Cardiac arrhythmias

Abnormal of Cardiac Rhythm

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

Cardiac conduction
system

Normal cardiac rhytm

Classification

Sympathomimetics : Ephedrine
Anticholonergic
: Atrophine

Mechanism of Cardiac Arrhytmias

Trigger automaticity
Afterdepolarization

Early Afterdepolarization

Delayed Afterdepolarization

Reentry

Macroreentry

Atrial Flutter

Microreentry

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)
(Adrenergik)
Parasimpatolitik (antikolinergik)
(Antiadrenergik)

Simpatomimetik
Simpatolitik

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 arrhythmias

Some arrhythmias should not be treated

Classification of anti arrhythmia

drugs

Farmakokinetik
O

Dosis

Kadar
puncak

Metab

Eks

Indikasi

KINIDIN

3 X 200 mg

60 90

G/H

AF, SVT

PROKAINAMID

3X (250000
500) mg

45 70

VES, SVT

Lupus like
syndrome,
leukopeni

DIISOPIRAMID

3X 100 mg

60 120

VES, SVT

Mulut kering,
konstipasi,
penglihatan kabur

LIDOKAIN

1 MG/ KG bb
=1mg/ jam

VT (pasca
miokard infark)

hipotensi

PROPAFENON

3 x(150 -300)
mg

Cinchonism
Demam
Tinitus
Penglihatn kabur
Diplopia
Sakit kepala
Delirium
Prikosis
Gangguan GIT

60 180

VES

Efek samping

Amiodaron
Farmakokinetik

indikasi

T1/2

25 60 jam

Dosis

VT, AF

Loading 600
s/d 800 mg/
hari
Maintenance
300mg/ hari

Efek samping
Pro aritmik,
Hipotensi, gangguan fungsi: hati,
tiroid, paru & mata

Sotalol
Farmakokinetik

indikasi

T1/2

11 jam

Dosis
800 s/d 320
mg/hari

SVT, VT

Efek samping
Gagal jantung

Bradicardy
Sinus Bradicardy
1.Ephedrine
2.Aminophyline
3.Atropine (I.V.)

Heart Block
1. Atropine (I.V.)
2. Temporary Pacemaker
3. Permanent Pacemaker

Permanent Pacemaker