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    Basic EKG Refresher

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    Jane Andrea Christiano Djianzonie
    1. The document discusses arrhythmias and heart disease, listing precipitating factors like underlying heart conditions, drugs, electrolyte abnormalities, and others. 2. It provides details on investigating arrhythmias through ECG, blood tests, chest x-rays and describes normal sinus rhythm, various types of arrhythmias like tachycardias and bradycardias. 3. Treatment options are outlined for different arrhythmias including atrial fibrillation, SVT, ventricular tachycardia, ventricular fibrillation and more.

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    Basic EKG Refresher

    Uploaded by

    Jane Andrea Christiano Djianzonie
    68 views57 pages
    1. The document discusses arrhythmias and heart disease, listing precipitating factors like underlying heart conditions, drugs, electrolyte abnormalities, and others. 2. It provides details on investigating arrhythmias through ECG, blood tests, chest x-rays and describes normal sinus rhythm, various types of arrhythmias like tachycardias and bradycardias. 3. Treatment options are outlined for different arrhythmias including atrial fibrillation, SVT, ventricular tachycardia, ventricular fibrillation and more.

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    Ekg

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    1. The document discusses arrhythmias and heart disease, listing precipitating factors like underlying heart conditions, drugs, electrolyte abnormalities, and others. 2. It provides details on investigating arrhythmias through ECG, blood tests, chest x-rays and describes normal sinus rhythm, various types of arrhythmias like tachycardias and bradycardias. 3. Treatment options are outlined for different arrhythmias including atrial fibrillation, SVT, ventricular tachycardia, ventricular fibrillation and more.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    68 views57 pages

    Basic EKG Refresher

    Uploaded by

    Jane Andrea Christiano Djianzonie
    1. The document discusses arrhythmias and heart disease, listing precipitating factors like underlying heart conditions, drugs, electrolyte abnormalities, and others. 2. It provides details on investigating arrhythmias through ECG, blood tests, chest x-rays and describes normal sinus rhythm, various types of arrhythmias like tachycardias and bradycardias. 3. Treatment options are outlined for different arrhythmias including atrial fibrillation, SVT, ventricular tachycardia, ventricular fibrillation and more.

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    Aritmia dan

    Kegawatan Jantung
    Zulfikri Mukhtar
    Departemen Kardiologi dan Kedokteran Vaskuler
    Fakultas Kedokteran USU
    Medan
    Arrhythmia.
     Definition : Lack of rhythm or abnormal
    rhythm.
    - Frequency ( bradycardia or tachycardia)
    (Normal sinus rhythm 60 – 100 x /min.)
    - Irregularity
    - Source of impuls
    - Sequence of activation
    Precipitating factors
     Underlying cardiac disease
    - Ischemic heart disease
    - Valvular heart disease
    - Hypertensive heart disease
    - Congenital heart disease
    - Pre excitation (short of PR interval)
    - Long QT (congenital or acquired)
    Precipitating factors
     Drugs
    - anti-arrhytmia
    - sympathomimetic.
    - B2 agonis, cocaine, anti depresants
    (tricyclic), Aminophylline, caffeine.
    - alcohol.
    Precipitating factors
     Metabolic abnormalities.
    - Electrolyte (low  K, Na, Ca, Mg )
    - Hypoximia, Hypercarbia.
    - Acidosis
    0 Endocrine abnormalities
    -Thyrotoxicosis, Phaeochrocytoma.
    Precipitating factors
     Miscellaneous.
    - Febrile illness
    - Emotional stress
    - Smoking
    - Fatigue.
    Investigation for arrhytmias
    1. 12 lead ECG and rhythm strip.
    2. Blood test : routine blood, electrolyte ,
    glucose, cardiac enzyme, thyroid level,
    drug level (digoxin), arterial blood gas.
    3. Chest x ray : heart size , pulmonary
    edema, lung cancer, pericardial
    effusion.
    EKG

