4 Pathofisiologi Palpitation.4.1

8/19/2019 4 Pathofisiologi Palpitation.4.1

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© 2012 Pearson Education, Inc.

PathophyisioloPalpitation


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Capaian Pembelajaran

1. Mahasiswa mampu menjelaskan irama dan frekuensi de

jantung yang normal dan tidak normal2. Mahasiswa mampu menjelaskan macam-macam gangg

irama dan frekuensi denyut jantung

3. Mahasiswa mampu menjelaskan etiologi dada berdebar

debar

4. Mahasiswa mampu menjelaskan patofisiologi dada

berdebar-debar


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!"#$%"&! "'()*"#%'( +,&


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+engaturan %rama /antung


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+engaturan %rama /antung

• +usat0

• Medulla 'blongata0 cardioacceleratory center cardioinhibitorycenter

• &fferen0 hipotalamus baroreseptor kemoreseptor resep

regang atrial

• Mekanisme0

• (eural

• #onus simpatis

• #onus parasimpatis

• $efleks atrial

• ,ormonal


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+arasympathetic ympathetic

• parasympathetic

• inhibits & node depolarisation & conduction• Muscarinic receptor

• ympathetic

• &ccelerate & node depolarisation

• #erutama 51 reseptor


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Palpitation

• is a common unpleasant and often alarming awareness

heartbeats.• %s sensations of a rapid or irregular heartbeat6are most

caused by cardiac arrhythmias or an7iety.

• %t may result from0

• increased conscious perception of the normal cardiac rhythm

• any cardiac arrhythmia producing changes in heart rate rhythm

contraction pattern

• may be reported as a skipping pounding fluttering or similar sen


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#ypes of palpitations and their clinical presentations

Type of

palpitation

Subjective

description Heartbeat

Onset and

termination Trigger situat

7trasystolic8kipping9missing abeat8

%rregular interspersedwith periods of normalheartbeat

udden $est

#achycardiac8:eating wings8 in thechest

$egular or irregularmarkedly accelerated

udden+hysical effortcooling down

&n7iety-related &n7iety agitation$egular slightlyaccelerated

;radualtress &n7ietyattacks

+ulsation ,eart pounding$egular normalfre


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tiology

• "ardiac

• "onducting system disorders0 cardiac arrhythmia

• ") = ",)9%,) M% ",> $,) etc.?• "ardiac anatomic defect

• aortic or mitral regurgitation patent ductus arteriosus and septal d

• 7tra cardiac

• &n7iety

• orthostatic hypotension0 sense palpitations caused by sinus tachon standing.

• hyperkinetic circulatory states

• anemia fe@er


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tiology

• 7tra cardiac

• lectrolyte imbalances

• eg hypokalemia hypocalcemia and hypomagnesemia• )rug9 substance

• ympathomimetic0 "hatecholamin betha agonist caffein pseudo

pheniphenylpropanolamine

• illicit drugs0 methamphetamine or cocaine

• )rug to7icity0 antiarrhythmic agents cardiac glycosides


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Mechanism

• sensory mechanisms responsible for palpitation are unk

• %n general palpitations reflect changes in0• cardiac rate rhythm or both

• changes in contractility and9or @entricular contraction pattern.


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cardiac arrhythmia

• :radycardias

• #achycardias


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:radycardias

• sinus bradycardia= normal A; pattern? BCD :+M

• sinoatrial heart block• atrio@enticular heart block = &-123 degrees?


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#achycardias

• sinus tachycardia = E1DD per minute?

• atrial tachycardia = E1FD-2DD per minute?• atrial flutter = E22D-3CD per minute?

• atrial fibrillation = E4DD-CFD per minute?

• @entricular tachycardia or @entricular fibrillation =>? = 3 o

more at E1DD per minute?

• paro7ysmal supra@entricular tachycardia


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Alarm

paro7ysmal supra@entricular tachycardia

Myocardial scarring

electrical reentrant circuits

'ld myocardial infarction

+aro7ysmal upra@entricular #achycardia

Palpitation

hyperthyroidism

polyuria

Gatrial natriuretic peptide =&(and Harginine @asopressin =&

timulants0

caffeine drugs alcohol


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Alarm

#

Myocardial scarring

electrical reentrant circuits

'ld myocardial infarction

entricular #achycardia

Palpitation

myocardial %schemic or infarction

"ardiac &rrest

death

hemodynamic collapse

ymphatic acti@ity

uddent death

opens A + channels

acidosis


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ffect of palpitation

• $elated to underlying problem0

•+olyuria may follow paro7ysmal supra@entricular tachycardia

• yncope following an episode sinus node dysfunction with o@er

suppression of normal pacemaker function after a bout of atrial

tachyarrhythmia.

• +alpitations immediately preceding syncope are classic sympto

sick sinus syndrome.

• hemodynamic collapse

• "ardiac &rrest

• uddent death0 >


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$eference

I !u eh / !ee ,ung / u ). 1LJ. Mechan

of polyuria and natriuresis associated with paro7ysmal supra@entricular tachycardia. /pn,eart /. 1LJ MarK2=2?02D3-L.

4 Pathofisiologi Palpitation.4.1

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