LAPORAN PENDAHULUAN ATRIAL FIBRILATION FIBRILATION
OLEH HARY BUDIANTO S. Kep 1514901132
UNIVERSITAS MUHAMMADIYAH BANJARMASIN PROGRAM STUDI PROFESI NERS A TAHUN AKADEMIK 2015/2016
1. Def!"
Atrial i!rila"i #A$% a&ala' "(at( )a*))(a* pa&a +a*t(*) ,a*) pali*) (-(- #rit-e +a*t(*) a!*r-al% ,a*) &ita*&ai &e*)a* ira-a &e*,(t +a*t(*) ire)(lar &a* pe*i*)/ata* re/(e*"i &e*,(t +a*t(*) ,ait( "e!e"ar 35050 -e*it. a&a &a"ar*,a atrial i!rila"i -er(pa/a* "(at( ta/i/ar&i "(pra6e*tri/(ler &e*)a* a/ti6a"i atrial ,a*) ti&a/ ter/r&i*a"i "e'i*))a ter+a&i )a*))(a* (*)"i -e/a*i/ atri(-. Kea&aa* i*i -e*,e!a!/a* ti&a/ ee/ti*,a pr"e" -e/a*i/ ata( p-pa &ara' +a*t(*) . Dari )a-!ara* ele/tr/ar&i)ra- A$ &apat &i/e*ali &e*)a* a!"e**,a )el-!a*) ,a*) &i)a*ti le' i!rila"i ata( "/ila"i a*tara 400700 per-e*it &e*)a* !er!a)ai !e*t(/ (/(ra* +ara/ &a* 8a/t( ti-!(l*,a ,a*) &i'(!(*)/a* &e*)a* re"p* 6e*tri/el ,a*) epat &a* ti&a/ terat(r !ila /*&(/"i A: -a"i' (t('. Ira-a "e-aa- i*i "eri*) &i"e!(t"e!a)ai )el-!a*) ;< 2. E#$%$&
Etil)i ,a*) ter/ait &e*)a* A$ ter!a)i -e*+a&i !e!erapa a/tra/tr &ia*tara*,a a&ala' = a. e*i*)/ata* te/a*a*re"i"te*"i atri(1. e*,a/it /at(p +a*t(*) 2. Kelai*a* pe*)i"ia* &a* pe*)"*)a* r(a*) atr i(3. Hipertri +a*t(*) 4. Kar&i-ipati 5. Hiperte*"i p(l- #chronic obstructive pulmonary disease &a* cor pulmonal chronic% . T(-r i*traar&ia !. r"e" i*iltrati &a* i*la-a"i 1. eriar&iti"-,ar&iti" 2. A-ili&"i" &a* "ari&"i" 3. $a/tr pe*i*)/ata* ("ia . r"e" i*e/"i 1. De-a- &a* "e)ala -aa- i*e/"i
&. Kelai*a* E*&/ri*
1. Hipertiri& 2. $e/r-"it-a e. Ne(r)e*i/ 1. Str/e 2. er&ara'a* "(!ara'*i& . I"/e-i/ Atri(- #I*ar/ -,ar&ial% ). O!at!ata* 1. Al/'l 2. Kaei* '. Ket(r(*a*)e*eti/
'. K%("f)("
>e*(r(t AHA # American Heart Association% /la"ii/a"i &ari atrial i!rila"i &i!e&a/a* -e*+a&i 4 +e*i" ,ait( = 1. A$ &ete/"i perta-a Se-(a pa"ie* &e*)a* A$ "elal( &ia8ali &e*)a* ta'ap A$ &ete/"i perta-a. Ta'ap i*i -er(pa/a* ta'apa* &i-a*a !el(- per*a' ter&ete/"i A$ "e!el(-*,a &a* !ar( perta-a /ali ter&ete/"i. 2. ar/"i"-al A$ A$ ,a*) !erla*)"(*) /(ra*) &ari 7 'ari ata( A$ ,a*) -e-p(*,ai epi"&e perta-a /ali /(ra*) &ari 4? +a- &i*a-a/a* &e*)a* par/"i"-al A$. A$ +e*i" i*i +()a -e-p(*,ai /ee*&er(*)a* (*t(/ "e-!