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7/21/2019 Gangguan Sistem Kardiovaskuler
http://slidepdf.com/reader/full/gangguan-sistem-kardiovaskuler-56e0cd9ff311e 1/34
7/21/2019 Gangguan Sistem Kardiovaskuler
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ACUT MYOCARDIAL INFARCTION (AMI)/
INFARK MYOKARD AKUT (IMA)
• DEFINISI:
Acut Myocardial I!arctio (AMI)"I!ar# Myo#ard A#ut (IMA) adala$ %#ro&i&
'yo#ard a#iat alira dara$ #% otot atu* t%r*a**u
• EPIDEMIOLO+I:
, -%y%a #%'atia -%rta'a di a'%ri#a
, ./ ta$u t%ra#$ir aya# dit%'u#a diIdo%&ia
7/21/2019 Gangguan Sistem Kardiovaskuler
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FA0TOR RESI0O
FA0TOR YN+ MEMPERCEPAT TER1ADINYA ATEROS0LEROSIS
• Fa#tor r%&i#o ya* da-atdi'odi2#a&i3 O%&ita&
3 4i-%rt%&i
3 M%ro#o#
3 E'o&i3 DM
3 4i-oa#ti2ta&
7/21/2019 Gangguan Sistem Kardiovaskuler
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• Fa#tor r%&i#o ya* tida# da-atdi'odi2#a&i
3 +%%ti#
3 1%i& #%la'i
3 0%-riadia ti-% A
FA0TOR PENCETUS
• E'o&i
• Str%&&• 0%ra 2&i# t%rlalu %rat
• 5aya# '%ro#o#
7/21/2019 Gangguan Sistem Kardiovaskuler
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PATO+ENESIS
at%ro&#l%ro&i& -%'ulu$ dara$#oro%r
P%yu'ata art%ri #oroaria ol%$tro'u& -ada -la6u%
at%ro&#l%ro&i&
N%#ro&i& 'yo#ard
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1ENIS AMI
• SECARA MORFOLO+IS.7 AMI TRANSMURAL
87 AMI SU5ENDO0ARDIAL
, RE+IONAL
, DIFUS
7/21/2019 Gangguan Sistem Kardiovaskuler
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• AMI TRANSMURAL
, '%*%ai &%luru$ didi* 'yo#ard
, t%radi -ada da%ra$ di&triu&i &uatuart%ri #oro%r
• AMI SU5ENDO0ARDIAL
, R%*ioal: t%radi -ada di&triu&i &atuart%ri #oro%r
, Di!u&: t%radi -ada di&triu&i l%i$ dari&atu art%ri #oro%r
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+E1ALA 0LINIS
• 0%lu$a ya* #$a&: y%ri dadar%tro&t%ral9 &%-%rti dir%'a&89 dit%#a9ditu&u#9 ditidi$
• Ny%ri da-at '%alar #% l%*a (u'u'yal%*a #iri)9 a$u9 l%$%r9 ra$a*9 a$#a-u**u* da %-i*a&triu'
• Ny%ri %rla*&u* l%i$ la'a dari a*ia-%#tori& (l%i$ dari / '%it)
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• Ny%ri &%ri* di&%rtai d%*a 'ual9'uta$9 &%&a# -u&i*9 #ri*at di*i
a$#a &i#o-%9 -a&i% &%ri* ta'-a##%ta#uta
• Pada -%'%ri#&aa 2&i#:'u#a -ucat9 ta#$i#ardi9 da uyi atu*II ya* -%ca$ -arado#&al (ira'a *allo-)9di&t%&i ;%a u*ulari& -ada i!ar#
;%tri#%l #aa
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DIA+NOSIS
• ANAMNESIS DAN P< FISI0• E0+
• LA5ORATORIUM
• RADIOLO+I
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PERU5A4AN PADA E0+
• S7d7 %%ra-a a' &%t%la$ &%ra*a AMI: E0+ or'al atau #%laia tida# #$a&
• 4itu*a a': d%-r%&i ST
• 1a' &7d7 4ari: *%lo'a* T ti**i
• 4ari &7d7 Mi**u: i;%r&i *%lo'a* T
• Mi**u &7d7 5ula: *%lo'a* = '%%ta-
• Ta$u:
-ada ./ > #a&u& da-at #%'ali or'al
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RADIOLO+I
• Tida# aya# '%'atu• 0%cuali ada %du*a -aru
• 0ada* t%rli$at #ardio'%*ali
