MI.16-MATERI EKG DISRITMIA PKKvTD 2024.pdf

ARITMIA

1. EKG DISRITMIA

2. SUKO BASUKI
Pendidikan : S1 Keperawatan UNDIP Semarang
Pekerjan : Ka.Ruang CVCU dan HCU Cardio
Organisasi : Pengurus INKAVIN seksi

3. TUJUAN PEMBELAJARAN
TujuanPembelajaranUmum
Pesertamampumemahamitentang
EKG Aritmia (EKG Strip)
TujuanPembelajarankhusus
Pesertamampumelakukan interpretasi
EKG Strip dengan benar

7. TERMINOLOGI
•Aritmia : IramaAbnormal
•Baseline : Merupakangarisdatar, lurus, garis
isoelektrik
•BentukGelombang: Gerakandaribaseline, naikatauturun
•Segmen : Garisisoelektrikyang menghubungkan
antara2 gelombang
•Interval : Jaraksatugelombangplus satusegmen
•Kompleks : Kombinasidaribeberapagelombang

8. LANGKAH INTERPRETASI EKG STRIP
Step 1 :Reguler/ ireguler.
•Step 2 :Frekuensi ( HR) berapa?
•Step 3:AdakahgelombangP ? Apakahbentuknya
normal?, PR interval?
•Step 4:AdakahkompleksQRS ? Bentuknya
normal?
•Step 5:ApakahgelombangP dankompleksQRS
berhubungan?
KESIMPULAN

9. SINUS RITME
Rate: Slow (60 sd 100 bpm)
Rhythm: Regular
P Waves: Normal (upright and uniform)
PR Interval: Normal (0.12–0.20 sec)
QRS: Normal (0.06–0.10 sec)

10. ARITMIA
Gangguanpembentukanimpuls
Gangguanpenghantaranimpuls

12. SINUS TACHYCARDIA
Rate: Fast (>100 bpm)
Rhythm: Regular
P Waves: Normal (upright and uniform)
PR Interval: Normal (0.12–0.20 sec)
QRS: Normal (0.06–0.12 sec)

13. Sinus Bradikhardi
Rate: Slow (<60 bpm)
Rhythm: Regular
P Waves: Normal (upright and uniform)
PR Interval: Normal (0.12–0.20 sec)
QRS: Normal (0.06–0.12 sec)

14. SINUS ARITMIA
Rate: Usually normal (60–100 bpm); frequently increases with inspiration and decreases
withexpiration
Rhythm: Irregular; varies with respiration
P Waves: Normal (upright and uniform)
PR Interval: Normal (0.12–0.20 sec)
QRS: Normal (0.06–0.12sec)

15. Sinus Arrest
Rate: Normal to slow; determined by duration and frequency of sinus pause (arrest)
Rhythm: Irregular whenever a pause (arrest) occurs
P Waves: Normal (upright and uniform) except in areas of pause (arrest)
PR Interval: Normal (0.12–0.20 sec)
QRS: Normal (0.06–0.12 sec)
3 -Sec pause/ arrest

17. B. Pembentukanimpulsdiatria (aritmiaatrial)
1. Ekstrasistolatrial
2. Takikardiaatrial
3. Flutteratrial
4. Fibrilasiatrial
GangguanPembentukanImpuls

18. AES/PAC ( Atrial Extra Sistole/ Premature Atrial Contraction)
Rate : Depends on rate of underlying rhythm
Rhythm : Irregular whenever a PAC occurs
P Waves : Present; in the PAC, may have a
different shape
PR Interval: Varies in the PAC; otherwise normal
(0.12–0.20 sec)
QRS : Normal (0.06–0.12 sec)
PAC

19. *
PAC
Fokus Ektopik
ada di atrial

20. ATRIAL TAKHIKARDI
Rate: 150–250 bpm
Rhythm: Regular
P Waves: Normal (upright and uniform) but differ in shape from sinus P waves
PR Interval: May be short (0.12 sec) in rapid rates
QRS: Normal (0.06–0.12sec) but can be aberrant at times