(' "e*&iri &ala- 8a/t( /(ra*) &ari 24 +a- ta*pa !a*t(a* kardioversi. 3. er"i"te* A$ A$ ,a*) "iat*,a -e*etap &a* !erla*)"(*) le!i' &ari 4? +a- tetapi /(ra*) &ari 7 'ari. Ber!e&a &e*)a* par/"i"-al A$ per"i"te* A$ perl( pe*))(*aa* &ari kardioversi (*t(/ -e*)e-!ali/a* ira-a "i*(" /e-!ali *r-al. 4. Kr*i/ #per-a*e* A
%$ A$ ,a*) "iat*,a -e*etap &a* !erla*)"(*) le!i' &ari 7 'ari. a&a per-a*e* A$ pe*))(*aa* kardioversi &i*ilai /(ra*) !erarti /are*a &i*ilai (/(p "(lit (*t(/ -e*)e-!ali/a* /e ira-a "i*(" ,a*) *r-al. Di"a-pi*) /la"ii/a"i -e*(r(t AHA # American Heart Association% A$ +()a "eri*) &i/la"ii/a"i/a* -e*(r(t la-a 8a/t( !erla*)"(*)*,a ,ait( A$ a/(t &a* A$ /r*i/. A$ a/(t &i/ate)ri/a* -e*(r(t 8a/t( !erla*)"(*)*,a ata( *"et ,a*) /(ra*) &ari 4? +a- "e&a*)/a* A$ /r*i/ "e!ali/*,a ,ait( A$ ,a*) !erla*)"(*) le!i' &ari 4? +a-. Ber&a"ar/a* a&a ti&a/*,a pe*,a/it ,a*) -e*&a"ari A$ &apat &i!e&a/a* -e*+a&i 14 = 1. A$ pri-er ter+a&i !ila ti&a/ &i"ertai pe*,a/it +a*t(*) ata( pe*,a/it "i"te-i/ lai**,a. 2. A$ "e/(*&er &i"ertai a&a*,a pe*,a/it +a*t(*) ata( pe*,a/it "i"te-i/ "eperti )a*))(a* tiri&. Ber&a"ar/a* !e*t(/ )el-!a*) A$ &i!e&a/a* ata"= A$ ar"e #/a"ar% A$ i*e #'al("% I*terpreta"i EK@ i!rila"i atri(- "e!)ai !eri/(t = 1. $re/(e*"i = re/(e*"i atri(- 350 "a-pai 00 &e*,(t per -e*it re"p* 6e*tri/(ler !ia"a*,a 120 "a-pai 200 &e*,(t per -e*it. 2. @el-!a*) = ti&a/ ter&apat )el-!a*) ,a*) +ela" ta-pa/ (*&(la"i ,a*) ire)(ler &i*a-a/a* )el-!a*) i!rila"i ata( )el-!a*) i*ter6al R ti&a/ &apat &i(/(r. 3. K-ple/" RS = !ia"a*,a *r-al. 4. Ha*tara* = !ia"a*,a *r-al -elal(i 6e*tri/el. Dita*&ai le' re"p* 6e*tri/el ire)(ler /are*a *&(" A: ti&a/ !ere"p*" ter'a&ap re/(e*"i atri(- ,a*) epat -a/a i-p(l" ,a*) &i'a*tar/a* -e*,e!a!/a* 6e*tri/el !ere" p*" ire)(ler. 5. Ira-a = ire)(ler &a* !ia"a*,a epat /e(ali !ila ter/*trl. Ire)(larita" ira-a &ia/i!at/a* le' per!e&aa* 'a*tara* pa&a *&(" A:.
*. M(!fe"#(" K%!"
