PPT Arlin Tanjung
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Transcript of PPT Arlin Tanjung
7/25/2019 PPT Arlin Tanjung
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Case report seCongestive Hea
FAKHRI ZUHRHANA
VIRISSA CALLIST
DOKTER MUDA PERIODE 3 Januari-3 Fe
Fa%ultas Ke&o%teran Universitas An&alas
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BAB I
PENDAHULUAN
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PENDAHULUAN
Kegagalan jantung memoma !a"a# untu$ memenu#% $e&utu#an meta&ol%'
tu&u# ()o"*a"! )a%lu"e+ atau jantung &%,a memoma !a"a# -ang a!e$uat #an-a
&%la te$anan eng%,%an jantung men%ng$at (&a'$*a"! )a%lu"e+
Pat#o#-,%olog- o) #ea"t !%,ea,e. Leona"! S L%l-. age /01
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PENDAHULUAN
Stu!% Fa"m%ng#am men-e&ut$an &a#*a $eja!%an gagal jantung e" ta#un a!a
o"ang &e"u,%a 2 34 ta#un a!ala# 5./ $a,u, ,et%a 0666 o"ang la$%7la$% !an 3.5
$a,u, ,et%a 0666 o"ang e"emuan8 D% Ame"%$a #am%" 4 juta o"ang
men!e"%ta gagal jantung98 Se'a"a $e,elu"u#an 46: !a"% total a,%en men%nggal!alam $u"un *a$tu emat ta#un8
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BAB II
Ilustrasi Kasus
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KU :
Sesak nafas yang meningkat sejak 5 hari SMRS
RPS
Sesak nafas yang meningkat sejak 5 hari SMRS. Sesak tidak menciut, tidak
dipengaruhi oleh cuaca ataupun makanan. Dirasakan saat pasien beraktivitas
ringan. Riwayat sesak sebelumnya !" sejak # tahun terakhir, Riwayat $%D !",
D&' !", &$ !", sembab di kaki (".
%yeri dada (", keringat dingin (", mual (", muntah ("
)erdebar(debar (", pusing (",pingsan ("
Pat#o#-,%olog- o) #ea"t !%,ea,e. Leona"! S L%l-.age /01
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$asien post pasang stent bulan januari dan maret #*+, kontrolteratur ke poli jantung RS-$ dr. M. Djamil, dapat terapi aptor ++**mg, ramipril ++* mg, furosemide +/* mg, bisoprolol +#,5 mg,simvastatin +/* mg, lansopra0ol +* mg, allopurinol ++** mg.
Di 12D 3 Sesak nafas !", nyeri dada (" 4aktor resiko 6D 3
( '(smoker !" berhenti sejak # tahun yang lalu
⁻ 78 ("
⁻ DM ("
⁻ Dislipidemia ("
⁻ 47 ("
Pat#o#-,%olog- o) #ea"t !%,ea,e. Leona"! S L%l-. age /01
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Kea!aan Umum ; ,e!ang
Ke,a!a"an ; C<C
TD ; 06/=56 mmHg
Na!% ; 1> ?=m "egule"
Pe"na)a,an ; /@ ?=m
Su#u ; @5.66 '
Sat8 O/ ; 9>:
Le#e" ; VP 4 / 'mH/6
<ata ; $onjungt%a t%!a$ anem%,. ,$le"a t%!a$ %$te"%$
Pat#o#-,%olog- o) #ea"t !%,ea,e. Leona"! S L%l-. age /01
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antung
In,e$,% ; I'tu, 'o"!%, ta$ te"l%#at
Pala,% ; I'tu, 'o"!%, te"a&a 0 ja"% late"al L<CS RIC VI
Pe"$u,% ; Bata, $anan; LSD
Bata, Ata, ; RIC II
Bata, K%"% 0 ja"% late"al L<CS RIC VI
Au,$ulta,% ; S0S/ "egule". mu"mu" (7=7+. !an gallo (7=7+
Pa"u
In,e$,% ; ,%met"%, $%"% $anan
Pala,% ; )"em%tu, $%"% $anan
Pe"$u,% ; ,ono" $%"% $anan
Au,$ulta,% ; B"on$oe,% $ule". R# = &a,a# #alu, !% &a,al.
*# 7=7
Pat#o#-,%olog- o) #ea"t !%,ea,e. Leona"! S L%l-. age /01
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A&!omenIn,e$,% ; t%!a$ tama$ mem&un'%tPala,% ; ,uel. #ea" !an l%en t%!a$ te"a&aPe"$u,% ; t%man%Au,$ulta,% ; BU (+ no"mal
E$,t"em%ta,
a$"al #angat. u!em 7=7
Pat#o#-,%olog- o) #ea"t !%,ea,e. Leona"! S L%l-. age /01
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EKG di IGD jam 14.37 wib
agal jantung me"ua$an &entu$ a$#%" !an man%)e,ta,% te"&e"at !a"% #ame"
,emua &entu$ en-a$%t jantung ,ee"t% at#e"o,'le"o,%, 'o"one". %n)a"$
m%o$a"!. $ela%nan $atu. #%e"ten,%. en-a$%t jantung &a*aan !an
$a"!%om%oat%8
Pat#o#-,%olog- o) #ea"t !%,ea,e. Leona"! S L%l-. age /01SR. RS "ate 11?=I. a?%, LAD. gelom&ang P no"mal. PR %nte"al 6./6G. RS !u"a,%6.06G. ST T '#ange (7+. LVH (7+. RVH (7+
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La&
Hb : 12,0 mg/dl
Leukosit : 9500/mm3
Ht : 37 %
Trombosit : 190.000/mm3
Na//!l : 13" /3,#/ 10#
$& : 121
'r/!r : "3/ 1,1
!!T : #3,#
!()
Tro* T
: 17
: + 0,01
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-nt/0nhra2s !