21. SVT ( Supraventricular Tachicardia)
Rate: 150–250 bpm
Rhythm: Regular
P Waves: Frequently buried in preceding T waves and difficult to see
PR Interval: Usually not possible to measure
QRS: Normal (0.06–0.12 sec)
This arrhythmia has such a fast rate that the P waves may not be seen.
P wave buried in T wave

22. PSVT ( Paroxismal SVT)
Rate : 150–250 bpm
Rhythm: Regular
P Waves: Frequently buried in preceding T waves and difficult to see
PR Interval: Usually not possible to measure
QRS : Normal (0.06–0.10 sec) but may be wide if abnormally conducted through ventricles

23. Atrial Flutter
Rate : Atrial: 250–350 bpm; ventricular: slow or fast
Rhythm : Usually regular but may be variable
P Waves: Flutter waves have a saw-toothed appearance
PR Interval : Variable
QRS : Usually normal (0.06–0.10 sec), but may appear widened if flutter waves
are buried in QRS
AV node conducts impulses to the ventricles at a 2:1, 3:1, 4:1, or greater ratio (rarely 1:1).

24. ATRIAL FIBRILASI
Rate: Atrial: 350 bpmor greater; ventricular: slow or fast
Rhythm: Irregular
P Waves: No true P waves; chaotic atrialactivity
PR Interval: None
QRS: Normal (0.06–0.12 sec)

25. Wolff-Parkinson-White (WPW)
Syndrome
Rate: Depends on rate of underlying rhythm
Rhythm: Regular unless associated with A-fib
P Waves: Normal (upright and uniform) unless A-fib is present
PR Interval: Short (0.12 sec) if P wave is present
QRS: Wide (0.10 sec); delta wave present
Delta wave

26. GangguanPembentukanImpuls
c.PembentukanimpulsdiNodusAV
1. Juntional Ekstrasistol(JES)
2. Junctinal Takikardia(JT)
3. Junctional Escape beat

27. Junctional Rhythm
Rate: 40–60 bpm
Rhythm: Regular
P Waves: Absent, inverted, buried, or retrograde
PR Interval: None, short, or retrograde
QRS: Normal (0.06–0.12 sec)
Inverted P Wave
Absent P wave

28. ASAL IMPULS IRAMA JUNCTIONAL

29. Junctional accelerated
Rate: 61–100 bpm
Rhythm: Regular
P Waves: Absent, inverted, buried, or retrograde
PR Interval: None, short, or retrograde
QRS: Normal (0.06–0.12 sec)

30. Juntional takhikardi
Retrograde P wave
Rate: 101–180 bpm
Rhythm: Regular
P Waves: Absent, inverted, buried, or retrograde
PR Interval: None, short, or retrograde
QRS: Normal (0.06–0.12 sec)

31. Juntional escape beat

32. PJC (Premature Juntional Contraction)
Rate: Depends on rate of underlying rhythm
Rhythm: Irregular whenever a PJC occurs
P Waves: Absent, inverted, buried, or retrograde in the PJC
PR Interval: None, short, or retrograde
QRS: Normal (0.06–0.10 sec)

33. GangguanPembentukan impuls
Pembentukanimpulsdiventrikel
( aritmiaventrikular)
1. Ekstrasistolventrikular
2. Takikardiaventrikular
3. Fibrilasiventrikular
4. Hentiventrikular

34. PVC (Premature Ventricular Contravtion), VES
Rate: Depends on rate of underlying rhythm
Rhythm: Irregular whenever a PVC occurs
P Waves: None associated with the PVC
PR Interval: None associated with the PVC
QRS: Wide (0.10 sec), bizarre appearance

