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Pathophyisiology
Palpitation
© 2012 Pearson Education, Inc.
Capaian Pembelajaran
1. Mahasiswa mampu menjelaskan irama dan frekuensi denyut
jantung yang normal dan tidak normal
2. Mahasiswa mampu menjelaskan macam-macam gangguan
irama dan frekuensi denyut jantung
3. Mahasiswa mampu menjelaskan etiologi dada berdebardebar
4. Mahasiswa mampu menjelaskan patofisiologi dada
berdebar-debar
ELECTRICAL CONDUCTION PATHWAY
Pengaturan Irama Jantung
Pengaturan Irama Jantung
• Pusat:
• Medulla Oblongata: cardioacceleratory center & cardioinhibitory
center
• Afferen: hipotalamus, baroreseptor, kemoreseptor, reseptor
regang atrial
• Mekanisme:
• Neural
• Tonus simpatis
• Tonus parasimpatis
• Refleks atrial
• Hormonal
Parasympathetic & Sympathetic
• parasympathetic
• inhibits SA node depolarisation & AV conduction
• Muscarinic receptor
• Sympathetic
• Accelerate SA node depolarisation
• Terutama β1 reseptor
Palpitation
• is a common, unpleasant, and often alarming awareness of
heartbeats.
• Is sensations of a rapid or irregular heartbeat—are most often
caused by cardiac arrhythmias or anxiety.
• It may result from:
• increased conscious perception of the normal cardiac rhythm
• any cardiac arrhythmia producing changes in heart rate, rhythm, or
contraction pattern
• may be reported as a skipping, pounding, fluttering, or similar sensation.
Types of palpitations and their clinical presentations
Type of
palpitation
Subjective
description
Heartbeat
Possible
Onset and
Trigger situations associated
termination
symptoms
Extrasystolic
'Skipping/missing a
beat',
Irregular, interspersed
with periods of normal
heartbeat
Sudden
Rest
—
Tachycardiac
'Beating wings' in the Regular or irregular,
chest
markedly accelerated
Sudden
Physical effort,
cooling down
Syncope, dyspnea,
fatigue, chest pain
Anxiety-related Anxiety, agitation
Regular, slightly
accelerated
Gradual
Stress, Anxiety
attacks
Tingling in the
hands and face,
atypical chest pain,
sighing dyspnea
Pulsation
Regular, normal
frequency
Gradual
Physical effort
Asthenia
Heart pounding
Etiology
• Cardiac
• Conducting system disorders: cardiac arrhythmia
• CVD ( CHD/IHD, MI, CHF, RHD, etc.)
• Cardiac anatomic defect
• aortic or mitral regurgitation, patent ductus arteriosus, and septal defects
• Extra cardiac
• Anxiety
• orthostatic hypotension: sense palpitations caused by sinus tachycardia
on standing.
• hyperkinetic circulatory states
• anemia, fever
Etiology
• Extra cardiac
• Electrolyte imbalances
• eg, hypokalemia, hypocalcemia, and hypomagnesemia
• Drug/ substance
• Sympathomimetic: Chatecholamin, betha agonist, caffein, pseudo-efedrine,
pheniphenylpropanolamine
• illicit drugs: methamphetamine, or cocaine
• Drug toxicity: antiarrhythmic agents, cardiac glycosides
Mechanism
• sensory mechanisms responsible for palpitation are unknown.
• In general, palpitations reflect changes in:
• cardiac rate, rhythm, or both
• changes in contractility and/or ventricular contraction pattern.
cardiac arrhythmia
• Bradycardias
• Tachycardias
Bradycardias
• sinus bradycardia( normal EKG pattern) <60 BPM
• sinoatrial heart block
• atrioventicular heart block ( AV-1,2,3 degrees)
Tachycardias
•
•
•
•
•
sinus tachycardia ( >100 per minute)
atrial tachycardia ( >150-200 per minute)
atrial flutter ( >220-360 per minute)
atrial fibrillation ( >400-650 per minute)
ventricular tachycardia or ventricular fibrillation (VF) ( 3 or
more at >100 per minute)
• paroxysmal supraventricular tachycardia
paroxysmal supraventricular tachycardia
Old myocardial infarction
hyperthyroidism
Stimulants:
caffeine, drugs, & alcohol
Myocardial scarring
electrical reentrant circuits
Paroxysmal Supraventricular Tachycardia
Palpitation
Alarm
↑atrial natriuretic peptide (ANP)
and ↓arginine vasopressin (AVP)
polyuria
VT
Old myocardial infarction
myocardial Ischemic or infarction
opens KATP channels
acidosis
Myocardial scarring
electrical reentrant circuits
Ventricular Tachycardia
Symphatic activity
Palpitation
hemodynamic collapse
Cardiac Arrest
Suddent death
Alarm
death
Effect of palpitation
• Related to underlying problem:
• Polyuria may follow paroxysmal supraventricular tachycardia
• Syncope following an episode sinus node dysfunction with overdrive
suppression of normal pacemaker function after a bout of atrial
tachyarrhythmia.
• Palpitations immediately preceding syncope are classic symptoms of
sick sinus syndrome.
• hemodynamic collapse
• Cardiac Arrest
• Suddent death: VF
Reference
• Luqman N, Sung RJ, Wang CL, Kuo CT. 2007. Myocardial ischemia and ventricular fibrillation:
pathophysiology and clinical implications.Int J Cardiol;119(3):283-90
• Tsai RC, Yamaji T, Ishibashi M, Takaku F, Yeh SJ, Lee YS, Hung JS, Wu D. 1987. Mechanism
of polyuria and natriuresis associated with paroxysmal supraventricular tachycardia. Jpn
Heart J. 1987 Mar;28(2):203-9.