A$ &apat "i-pt-ati/ &apat p(la a"i-pt-ati/. @e+ala)e+ala A$ "a*)at !er6aria"i ter)a*t(*) &ari /eepata* la+( ira-a 6e*tri/el $i!rila"i atri(- #A$% !ia"a*,a -e*,e!a!/a* 6e*tri/el !er/*tra/"i le!i' epat &ari !ia"a*,a. Keti/a i*i ter+a&i 6e*tri/el ti&a/ -e-ili/i (/(p 8a/t( (*t(/ -e*)i"i "epe*('*,a &e*)a* &ara' (*t(/ -e--pa /e par(par( &a* t(!('. Atrial i!rila"i "eri*) ta*pa &i"er tai )e+ala tapi /e!a*,a/a* pe*&erita
-e*)ala-i palpita"i #pera"aa* ,a*) /(at &ari &e*,(t +a*t(*) ,a*) epat ata( C!er&e!arC &ala- &a&a% *,eri &a&a ter(ta-a "aat !era/ti6ita" p("i*) ata( pi*)"a* "e"a/ *apa" epat lela' la+( &e*,(t +a*t(*) -e*i*)/at i*tlera*"i ter'a&ap la'ra)a "i*/p ata( )e+ala tr-!e-!li ata( &apat &i"ertai )e+ala)e+ala )a)al +a*t(*) #"eperti ra"a le-a' "a/it /epala !erat &a* "e"a/ *aa"% ter(ta-a +i/a &e*,(t 6e*tri/el ,a*) "a*)at epat #"eri*) 14010 &e*,(ta*-e*it%. a"ie* &apat +()a &i"ertai ta*&a &a* )e+ala "tr/e a/(t ata( /er("a/a* r)a* t(!(' lai**,a ,a*) !er/aita* &e*)a* e-!li ","te-i. A$ &apat -e*et("/a* )e+ala i"/e-i/ pa&a A$ &e*)a* &a"ar pe*,a/it +a*t(*) /r*er. 5. P(#$f"$%$&
>e/a*i"-e A$ ter&iri &ari 2 pr"e" ,ait( pr"e" a/ti6a"i l/al &a* -(ltiple 8a6elet ree*tr,. r"e" a/ti6a"i l/al !i"a -eli!at/a* pr"e" &eplari"a"i t(*))al ata( &eplari"a"i !er(la*). a&a pr"e" a/ti6a"i l/al /(" e/tpi/ ,a*) &-i*a* a&ala' !era"al &ari 6e*a p(l-*ali" "(perir. Selai* it( /(" e/tpi/ !i"a +()a !era"al &ari atri(- /a*a* 6e*a a6a "(perir &a* "i*(" r*ari(". $/(" e/tpi/ i*i -e*i-!(l/a* "i*,al ele/tri/ ,a*) -e-pe*)ar('i pte*"ial a/"i pa&a atri(- &a* -e*))a*)( pte*"ial a/"i ,a*) &iet("/a* le' *&(" SA. Se&a*)/a* -(ltiple 8a6elet ree*tr, -er(pa/a* pr"e" pte*"ial a/"i ,a*) !er(la*) &a* -eli!at/a* "ir/(it+al(r &eplari"a"i. >e/a*i"-e -(ltiple 8a6elet ree*tr, ti&a/ ter)a*t(*) pa&a a&a*,a /(" e/tpi/ "eperti pa&a pr"e" a/ti6a"i l/al tetapi le!i' ter)a*t(*) pa&a "e&i/it !a*,a/*,a "i*,al ele/tri/ ,a*) -e-pe*)ar('i &eplari"a"i. a&a -(ltiple 8a6elet ree*tr, "e&i/it !a*,a/*,a "i*,al ele/tri/ &ipe*)ar('i le' 3 a/tr ,ait( peri&e reratr, !e"ar*,a r(a*) atri(- &a* /eepata* /*&(/"i. Hal i*i !i"a &ia*al)i/a* !a'8a pa&a pe-!e"ara* atri(- !ia"a*,a a/a* &i"ertai &e*)a* pe-e*&e/a* peri&e reratr, &a* pe*(r(*a* /eepata* /*&(/"i. Keti)a a/tr ter"e!(tla' ,a*) a/a* -e*i*)/at/a*
"i*,al
