Kuliah Aritmia
Transcript of Kuliah Aritmia
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Cardiac arrhythmias Abnormal of Cardiac Rhythm
Prof. dr. Peter Kabo PhD, MD, SpJP, SpFK, FIHA
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Cardiac conduction system
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Normal cardiac rhytm
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Classification
Sympathomimetics : EphedrineAnticholonergic : Atrophine
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Mechanism of Cardiac Arrhytmias
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Trigger automaticityAfterdepolarization
Early Afterdepolarization
Delayed Afterdepolarization
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Reentry
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MacroreentryMacroreentry MicroreentryMicroreentry
Atrial Flutter Atrial Fibrillation
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The commonly found arrthymias Sinus tachycardia/ sinus bradycardia Atrial-/ ventricular- extrasystole Supra-ventricular tachycardia Atrial fibrilation/flutter
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Common underlying diseases causing arrhythmias
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Parasimpatomimetik (Kolinergik) Simpatomimetik (Adrenergik)Parasimpatolitik (antikolinergik) Simpatolitik (Antiadrenergik)
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FAAL SSO
Transmisi Neurohormonal
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Ion Channel in Cell Membrane
Ca+2 ↓
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Functional Consequences of The Arrhythmias
Palpitation Dizziness Syncope/ pre-syncope Fatigue Dyspnea Chest pain
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The Physical Examination (ECG are complemantery)
Jugular venous pulse Arterial pulse Heart sound
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Mechanism of anti arrhythmias drug action
Ant arrhythmic drugs can cause arrhythmiasSome arrhythmias should not be treated
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Classification of anti arrhythmia drugs
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O P Dosis Kadar puncak
Metab Eks Indikasi Efek samping
KINIDIN + + 3 X 200 mg 60 – 90’ H G/H AF, SVT
PROKAINAMID + + 3X (250000 – 500) mg
45 – 70’ H G VES, SVT Lupus like syndrome, leukopeni
DIISOPIRAMID + - 3X 100 mg 60 – 120’ H G VES, SVT Mulut kering, konstipasi, penglihatan kabur
LIDOKAIN - + 1 MG/ KG bb =1mg/ jam
H VT (pasca miokard infark)
hipotensi
PROPAFENON + + 3 x(150 -300) mg
60 – 180’ VES
Cinchonism
•Demam•Tinitus•Penglihatn kabur•Diplopia•Sakit kepala•Delirium•Prikosis•Gangguan GIT
Farmakokinetik
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AmiodaronFarmakokinetik indikasi Efek samping
O P T1/2 Dosis VT, AF Pro aritmik,Hipotensi, gangguan fungsi: hati, tiroid, paru & mata+ + 25 – 60 jam Loading 600
s/d 800 mg/ hariMaintenance 300mg/ hari
Farmakokinetik indikasi Efek samping
O P T1/2 Dosis SVT, VT Gagal jantung
+ - 11 jam 800 s/d 320 mg/hari
Sotalol
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Bradicardy
Heart Block1. Atropine (I.V.)2. Temporary Pacemaker3. Permanent Pacemaker
Sinus Bradicardy1.Ephedrine2.Aminophyline3.Atropine (I.V.)
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Permanent Pacemaker
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