Bradikardia Simtomatis slide versio.pptx

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1. Bradikardia Simtomatis (SKDI 2019 : 3B) TOMMY DAINDES 1

2. Definisi Frekuensi Jantung < 60x/ menit dan biasanya baru menimbulkan gejala setelah < 50x/ menit Kriteria Bradikardia Simtomatis : Frekuensi jantung < 60x/ menit Pasien memiliki gejala Gejala yang timbul disebabkan oleh lambatnya frekuensi jantung Gejala : Chest discomfort, sesak nafas , penurunan kesadaran , keletihan , h oyong , pusing , pre- sinkop , sinkop Fauci A. Harrison's Principles of Internal Medicine 20 th Edition, McGraw Hill, 2018. 2

3. Klasifikasi Berdasarkan penyebab ; Fisiologis : selama istirahat , athlete’s heart Patologis Berdasarkan mekanisme : Gangguan pembentukan impuls Gangguan penghantaran impuls Berdasarkan lokasi penyebab : Kardiak ( intrinsik ) Non Kardiak ( ekstrinsik ) Fauci A. Harrison's Principles of Internal Medicine 20 th Edition, McGraw Hill, 2018. 3

4. Mekanisme Terjadinya Bradi-Aritmia Gangguan pembentukan impuls : Symptomatic Sinus Bradycardia Chronotropic Incompetence Sick Sinus Syndrome (SSS) Sinus Pause Sinus Arrest Gangguan penghantaran impuls : Sinoatrial (SA) Exit Block Atrioventricular (AV) Block 4 Fauci A. Harrison's Principles of Internal Medicine 20 th Edition, McGraw Hill, 2018.

5. Sinus Bradycardia 5

6. Sick Sinus Syndrome / Brady- Tachy Syndrome 6

7. Sinus Pause/Arrest 7

8. SA Exit Block 1 st Dgr . : Delay between impulse generation and transmission to the atrium. Not detected in surface ECG 2 nd Dgr . Type I (Wenckebach) : Progressive lengthening of the interval between impulse generation and transmission, culminating in failure of transmission. 2 nd Dgr . Type II : Intermittent dropped P waves with a constant interval between impulse generation and atrial depolarization. 3 rd Dgr . : None of the sinus impulses are conducted to the right atrium. Seen as Sinus Arrest / Sinus Pause in surface ECG 8 www.AlilaMEdicalMedia.com

9. Penyebab Bradikardia 9 American College of Cardiology (ACC) Bradycardia Guidelines, 2018. Intrinsic Cardiomyopathy (ischemic or nonischemic) Congenital heart disease Degenerative fibrosis Infection/inflammation Chagas disease Diphtheria Infectious endocarditis Lyme disease Myocarditis Sarcoidosis Toxoplasmosis Infiltrative disorders Amyloidosis Hemochromatosis Lymphoma Ischemia/infarction Rheumatological conditions Rheumatoid arthritis Scleroderma Systemic lupus erythematosus Surgical or procedural trauma Cardiac procedures such as ablation or cardiac catheterization Congenital heart disease surgery Septal myomectomy for hypertrophic obstructive cardiomyopathy Valve surgery (including percutaneous valve replacement) Extrinsic Autonomic perturbation Carotid sinus hypersensitivity Neurally-mediated syncope/presyncope Physical conditioning Situational syncope Cough Defecation Glottic stimulation Medical procedures Micturition Vomiting Sleep (with or without sleep apnea) Metabolic Acidosis Hyperkalemia Hypokalemia Hypothermia Hypothyroidism Hypoxia

10. Obat – Obatan yang Dapat Menginduksi Bradikardia 10 Antihypertensive Antiarrhythmic Psychoactive Other Beta-adrenergic receptor blockers (including beta-adrenergic blocking eye drops used for glaucoma) Clonidine Methyldopa Non-dihydropyridine calcium channel blockers Reserpine Adenosine Amiodarone Dronedarone Flecainide Procainamide Propafenone Quinidine Sotalol Donepezil Lithium Opioid analgesics Phenothiazine antiemetics and antipsychotics Phenytoin Selective serotonin reuptake inhibitors Tricyclic antidepressants Anesthetic drugs (propofol) Cannabis Digoxin Ivabradine Muscle relaxants (e.g., succinylcholine) American College of Cardiology (ACC) Bradycardia Guidelines, 2018.

11. Penegakan Diagnosis European Society of Cardiology (ESC) Guidelines in Cardiac Pacing & Cardiac Resynchronization Therapy, 2021. 11

12. Evaluasi Komprehensif Pasien Bradikardia 12 American College of Cardiology (ACC) Bradycardia Guidelines, 2018.

13. Penatalaksanaan Kondisi Akut 13 American Heart Association (AHA) Guideline in Advance Cardiac Life Support, 2020.

14. Bahan Bacaan Libby P, et al. Braunwald's Heart Disease. A Textbook of Cardiovascular Medicine, 2-Volume Set Harrison's Principles of Internal Medicine 20 Edition European Society of Cardiology (ESC) Guidelines in Cardiac Pacing & Cardiac Resynchronization Therapy, 2021. American College of Cardiology (ACC) Bradycardia Guidelines, 2018. American Heart Association (AHA) Guideline in Advance Cardiac Life Support, 2020. 14