ele/tri/ &a*
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pe*i*)/ata*
&eplari"a"i
"erta
-e*et("/a* ter+a&i*,a A$. A/ti6a"i /al /(" &ia8ali !ia"a*,a &ari &aera' 6e*a p(l-*ali" ti-!(l*,a )el-!a*) ,a*) -e*etap &ari >(ltiple 8a6elet ree*tr, &eplari"a"i atrial ata( 8a6elet" ,a*) &ipi( le' &eplari"a"i atrial pre-at(re ata( a/ti6ita" arit-)e*i/ &ari /(" ,a*) teret(" "eara epat. >e/a*i"-e i!rila"i atri(- i&e*ti/ &e*)a* -e/a*i"-e i!rila"i 6e*tri/el /e(ali !ila pr"e"*,a ter*,ata 'a*,a &i -a""a tt atri(- &a* !(/a* &i -a""a tt 6e*tri/el. e*,e!a! ,a*) "eri*) -e*i-!(l/a* i!rila"i atri(- a&ala' pe-!e"ara* atri(a/i!at le"i /at(p +a*t(*) ,a*) -e*e)a' atri(- -e*)"*)/a* i"i*,a "eara a&e/(at /e
&ala- 6e*tri/el ata( a/i!at /e)a)ala* 6e*tri/el &e*)a* pe-!e*&(*)a* &ara' ,a*) !a*,a/ &i &ala- atri(-. Di*&i*) atri(- ,a*) !er&ilata"i a/a* -e*,e&ia/a* /*&i"i ,a*) tepat (*t(/ "e!(a' +al(r /*&(/"i ,a*) pa*+a*) &e-i/ia* +()a /*&(/"i la-!at ,a*) /e&(a*,a -er(pa/a* a/tr pre&i"p"i"i !a)i i!rila"i atri(-. $i!rila"i atri(- &apat +()a &i"e!a!/a* le' )a*))(a* /at(p +a*t(*) pa&a &e-a- re(-ati/ ata( )a*))(a* alira* &ara' "eperti ,a*) ter+a&i pa&a pe*&erita ater"/ler"i" 10. a&a A$ a/ti6ita" "itli/ pa&a atri(- /iri ti&a/ terat(r ter+a&i pe*(r(*a* atrial l8 6elitie" ,a*) -e*,e!a!/a* "tati" pa&a atri(- /iri &a* -e-(&a'/a* ter!e*t(/*,a tr-!(". a&a pe-eri/"aa* TEE tr-!(" pa&a atri(- /iri le!i' !a*,a/ &i+(-pai pa&a pa"ie* A$ &e*)a* "tr/e e-!li &i!a*&i*)/a* &e*)a* A$ ta*pa "tr/e e-!li. 23 "a-pai "tr/e i"/e-i/ ,a*) ter+a&i pa&a pa"ie* &e*)a* A$ ** 6al6(lar /are*a "tr/e e-!li.Be!erapa pe*elitia* -e*)'(!(*)/a* A$ &e*)a* )a*))(a* 'e-"ta"i" &a* t'r-!"i". Kelai*a* ter"e!(t -(*)/i* a/i!at &ari "tati" atrial tetapi -(*)/i* +()a "e!a)ai /a/tr ter+a&i*,a tr-!e-!li pa&a A$. 6. K$+,%)("
A$ -e-ili/i &(a /-pli/a"i (ta-a "tr/e &a* )a)al +a*t(*). -. Pe+e)"((! Pe!!(!&
e-eri/"aa* pe*(*+a*) (*t(/ &ia)*"i" atrial i!rila"i a*tara lai* 5 = 1. A*a-*e"i" = a. Dapat &i/eta'(i tipe A$ &e*)a* -e*)eta'(i la-a ti-!