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• 0ELAINAN LO0AL DINDIN+ DADA
y%ri &%t%'-at9 %rta'a$ d%*at%#aa atau -%rua$a -o&i&i
• 0OMPRESI SARAF (TERUTAMA C,)
y%ri t%rda-at -ada di&triu&i &ara!t%r&%ut
• 0ELAINAN INTRA A5DOMINAL
a#ut ado'% atau -#r%atiti& a#ut
'%y%ru-ai a'i
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PENATALAKSANAAN
• Mortalita& u'u'ya t%radi a' -%rta'a• 5ila t%radi AMI -a&i% la*&u* diruu# #%
RS t%rd%#at ya* &%ai#ya '%'-uyai
!a&ilita& ICCU• 5ila tida# ada -%yulit &%t%la$ , $ari
di-ida$ #%rua* it%r'%diat% coroary?o%
• Di%t -ada $ari I dala$ 'a#aa &ari* dadi%t r%da$ *ara' ila ad *a*al atu*
7/21/2019 Gangguan Sistem Kardiovaskuler
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• I!u& d%<tro&a > lii
• P%*%dalia y%ri
'or2 '* atau -%tidi 8,/ '*
• O#&i*%
8, L"'%it ila ada %du*a -aru
• S%dati! utu# '%*ura*i #l%ta#uta
dia?%-a' 8, '* <"$ari -o
• Ati#oa*ula:
3 4%-ari 8////,//// U"8 a' i; tia- , a'
3 Dit%ru&#a d* a&%ta#u'arol atau ar!ari
7/21/2019 Gangguan Sistem Kardiovaskuler
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• Tro'oliti# (Str%-ta&%9 rt,PA9 APSAC)
3 S%a*ai &ala$ &atu u&a$a r%-%r!u&i
3 4aru& &uda$ di'ulai / '%it &%t%la$-%'%ri#&aa
3 M%'%ri $a&il ya* ai# ila di%ri#a-ada a' -%rta'a &%t%la$ &%ra*a
3 Str%-ta&% .9 uta uit dl' . a'
3 rt,PA .// '* dala' G/ '%it
3 APSAC / uit dala' 8, '%it
7/21/2019 Gangguan Sistem Kardiovaskuler
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0OMPLI0ASI
• P%rlua&a i!ar# da i&#%'i -a&ca i!ar#• Arit'ia
• Di&!u*&i otot atu*
+a*al atu* #iri $i-ot%&i &yo#• I!ar# ;%tri#%l #aa
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PRO+NOSIS
Pro*o&i& t%r*atu* dari:.7 Pot%&i t%radiya arit'ia ya* *aat
(arit'ia ;%tri#%l)
87 Pot%&i &%ra&*a i&#%'i l%i$ au$
7 Pot%&i -%'uru#a *a**ua$%'odia'i# l%i$ au$
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DEKOMPENSASI
CORDIS
(DEKOM CORDIS)
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DE0OMPENSASI CORDIS
• ISTILA4 LAIN:+a*al atu*9 -aya$ atu*9 $%art !ailur%9co*%&ti;% $%art !ailur%9 *a*al atu*#o*%&ti!
• DEFINISI:Suatu #%adaa -ato2&iolo*i& adaya#%laia !u*&i atu* %ra#iat atu**a*al '%'o'-a#a dara$ utu#'%'%u$i #%utu$a '%taoli&'%
ari*a da"atau #%'a'-uaya $ayaada #alau di&%rtai -%i**ia t%#aa-%*i&ia ;%tri#%l #iri
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FA0TOR PREDISPOSISI
• PENYA0IT YAN+ MENIM5UL0ANPENURUNAN FUN+SI HENTRI0EL:
P%ya#it art%ri #oro%r9 $i-%rt%&i9#ardio'yo-ati9 -%ya#it -%'ulu$
dara$9 da -%ya#it atu*#o*%ital
• 0EADAAN YAN+ MEM5ATASI PEN+ISIAN
HENTRI0ELSt%o&i& 'itral9 #ardio'yo-ati9
-%ya#it -%ri#ardial
7/21/2019 Gangguan Sistem Kardiovaskuler
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PATOFISIOLO+I
• TEORI 5AC0ARD FAILURE
• TEORI FORARD FAILURE
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FA0TOR PENCETUS
• AMI ya* t%r&%'uyi• S%ra*a $i-%rt%&i
• Arit'ia a#ut
• I!%#&i• E'oli -aru
• A%'ia
• Tiroto#&i#o&i&
• 0%$a'ila %do#arditi& i!%#ti!
