EKG & TAKIARITMIA

SA node
Sumber impuls normal/
alamiah , 60 – 100 x/m

AV node
Bisa mengeluarkan
impuls 40-50x/menit

Berkas His
Serabut Purkinje

Ventrikel
Bisa mengeluarkan impuls
30 x/m
Terminologi morfologi QRS

R
qRs Rs rS

QR Q/QS RsR’ rSr’

Cause of cardiac arrhythmias :

• Disturbances in automaticity : bertambah cepat atau

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 and conduction.

 How to identify arrhythmias ?

“Treat the patient, not the monitor”

 QRS complex
Regular / irregular ?

QRS complex
Normal-looking QRS complex?
Wide / narrow ?

P wave ?

Relationship between P and QRS ?

PSVT :
-due to re-entry mechanism
-narrow QRS complex
-regular
-retrograde atrial depolarisation
-P wave ?
PSVT
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
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”
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, or
follow the QRS
SR

VES
 Sinus rhythm with multifocal VES

VES VES

SR SR
SR SR SR SR
Sinus rhythm with VES couplet
Sinus Rhythm with VES, R on T
 1st degree AV block

Prolonged PR interval
2nd degree AV block, type 1

Missing QRS Missing QRS

2nd degree AV block, type 2

Missing QRS
Total AV Block / 3rd degree AV block

QRS QRS QRS

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

SELESAI