%- + ," */A N" */P m0nnjl" in//an/ jantun/ m0ndatar" a02s t0rtanam"2ranialisasi )5" in6iltrat )5.
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D= 7 CHF )' III e' CAD
7 Po,t PTCA / ,tent DES ta#un /60@
7 H%o$alem%a
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PATOFISIOLOI
Pen-e&a& gagal jantung &%,a !%&ag% menja!% ;
08Kont"a$t%l%ta, jantung -ang menu"un
/8A)te"loa! -ang men%ng$at
@8Rela$,a,% !an eng%,%an ent"%$el -ang te"ganggu
Pat#o#-,%olog- o) #ea"t !%,ea,e. Leona"! S L%l-. age //3
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PATOFISIOLOI
Pen-e&a& gagal jantung &%,a !%&ag% menja!% ;
08Kont"a$t%l%ta, jantung -ang menu"un
/8A)te"loa! -ang men%ng$at
@8Rela$,a,% !an eng%,%an ent"%$el -ang te"ganggu
Pat#o#-,%olog- o) #ea"t !%,ea,e. Leona"! S L%l-. age //3
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PATOFISIOLOI
Pen-e&a& gagal jantung &%,a !%&ag% menja!% ;
08Kont"a$t%l%ta, jantung -ang menu"un
/8A)te"loa! -ang men%ng$at
@8Rela$,a,% !an eng%,%an ent"%$el -ang te"ganggu
Pat#o#-,%olog- o) #ea"t !%,ea,e. Leona"! S L%l-. age //3
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PATOFISIOLOI
Pen-e&a& gagal jantung &%,a !%&ag% menja!% ;
08Kont"a$t%l%ta, jantung -ang menu"un
/8A)te"loa! -ang men%ng$at
@8Rela$,a,% !an eng%,%an ent"%$el -ang te"ganggu
Pat#o#-,%olog- o) #ea"t !%,ea,e. Leona"! S L%l-. age //3
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PATOFISIOLOI
Pen-e&a& gagal jantung &%,a !%&ag% menja!% ;
08Kont"a$t%l%ta, jantung -ang menu"un
/8A)te"loa! -ang men%ng$at
@8Rela$,a,% !an eng%,%an ent"%$el -ang te"ganggu
Pat#o#-,%olog- o) #ea"t !%,ea,e. Leona"! S L%l-. age //3
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Pat#o#-,%olog- o) #ea"t !%,ea,e. Leona"! S L%l-.
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Hea"t )a%lu"e *%t# "e!u'e! EF
Vent"%$el -ang te"$ena mem%l%$% $aa,%ta, -ang te"&ata, untu$ memoma
!a"a# $a"ena $ont"a$t%l%ta, -ang menu"un atau a)te"loa! -ang men%ng$at
SV menu"un ESV men%ng$at EDV men%ng$at te$anan LV men%ng$at
te$anan LA men%ng$at te$anan #%!"o,tat%$ $a%le" ulmonal men%ng$at
$onge,t% ulmonal
Pat#o#-,%olog- o) #ea"t !%,ea,e. Leona"! S L%l-. age //4
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Hea"t )a%lu"e *%t# "e,e"e! EF
Fung,% !%a,tol%' -ang t%!a$ no"mal EDP men%ng$at !%tan,m%,%$an "et"og"a!e
$e ena ulmonal !an ,%,tem%$ $onge,t% a,'ula" ,%,tem%$ !an a"u
Pat#o#-,%olog- o) #ea"t !%,ea,e. Leona"! S L%l-. age //1
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agal jantung $anan !an gagal jantung
$%"%
agal jantung $%"% a!an-a tan!a !an gejala en%ng$atan te$anan !an $onge,t% !%
ena ulmonal !an $a%le"8
agal jantung $anan a!an-a gejala !an tan!a en%ng$atan te$anan !an $onge,t%
!% ena ,%,tem%$ !an $a%le"8 D%tan!a% !engan en%ng$atan VP !an $onge,t% #ea"8
agal jantung $anan &%a,an-a te"ja!% ,etela# gagal jantung $%"%
Hu",tJ, t#e #ea"t olume one age 5/6
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Pat#o#-,%olog- o) #ea"t !%,ea,e. Leona"! S L%l-. age //1
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<EKANIS<E KO<PENSASI
08 F"an$ ,ta"l%ng me'#an%,m
SV menu"un ESV men%ng$at EDV men%ng$at men%ng$at$an
!a"% m%o)%&e", men%ng$at$an $ont"a$,% !an SV !% $ont"a$,% ,elan
<e$an%,me $omen,a,% %n% mem%l%$% &ata, a!a a$#%"n-a SV menu"u
$ont"a$t%l%ta, menu"un. EDV men%ng$at
$onge,t% a"u !an e!em
Pat#o#-,%olog- o) #ea"t !%,ea,e. Leona
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/8 Neu"o#o"monal 'omen,ato"- me'#an%,m
A!"ene"g%' ne"ou, ,-,tem
Ren%n7ang%oten,%n al!o,te"one ,-,tem
Ant%!%u"et%' #o"mone
Pat#o#-,%olog- o) #ea"t !%,ea,e. Leona"! S L%l-. age //>
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Pat#o#-,%olog- o) #ea"t !%,ea,e.