(l*,a #epi"&e perta-a par/"i"-al per"i"te* per-a*e*% !. >e*e*t(/a* !erat*,a )e+ala ,a*) -e*,ertai= !er&e!ar&e!ar le-a' "e"a/ *apa" ter(ta-a "aat a/ti6ita" p("i*) )e+ala ,a*) -e*(*+(//a* a&a*,a i"/e-ia ata( )a)al +a*t(*) /*)e"ti . e*,a/it +a*t(*) ,a*) -e*&a"ari pe*,e!a! lai* &ari $A -i"al*,a 'ipertiri& 2. e-eri/"aa* i"i/ = a. Ta*&a 6ital = &e*,(t *a&i !er(pa /eepata* &a* re)(larita"*,a te/a*a* &ara' !. Te/a*a* 6e*a +()(lari" . R*/i pa&a par( -e*(*+(//a* /e-(*)/i*a* ter&apat )a)al +a*t(*) /*)e"ti &. Ira-a )allp "3 pa&a a("/(lta"i +a*t(*) -e*(*+(//a* /e-(*)/i*a* ter&apat )a)al +a*t(*) /*)e"ti ter&apat*,a !i"i*) pa&a a("/(lta"i /e-(*)/i*a* a&a*,a pe*,a/it /at(p +a*t(*)
e. Hepat-e)ali = /e-(*)/i*a* ter&apat )a)al +a*t(*) /a*a* .
E&e-a perier = /e-(*)/i*a*ter&apat )a)al +a*t(*) /*)e"ti
3. La!ratri(- = 'e-at/rit #a*e-ia% TSH #pe*,a/it )*&/% e*i- +a*t(*) !ila &i(ri)ai ter&apat i"/e-ia +a*t(*) 4. e-eri/"aa* EK@ = &apat &i/eta'(i a*tara lai* ira-a #6erii/a"i $A% 'ipertrpi 6e*tri/el /iri pree/"ita"i 6e*tri/el /iri "i*&r-a pree/"ita"i #"i*&r-a FF% i&e*tii/a"i a&a*,a i"/e-ia% 5. $t r*t)e* tra/" . E//ar&i)rai (*t(/ -eli'at a*tara lai* /elai*a* /at(p (/(ra* &ari atri(- &a* 6e*tri/el 'ipertri 6e*tri/el /iri (*)"i 6e*tri/el /iri !"tr(/"i (tl8 &a* TEE #Trans Esopago Echocardiography% (*t(/ -eli'at t'r-!(" &i atri(- /iri 7. e-eri/"aa* (*)"i tiri&. a&a A$ epi"&e perta-a !ila la+( ira-a 6e*tri/el "(lit &i/*trl ?. U+i lati' = i&e*tii/a"i i"/e-ia +a*t(*) -e*e*t(/a* a&e/(a"i &ari /*trl la+( ira-a +a*t(*). 9. e-eri/"aa
lai* ,a*)
-(*)/i* &iperl(/a* a&ala'
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. Pe!(#(%()"(!((!
Sa"ara* (ta-a pa&a pe*atala/"a*aa* A$ a&ala' -e*)*trl ira-a +a*t(*) ,a*) ti&a/ terat(r -e*(r(*/a* pe*i*)/ata* &e*,(t +a*t(*) &a* -e*e)a' ter+a&i*,a /-pli/a"i tr-!e-!li"-e. Kar&i6er"i -er(pa/a* "ala' "at( pe*atala/"a*aa* ,a*) &apat &ila/(/a* (*t(/ A$. >e*(r(t pe*)ertia**,a /ar&i6er"i "e*&iri a&ala' "(at( tata la/"a*a ,a*) !er(*)"i (*t(/ -e*)*trl /eti&a/terat(ra* ira-a &a* -e*(r(*/a* &e*,(t +a*t(*). a&a
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# Pharmacological Cardioversion% &a* pe*)!ata* ele/tri/ # Electrical Cardioversion%. a. >e*e)a' pe-!e/(a* &ara' #tr-!e-!li"-e% !. >e*)(ra*)i &e*,(t +a*t(*) . >e*)e-!ali/a* ira-a +a*t(*) Kar&i6er"i -er(pa/a* "ala' "at( pe*atala/"a*aa* ,a*) &apat &ila/(/a* (*t(/ -e*terat(r/a* ira-a +a*t(*). >e*(r(t pe*)ertia**,a /ar&i6er"i "e*&iri a&ala' "(at( tata la/"a*a ,a*) !er(*)"i (*t(/ -e*)*trl /eti&a/terat(ra* ira-a &a* -e*(r(*/a* &e*,(t +a*t(*).a&a &a"ar*,a /ar&i6er"i &i!a)i -e*+a&i 2 ,ait( pe*)!ata*
