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 1 reseptor

Palpitation
is a common, unpleasant, and often alarming awareness of
heartbeats.
Is sensations of a rapid or irregular heartbeatare 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.