//>
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Nat"%u"et%' et%!e,
7 At"%al nat"%u"et%' et%!e ; !%,%man !% ,el at"%al !an !%lea,$an ,e&aga%
"e,on !a"% !%,ten,% at"%al
7 B7T-e nat"%u"et%' et%!e ; !%"o!u$,% $et%$a m%o$a"!%um ent"%$el
mengalam% ,t"e,, #emo!%nam%$
Pat#o#-,%olog- o) #ea"t !%,ea,e. Leona"! S L%l-. age /@6
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<an%)e,ta,% Kl%n%,
S-mtom,
Le)t7,%!e! #ea"t )a%lu"e ;
7 !-,nea
7 o"t#onea
7 Pa"o?-,mal no'tu"nal !-,nea
7 Fat%gue
R%g#t7,%!e! #ea"t )a%lu"e ;
7 Pe"%#e"al e!ema
7 R%g#t ue" ua!"ant !%,'om)o"t
Pat#o#-,%olog- o) #ea"t !%,ea,e. Leona"! S L%l-. age /@/
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ESC gu%!el%ne, /60/ )o" t#e !%agno,%, an! t"eatment o) #ea"t )a%lu"e
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Pat#o#-,%olog- o) #ea"t !%,ea,e. Leona"! S L%l-. age /@@
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P#-,%'al ,%gn,
Le)t7,%!e! #ea"t )a%lu"e ;
7 D%a#o"e,%, (,*eat%ng+
7 Ta'#-'a"!%a. ta'#-nea
7 Pulmona"- "ale,7 Lou! P/
7 S@ gallo (%n ,-,tol%' !-,)un't%on+
7 S3 gallo (%n !%a,tol%' !-,)un't%on+
R%g#t7,%!e! #ea"t )a%lu"e ;
7 ugula" enou, !%,tent%on
7 Heatomegal-
7 Pe"%#e"al e!ema
Pat#o#-,%olog- o) #ea"t !%,ea,e. Leona
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ESC gu%!el%ne, /60/ )o" t#e !%agno,%, an! t"eatment o) #ea"t )a%lu"e
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ESC gu%!el%ne, /60/ )o" t#e !%agno,%, an! t"eatment o) #ea"t )a%lu"e
Algo"%tma !%agno,%, #ea"t )a%lu"e
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Algo"%tma !%agno,%, #ea"t )a%lu"e
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Te"a%
Tujuan te"a% gagal jantung ;
<eme"&a%$% tan!a !an gejala -ang mun'ul
<en'ega# e"a*atan %na !% "uma# ,a$%t
<eme"&a%$% ang$a ,u"%al
ESC gu%!el%ne, /60/ )o" t#e !%agno,%, an! t"eatment o) #ea"t )a%lu"e
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Te"a% a!a #ea"t )a%lu"e7"e!u'e! EF
(,-,tol%' #ea"t )a%lu"e+
ACE7In#%&%to" Beta7&lo'$e"
<%ne"alo'o"t%'o%!=al!o,te"one "e'eto" antagon%,t
ARB
Ia&"a!%ne
D%go?%n !an !%g%tal%, gl%$o,%! la%n
Kom&%na,% #-!"ala%ne !an %,o,o"&%!e !%n%t"at
Omega7@ ol-un,atu"ate! )att- a'%!
ESC gu%!el%ne, /60/ )o" t#e !%agno,%, an! t"eatment o) #ea"t )a%lu"e
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Te"a% a!a #ea"t )a%lu"e7PEF
(!%a,tol%' #ea"t )a%lu"e+
Belum a!a te"a% -ang te"&u$t% !aat mengu"ang% ang$a mo"&%!%ta, !anmo"tal%ta, a,%en HF7PEF
D%u"et%$
Te"a% #%e"ten,%
Te"a% m%o$a"!%al %,$em%a
Pa!a a,%en HF7PEF !engan AF enggunaan CCB (e"aam%l+ !an &eta7
&lo'$e" &e"guna untu$ mengont"ol ent"%'ula" "ate
ESC gu%!el%ne, /60/ )o" t#e !%agno,%, an! t"eatment o) #ea"t )a%lu"e