35. VES UNIFORM/ UNIFOKAL
VES MULTIFORM/MULTIFOKAL
VES BIGEMINY

36. VES TRIGEMINY
VES TRIGEMINY, JIKA POLA INI BERULANG
VES COUPLET/ SALVO/ CONSECUTIVE/BERPASANGAN

37. VES R on T
VES munculdigelombangTpadaQRS sebelumnya

38. VT ( Ventricular Tachicardia)
Rate: 100–250 bpm
Rhythm: Regular
P Waves: None or not associated with the QRS
PR Interval: None
QRS: Wide (0.10 sec), bizarre appearance

40. TORSADE DE POINTES
Rate: 200–250 bpm
Rhythm: Irregular
P Waves: None
PR Interval: None
QRS: Wide (0.10 sec), bizarre appearance

41. VF ( Ventricular Fibrilasi)
Rate: Indeterminate
Rhythm: Chaotic
P Waves: None
PR Interval: None
QRS: None

42. IDIOVENTRIKULER
Irama : Teratur
Frekuensi : 20 –40x/ menit
GelombangP : Tidakada
Interval PR : Tidakada
GelombangQRS :Lebar> 0,12 detik

43. ASISTOLE

44. Gangguan Penghantaran Impuls
•Blok Sino Atrial
•Blok Atrioventrikuler
•Blok Intraventrikuler

45. SA BLOCK
DROPPED BEAT
Ciri-ciriSA Block:
Irama : Teraturkecualipadagelombangyang hilang
Frekuensi: Umumnya< 60x/menit, dipengaruhidurasidanfrekuensidaridrop beats.
GelombangP : Normal danhilangpadasaatterjadiblok
Interval PR : Normal danhilangsaatterjadiblok
GelombangQRS: Normal (0,06 –0,12 detik)

46. AV BLOCK DERAJAT 1
Rate: Depends on rate of underlying rhythm
Rhythm: Regular
P Waves: Normal (upright and uniform)
PR Interval: Prolonged (0.20 sec)
QRS: Normal (0.06–0.10 sec)

47. AVB DRAJAT 1 Mobitz I (Wenckebach)
Blocked beat
Rate: Depends on rate of underlying rhythm
Rhythm: Irregular
P Waves: Normal (upright and uniform)
PR Interval: Progressively longer until one P wave is blocked and a QRS is dropped
QRS: Normal (0.06–0.10 sec)

49. AVB DERAJAT II Mobitz II
•Irama :Umumnya tidak teratur, kadang bisa teratur
•Frekwensi HR:Umumnya lambat kurang dari 60 x/menit
•Gel. P :Normal / tapi ada satugel.P yg tidak diikuti gel
QRS
•Interval PR :Normal atau memanjang secara konstan.
•Gel. QRS :Normal

50. AV BLOCK TOTAL/ DERAJAT III
Rate: Atrial: 60–100 bpm; ventricular: 40–60 bpmif escape focus is junctional, 40 bpmif
escape focus is ventricular
Rhythm: Usually regular, but atria and ventricles act independently
P Waves: Normal (upright and uniform); may be superimposed on QRS complexes or T
waves
PR Interval: Varies greatly
QRS: Normal if ventricles are activated by junctionalescape focus; wide if escape focus
isventricular

51. BBB

55. GelombangP
Ada / Normal
Tidak Ada
Diikuti QRS
PR Interval
Tidak dapat dihitungMemanjang
Gel P teratur spt mata
gergaji
Normal
Gel P tidak teratur
TidakTeratur
Frekwensi
Teratur
< 60 x/mnt 60-100 x/mnt > 100 x/mnt
Sinus Rhythm Sinus Takikardi
Sinus Aritmia
Atrial Flutter
Sinus Bradikardi
Atrial Fibrilasi
AV Blok
Atrial Takikardi/ Supra
ventricular takikardi
Ventrikel
takikardi
Sempit Lebar
Komplek QRS
Teratur
Irama
Tidakteratur
Irama
Ventrikelfibrilasi

56. TENGKIYU