    I. Sebutkan iramanya :
    Normal Sinus Rhythm
    The Heartbeat.
    Electromechanical association
    II. MENGHITUNG DENYUT JANTUNG :
    PJK
     SCHEMIA : ST depresi atau T
    inverted

     INFARCT : ST Elevasi

     NECROSIS (OLD INFARCT) :


    gel. Q patologis atau QSI
    Early Repolarisasi
    RBBB
    Acute Anterior MI
    Acute Inferoposterior MI
    Arrhytmia

    Tachyarrhythmia Bradyarrhytmia
    (rate >100 x/min) (rate < 60 X/min)

    • QRS sempit (<0.12 ms) • AV blok derajat 1, 2 & 3


    • QRS lebar (>0.12 ms) • RBBB & LBBB
    Diagnostic Tachyarrhytmia

     Lebar gel. QRS

     Keteraturan gel. QRS

    P wave ??
    QRS complex
    Teratur / tidak teratur ?

    QRS complex
    Sempit / lebar ?

    P wave ?

    Hubungan antara P and QRS ?


    QRS sempit : Supraventricular origin

    QRS sempit

    Irama
    Irama Teratur
    Tidak teratur

    Sinus Supraventricular Atrial


    Tachycardia Tachycardia Fibrillation

    Atrial Flutter
    QRS Lebar : Ventricular origin

    QRS lebar

    Irama
    Irama Teratur
    tidak teratur

    Ventricular Ventricular
    Tachycardia Fibrillation
    VES (Ventricular extrasystole)- VPB (ventricular prematur beat)- begemini -bifocal.

    VES couplet

    VT-ventricular tachycardia
    AF-atrial fibrillation, course P wave , RR interval irregular
    SVT
    RR interval regular, P or T wave not identified
    AF rapid
    VT , wide qrs , fixed axis

    VF, ventricular fibrillation, changed axis


    VT
    VT
    VF
    Torsade de Pointes
    Bradyarrhytmia
    (rate < 60 x/min)

    Failure of impulse AV conduction


    formation abnormalities
     Sinus Bradycardia  1st and 2nd AV Block

     Sick Sinus Syndrome  Total AV Block


     BBB (Bundle Branch
    Block)
    Sick Sinus Syndrome
    LBBB
    LBBB
    Treatment
     Atrial Fibrillation.
    - Rate control :
    1. Digoxin.
    Digitalization dose : 0,03 x BW (Kg)
    Maintenance dose : 0,125 – 0,25 mg
    /day, depends on – renal function.
    Route :oral tablet 0,25 mg or
    Injection ampule 0,5 mg
    The
    Deadly
    Rhythms

    PEA
    VT VF
    VF (Pulse less
    Electrical
    Activity)
    A systole
    2. Beta blocker
    - Propranolol
    - Metoprolol
    - Atenolol
    - Bisoplrolol
    - Carvedilol
    2. Rhythm control
    Main purpose is conversion to sinus rhythm.

     Amiodaron
    Tablet : 200 mg.
    Injection : 150 mg
    Loading dose : 3 x 200 mg ( 5 days)
    Maintenance dose : 100 – 200 mg / day.
    Contraindication : Thyroid and Lung
    (fibrotic) dysfunction.
    SVT-supraventricular Tachycardia
    1. ADP injection ( 8 mg – 20 mg )
    2. Verapamil injection ( 2,5 – 10 mg)
    3. Amiodaron injection.
    Loading dose : 300 mg / 250 cc in 30
    – 60 minutes.
    Maintenance dose : 450 – 600 mg /day
    4. Cardioversion : DC shock synchronize
    5. Ablation : radiofrequency or laser.
    VES.
     Amiodaron
    oral or injection : depends on benign or
    malignant extrasystole.
    VT
    Amiodaron : if patients hemodynamic:
    good (conscious, BP )
    DC shock synchronize : if instability
    hemodynamic.
    100 – 300 Joule.
    VF – ventricular fibrillation.
     DC shock asynchronized
    300- 350 joule.
    ICD – intracardiac defibrillation.

    EMD-electromechanical dissociation.

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