Cardiac arrhythmias Abnormal of Cardiac Rhythm

Prof. dr. Peter Kabo PhD, MD, SpJP, SpFK, FIHA

Cardiac conduction system

Normal cardiac rhytm

Classification

Sympathomimetics : EphedrineAnticholonergic : Atrophine

Mechanism of Cardiac Arrhytmias

Trigger automaticityAfterdepolarization

Early Afterdepolarization

Delayed Afterdepolarization

Reentry

MacroreentryMacroreentry MicroreentryMicroreentry

Atrial Flutter Atrial Fibrillation

The commonly found arrthymias Sinus tachycardia/ sinus bradycardia Atrial-/ ventricular- extrasystole Supra-ventricular tachycardia Atrial fibrilation/flutter

Common underlying diseases causing arrhythmias

Parasimpatomimetik (Kolinergik) Simpatomimetik (Adrenergik)Parasimpatolitik (antikolinergik) Simpatolitik (Antiadrenergik)

FAAL SSO

Transmisi Neurohormonal

Ion Channel in Cell Membrane

Ca+2 ↓

Functional Consequences of The Arrhythmias

Palpitation Dizziness Syncope/ pre-syncope Fatigue Dyspnea Chest pain

The Physical Examination (ECG are complemantery)

Jugular venous pulse Arterial pulse Heart sound

Mechanism of anti arrhythmias drug action

Ant arrhythmic drugs can cause arrhythmiasSome arrhythmias should not be treated

Classification of anti arrhythmia drugs

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

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

Bradicardy

Heart Block1. Atropine (I.V.)2. Temporary Pacemaker3. Permanent Pacemaker

Sinus Bradicardy1.Ephedrine2.Aminophyline3.Atropine (I.V.)

Permanent Pacemaker