhythmias

a. Sinus Tachycardia

Increased activity of the sinus node, which is an important description of the ECG are: the
rate of more than 100 X waves per minute, regular rhythm and no P wave upright
disandapan I, II, and aVF.

b. Sinus bradycardia

A decrease in the rate of depolarization atrim. Overview of the most important in the ECG is
less than the rate of 60 per minute, regular rhythm, wave p tgak disandapan I, II, and aVF.

c. Atrial premature complexes

Electrical impulses originating in the atrium but outside the sinus node causes atrial
premature complexes, sinus rate following the onset sebelu. ECG picture shows an irregular
rhythm, visible P waves of different shape to the next P wave.

d. tachycardia Atrium

An episode of atrial tachycardia is usually preceded by an atrial premature complexes that

occur reentri at the level of the AV node.

e. Fluter atrium.

This disorder because reentri at the atrial level. Accept atrial depolarization and orderly, and
the picture looks inverted II, III and aVF as picture or sawtooth

f. atrial fibrillation
Atrial fibrillation can tibul of ectopic focus and a dual or multiple reentri area. Atrial activity
very quickly.

The prevalence of Arrhythmia

Long-term epidemiological studies show that men are at risk of ventricular rhythm
disorder 2-4 times more than women. Epidemiological data from the New England Medical
Journal (2001) states that structural abnormalities of the coronary arteries is the cause of
80% of heart rhythm disturbances that can end with sudden death. Framingham the data in
2002 showed the incidence of heart rhythm disorders increases with age. expected, the
geriatric population (the elderly) will reach 11.39% in Indonesia, or 28 million people by
2020. Indonesia is increasingly age, preentase incidence will increase 70% by the age of 65-
85 years and 84% over 85 years.

Web : http://www.healthyenthusiast.com/aritmia.html

Document : Journal Arrhythmia

Definisi aritmia

Gangguan irama jantung atau aritmia merupakan komplikasi yang sering terjadi pada infark
miokardium. Aritmia atau disritmia adalah perubahan pada frekuensi dan irama jantung
yang disebabkan oleh konduksi elektrolit abnormal atau otomatis (Doenges, 1999). Aritmia
timbul akibat perubahan elektrofisiologi sel-sel miokardium. Perubahan elektrofisiologi ini
bermanifestasi sebagai perubahan bentuk potensial aksi yaitu rekaman grafik aktivitas listrik
sel (Price, 1994). Gangguan irama jantung tidak hanya terbatas pada iregularitas denyut
jantung tapi juga termasuk gangguan kecepatan denyut dan konduksi (Hanafi, 1996).


Etiologi aritmia jantung dalam garis besarnya dapat disebabkan oleh :

Peradangan jantung, misalnya demam reumatik, peradangan miokard (miokarditis karena


Gangguan sirkulasi koroner (aterosklerosis koroner atau spasme arteri koroner), misalnya
iskemia miokard, infark miokard.

Karena obat (intoksikasi) antara lain oleh digitalis, quinidin dan obat-obat anti aritmia

Gangguan keseimbangan elektrolit (hiperkalemia, hipokalemia)

Gangguan pada pengaturan susunan saraf autonom yang mempengaruhi kerja dan irama

Ganggguan psikoneurotik dan susunan saraf pusat.

Gangguan metabolik (asidosis, alkalosis)

Gangguan endokrin (hipertiroidisme, hipotiroidisme)

Gangguan irama jantung karena kardiomiopati atau tumor jantung

Gangguan irama jantung karena penyakit degenerasi (fibrosis sistem konduksi jantung)

D. Tanda Dan Gejala Aritmia

Ada beberapa tanda dan gejala Aritmia, yaitu

a. Perubahan TD ( hipertensi atau hipotensi ); nadi mungkin tidak teratur; defisit nadi;
bunyi jantung irama tak teratur, bunyi ekstra, denyut menurun; kulit pucat, sianosis,
berkeringat; edema; haluaran urin menurun bila curah jantung menurun berat.
b. Sinkop, pusing, berdenyut, sakit kepala, disorientasi, bingung, letargi, perubahan

c. Nyeri dada ringan sampai berat, dapat hilang atau tidak dengan obat antiangina,

d. Nafas pendek, batuk, perubahan kecepatan/kedalaman pernafasan; bunyi nafas

tambahan (krekels, ronki, mengi) mungkin ada menunjukkan komplikasi pernafasan seperti
pada gagal jantung kiri (edema paru) atau fenomena tromboembolitik pulmonal;

e. Demam; kemerahan kulit (reaksi obat); inflamasi, eritema, edema (trombosis

siperfisial); kehilangan tonus otot/kekuatan

f. Palpitasi

g. Pingsan

h. Rasa tidak nyaman di dada

i. Lemah atau keletihan (perasaan

j. Detak jantung cepat (tachycardia)

k. Detak jantung lambat (bradycardia)

B. Macam-Macam Aritmia

a. Sinus Takikardi

Meningkatnya aktifitas nodus sinus, gambaran yang penting pada ECG adalah : laju
gelombang lebih dari 100 X per menit, irama teratur dan ada gelombang P tegak disandapan
I,II dan aVF.

b. Sinus bradikardi

Penurunan laju depolarisasi atrim. Gambaran yang terpenting pada ECG adalah laju kurang
dari 60 permenit, irama teratur, gelombang p tgak disandapan I,II dan aVF.

c. Komplek atrium prematur

Impul listrik yang berasal di atrium tetapi di luar nodus sinus menyebabkan kompleks atrium
prematur, timbulnya sebelu denyut sinus berikutnya. Gambaran ECG menunjukan irama
tidak teratur, terlihat gelombang P yang berbeda bentuknya dengan gelombang P
d. Takikardi Atrium

Suatu episode takikardi atrium biasanya diawali oleh suatu kompleks atrium prematur
sehingga terjadi reentri pada tingkat nodus AV.

e. Fluter atrium.

Kelainan ini karena reentri pada tingkat atrium. Depolarisasi atrium cept dan teratur, dan
gambarannya terlihat terbalik II,III dan atau aVF seperti gambaran gigi gergaji

f. Fibrilasi atrium

Fibrilasi atrium bisa tibul dari fokus ektopik ganda dan atau daerah reentri multipel. Aktifitas
atrium sangat cepat.

prevalensi aritmia

studi epidemiologi jangka panjang menunjukan bahwa pria mempunyai resiko gangguan
irama ventrikel 2-4 kali lipat dibandingkan dengan wanita. data epidemiologi dari New
England Medical Journal (2001) menyebutkan bahwa kelainan struktur arteri koroner
merupakan penyebab 80% gangguan irama jantung yang dapat berakhir dengan kematian
mendadak. data framingham 2002 menunjukan angka kejadian gangguan irama jantung
akan meningkat dengan pertambahan usia. diperkirakan, populasi geriatri(lansia) akan
mencapai 11,39% di indonesia atau 28 juta orang indonesia pada tahun 2020. makin
bertambah usia, preentase kejadian akan meningkat yaitu 70% pada usia 65-85 tahun dan
84% diatas 85 tahun