• 5%a caira ya* %rl%i$a
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MANIFESTASI 0LINIS
• 5ERDASAR 5A+IAN 1ANTUN+ YAN+MEN+ALAMI 0E+A+ALAN PEMOMPAANDECOM CORDIS DI5A+I MEN1ADI:
3 DECOM CORDIS 0IRI
3 DECOM CORDIS 0ANAN
3 C4F
• MANIFESTASI 0LINIS 5ER5EDA SESUAI
PEM5A+IAN TERSE5UT
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+A+AL 1ANTUN+ 0IRI
• Dy&-%u dJ %Kort• Fati*u%• Orto-%u• Dy&-%u o#tural -aro#&i&'al
• 5atu#• P%'%&ara atu*• Ira'a d%ra- S• P%ra!a&a c$%y%% &to#%&• Ta#i#ardi• Ro#$i #o*%&ti ;%a -ul'oali&
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DE0OM CORDIS 0ANAN
• Fati*u%
• Ed%'a• li;%r %*or*%'%t• Aor%#&ia• 0%'u*• 4i-%rtro2 atu* #aa• ira'a d%ra- atriu' #aa• Mu'ur• Tada8 -%ya#it -aru #roi#• T%#aa ;%a u*ulari& '%i*#at
• A&cit%&• 4idrot$ora#&• 4%-ato'%*ali• Pitti* %d%'a
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C4F
• Mai!%&ta&iya *au*a dari d%co'-cordi& #iri da #aa
• 0rit%ria 'ayor:.7Di&-%a o#tural -aro#&i&'al atau ort$o-%a
87P%i*#ata t%#aa ;%a u*ulari&7Ro#$i a&a$ tida# yari*
70ardio'%*ali
7Ed%'a -aru a#ut
7Ira'a d%ra- S7P%i*#ata ;%a . c' 48/
7R%u#& $%-atou*ular
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• 0rit%ria 'ior
.7Ed%'a -%r*%la*a #a#i
875atu# 'ala' $ari7Dy&-%u dJ %Kort
74%-ato'%*ali
7E!u&i -l%ura
70a-a&ita& ;ital %r#ura* '%adi ."'a#&i'u'
7 Ta#i#ardi (ia&aya .8/ #ali"'t
• Dia*o&i& dit%*a##a d%*a
3 8 #rit%ria 'ayor
3 atau . #rit%ria 'ayor da 8 #rit%ria 'ior ya*ada -ada &aat ya* %r&a'aa
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PEMERI0SAAN PENUN1AN+
• RB T$ora#&:3 0ardio'%*ali
3 Cora#a ;a&#ul%r '%i*#at
3 I2ltrat -r%#ordial #%dua -aru
3 E!u&i -l%ura• E0+:
3 M%li$at -%ya#it ya* '%da&ari ('i&al i!ar#'io#ard atau arit'ia
• P%'%ri#&aa lai3 49 %l%#trolit9 %#o#ardio*ra29 a*io*ra29 !u*&i*ial9 da !u*&i tiroid dila#u#a ata& idi#a&i
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PENATALA0SANAAN
.7 M%i*#at#a o#&i*%a&ia) P%'%ria o#&i*%
) M%uru#a #o&u'&i o#&i*%
i&tira$at"-%'ata&a a#ti;ita&
87 M%'-%rai#i #otra#tilita& atu*a) M%*ata&i #%adaa ya* r%;%r&i%l &%-%rtitiroto#&i#o&i& 'i#&%d%'a da arit'ia
) Di*itali&a&i-%'%ria di*o#&i
.7 Di*itali&a&i c%-at: /9,8 '* dala' , do&i&&%la'a 8 a'9dilaut#a 8 < /9 '*&%la'a 8 a'
87 Di*o#&i i; /9,. '* dala' do&i& &%la'a8 a'
7 C%dilaid i; .98,.9 '* dl' 8 a'
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7 M%uru#a %a atu*a) Di%t r%da$ *ara'
) Diur%ti#a, Furo&%'id /,/ '*
c) Ha&odilator, Nitro*li&%ri
, Nitro-u&id, Pra?o?i
, Ca-to-ril
, ISDN
d) M%*%luar#a caira &%cara '%#ail, Tora#o&it%&i&
, Para&it%&i&
, Diali&i&
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TERIMA 0ASI4