ar-a/l)i #'ar-al)ial Gar&i6er"i*% &a* pe*)!ata* ele/tri/ #Eletrial Gar&i6er"i*%. 1. 'ar-al)ial Gar&i6er"i* #A*tiarit-ia%
A-i&ar*e
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DAFTRA PUTAKA
1. Nar(-i,a T Sa/a-a/i T Sat Y Ka*-at"("e K # a*(ar, 2003%. “Relationship between left atrial appendage function and left atrial thrombus in patient with nonvalvular chronic atrial fibrillation and atrial flutter. Gir(lati* (r*al 7. 2. Sa*ilipp A A!a"al :> S'ee'a* > Oertel LB Harri)a* H()'e" RA &a* Fe,-a* AE #1990%. !Atrial enlargement as a conse"uence of atrial fibrillation A prospective echocardiographic study! . Gir(lati* ?2 #3%= 7927. 3. C Atrial #ibrillation $for Professionals%! . A-eria* Heart A""iati* I*. 200?1204. Ar'i6e& r- t'e ri)i*al * 2009032?. 4. >appa',a AA. Atri(- $i!rilati* T'erap', T re6e*t Str/e= A Re6ie8. T'e I*&*e"ia* (r*al >e&ial Sie*e :l(-e 1 N.? April 2009 p. 4774?9. 5. S(&, AF Seti,'a&i B Al8i I. B(/( A+ar Il-( e*,a/it Dala- ili& III E&i"i I:. a/arta= $a/(lta" Ke&/tera* U*i6er"ita" I*&*e"ia 2007. . Na"(ti* SA I"-ail D. 200. $i!rila"i Atrial. &uku A'ar (lmu penyakit )alaml* E&.3. a/arta. E@G 152227. 7. Fatti)*e, FA >e*"a' @A Grt B #2002%. CI*rea"e& atrial i!rillati* -rtalit,= U*ite& State" 19?0199?C. Am* +* Epidemiol* 155 #9%= ?192. ?. Bla/"'ear L O&ell A #$e!r(ar, 199%. CAppe*&a)e !literati* t re&(e "tr/e i* ar&ia "(r)ial patie*t" 8it' atrial i!rillati*C. Ann* Thorac* ,urg* 1 #2%= 7559. 9. Harri"* #2000%. ri*"ippri*"ip Il-( e*,a/it Dala- :l(-e 3 E&i"i 13. E@G= 141??7. 10. Ner S. &uku A'ar (lmu Penyakit )alam +ilid ( Edisi ketiga. a/arta= Balai e*er!it $KUI 199. 11. Emergency Cardiovascular Care Program- Advanced Cardiac .ife ,upport 19971999 A-eria* Heart A""iati*. 12. S-elter SG* &uku A'ar /eperawatan 0edikal &edah Br(**er J S(&&art' E&i"i ? :l(-e 2. a/arta= E@G 2001. 13. Fl A Da8!er TR T'-a" HE Ka**el FB #197?%. !Epidemiologic assessment of chronic atrial fibrillation and risk of stroke1 the #ramingham study! . Ne(rl), 2? #10%= 9737. 14. $ir&a(" I. #ibrilasi Atrium Pada Penyakit Hipertiroidisme* Patogenesis dan Tatalaksana* (r*al Kar&il)i I*&*e"ia Septe-!er 2007= :l. 2? N. 5. 15. @(,t* #1995%. #isiologi 0anusia dan 0ekanisme Penyakit . E@G= 2?7305.
