Kirim Ukai Arrhytmia

7/25/2019 Kirim Ukai Arrhytmia

1/24

ARITMIA

PATOFISIO-

LOGIFARMAKO-

TERAPI

7/25/2019 Kirim Ukai Arrhytmia

2/24

OBJECTIVES

1. MENJELASKAN TUJUANSASARAN

STRATEGI TERAPI - PROGNOSIS

2. MENJELASKAN MEKANISME KERJA OBAT

7/25/2019 Kirim Ukai Arrhytmia

3/24

Cardiovascular System: Heart

Conduction #1

No Nama

apex

atrioventricular bundle

atrioventricular node

left atrium

left ventricle

left and right bundle

branches

purkinje fibers

sinoatrial node

7/25/2019 Kirim Ukai Arrhytmia

4/24

Komponen sistem konduksi

(elektrik) jantung:

A. Noduspace makerterdiri dari 4 jenis

nodes, kerja nodes tersebut bergantian yang

paling dominan yang mengatur yaitu yang

memiliki frekuensi yang paling cepat dan

paling kuat. Pacemaker (PM) melakukan

perangsangan terhadap otot jantung terjadi

depolarisasi mendahului otot kontraksikembali repolarisasi dan otot kembali

relaksasi.

7/25/2019 Kirim Ukai Arrhytmia

5/24

TAMBAHAN

7/25/2019 Kirim Ukai Arrhytmia

6/24

TAMBAHAN

7/25/2019 Kirim Ukai Arrhytmia

7/24

7/25/2019 Kirim Ukai Arrhytmia

8/24

TAMBAHAN

7/25/2019 Kirim Ukai Arrhytmia

9/24

RANGSANG JANTUNG

Keadaan normal: pusat pembuat rangsang

jantung (pacemaker) ada di NSA nodus

sinoatrial atau sinus.

Aritmia : NSA tidak normal atau

meningkatnya frekuensi dan/atau kekuatan

pacemaker ektopik --- ritme jantung

sementara atau jangka panjang diatur olehpacemaker ektopik

7/25/2019 Kirim Ukai Arrhytmia

10/24

Jenis-jenis Aritmia

Pacemaker: primer vs. ektopik;

normal vs. abnormal

Pacemaker: jenis

atrial--- aritmia atrial

NSA ---- artimia sinusal

NAV ----aritmia junctional

ventrikelaritmia ventrikuler

7/25/2019 Kirim Ukai Arrhytmia

11/24

Aritmia

Aritmia 100-250x/m, ritme atrium = ventrikel.

Frekuensi 250-350x/m terdiri: frek atrium 300x/m; dan

frek ventrikel berupa atrial flutter rapid ventricle response;

atrial flutter normal ventricle response; atrial flutter slow

ventricle response.

Atrial fibralasi >350x/m risikostasis di atrium, agregasi

trombosit thrombus, thrombus bila terlepas dr tmp

menempelembolistroke. Bila terjadi di ventrikel

pengaruh hemodinamika kr ggg kontraksi.

7/25/2019 Kirim Ukai Arrhytmia

12/24

BRADIARITMIA

Terjadi kr depresi, kegagalan pembentukan

impuls dan kegagalan konduksi AV. Biasanya

asimptom tidak perlu terapi (stabil

hemodinamik). Perlu terapi bila terjadi

hipoperfusisirkulasi serebral dan koroner

tidak adekuat.

Terapi akut: atropin IV 0.6(max 3mg);isoprenalin infus 0.5-10mcg/min (hati2

pada IHD)

7/25/2019 Kirim Ukai Arrhytmia

13/24

Treatment goals

Prevent blood clots from forming to reduce

stroke risk

Control your heart ratewithin a relatively

normal range

Restore a normal heart rhythm, if possible

Treat heart disease/condition that may be

causing arrhythmia

Reduce other risk factors for heart disease

and stroke

7/25/2019 Kirim Ukai Arrhytmia

14/24

7/25/2019 Kirim Ukai Arrhytmia

15/24

TERAPI

7/25/2019 Kirim Ukai Arrhytmia

16/24

Manage risk factors

an arrhythmia increases risk of heart attack,

cardiac arrest and stroke. Control other risk

factors:

Reduce high blood pressure

Control cholesterol levels

Lose excess weight

Eat a heart-healthy diet

Avoid tobacco smoke

Enjoy regular physical activity

7/25/2019 Kirim Ukai Arrhytmia

17/24

Substances to avoid

Caffeine

Tobacco

Alcohol

Cold and cough medications Appetite suppressants

Psychotropic drugs (used to treat certain mental illnesses)

Antiarrhythmics (paradoxically, the same drugs used to

treat arrhythmia can also cause arrhythmia. Yourhealthcare team will monitor you carefully if you're taking

antiarrhythmic medication.)

Beta-blockers for high blood pressure

Cocaine, marijuana and speed or methamphetamines

7/25/2019 Kirim Ukai Arrhytmia

18/24

Medications

1. Antiaritmia

Amiodarone (Cordarone)

Bepridil Hydrochloride (Vascor)

Disopyramide (Norpace)

Dofetilide (Tikosyn)

Dronedarone (Multaq)

Flecainide (Tambocor)

Ibutilide (Corvert)

Lidocaine (Xylocaine)

Procainamide (Procan, Procanbid)

Propafenone (Rythmol) Propranolol (Inderal)

Quinidine (many trade names)

Sotalol (Betapace)

Tocainide (Tonocarid)

2. CCB

3. Beta-blockers

4. Anticoagulants

7/25/2019 Kirim Ukai Arrhytmia

19/24

MANAGEMENT OF ARRYTHMIA

Aritmia (bradikardia)

Takikardia

Atrialfibralasi

Coronary Bypass

Pacemaker

Catheter Ablation

Antikoagulan

7/25/2019 Kirim Ukai Arrhytmia

20/24

7/25/2019 Kirim Ukai Arrhytmia

21/24

7/25/2019 Kirim Ukai Arrhytmia

22/24

7/25/2019 Kirim Ukai Arrhytmia

23/24

TAMBAHAN

7/25/2019 Kirim Ukai Arrhytmia

24/24

TERIMA KASIH