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KEHAMILAN PADA PENYAKIT JANTUNG

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Penyakit jantung merupakan salah satu PENDAHULUAN penyebab kematian maternal non-obstetrik yang cukup penting Angka kejadian : 0,4-4,1%
Indonesia (2005-2006) : 1,2%

Perubahan sistem kardiovaskular dan hematologis selama kehamilan


Mempersulit penegakan diagnosis Memperberat kelainan tersebut
Penanganan Konseling pra-konsepsi yang baik Manajemen pendekatan multidisiplin www.Jantunghipertensi.com

Antepartum Volume meningkat 50% Tahanan Perifer menurun 20% Tekanan darah menurun pada 24 minggu pertama CVP tetap HR meningkat 10-15/m CO meningkat 30-50%

PERUBAHAN SISTEM KARDIOVASKULAR PADA KEHAMILAN


Fraksi ejeksi ventrikel kanan meningkat Darah cenderung hiperkoagulasi Perubahan ECG LAD 15o Low voltage QRS Inversi T pada Lead III Gel. Q pada Lead III dan aVF Denyut prematur atrial dan ventrikel Perubahan X-Ray Thoraks

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INTRAPARTUM
CO meningkat 20-30% Tiap kontraksi melepaskan 300-500 ml darah dari uterus ke sirkulasi sistemik BP meningkat 10-20 mmHg tiap kontraksi Posisi terlentang menurunkan CO 30% Konsumsi oksigen meningkat 100%

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POSTPARTUM
CO meningkat 10-20% pada awal periode post partum SV meningkat Refleks bradikardia Menetap 1-2 minggu postpartum

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KLASIFIKASI ETIOLOGIS
Penyakit Jantung Kongenital
Sianotik Asianotik

Penyakit Jantung Didapat


Penyakit Jantung Reumatik Penyakit Jantung Koroner

Penyakit Jantung Spesifik Kehamilan


Peripartum Cardiomyopathy
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KLASIFIKASI BERDASAR RISIKO MATERNAL


Kelompok 1 (Mortality Risk <1%) ASD,VSD, PDA, Kelainan katup pulmonal/trikuspid, TF dengan koreksi, katup bioprostetik, MS NYHA I-II Kelompok 2 (Mortality Risk 5-15%) Coarctatio aorta tanpa kelainan katup, TF tanpa koreksi, Sindroma Marfan dengan aorta normal, katup prostetik mekanis, MS dengan AF atau NYHA III-IV, Stenosis aorta, Riwayat Infark Myokardium
Kelompok 3 (Mortality Risk 25-50%) HT pulmonal primer maupun sekunder (termasuk Eisenmenger), Coarctatio aorta dengan kelainan katup, Sindroma Marfan dengan kelainan aorta, Kardiomiopati peripartum
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KARDIOVASKULER SELAMA KEHAMILAN


Normal
Lelah Dispneu Kadang palpitasi Murmur sistolik(1-2/6) Pulsasi vena leher Edema ekstrimitas bawah S1 wide-split, keras

Abnormal
Sinkop PND Takikardi >120x/menit Aritmia terus menerus Nafas memendek saat istirahat Distensi vena leher Summation gallop Murmur sistolik (4-6/6) Murmur diastolik Nyeri dada Hemoptisis Sianosis

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STAGES OF HEART FAILURE (ACC/AHA)


Stages A At high risk for HF but without structural heart disease or symptoms of HF HT, CAD,DM,Cardiotoxin, family history of CMP Stages B Structural heart disease but without symptoms of HF Previous MI, LV systolic dysfunction, asymptomatic valvular disease Stages C Structural heart disease with prior or current symptoms of HF Known structural heart disease, SOB and fatigue, reduced exercise tolerance Stages D Refractory HF requiring specialized interventions Marked symptoms at rest despite maximal medical therapy
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NYHA CLASSIFICATION
NYHA Class I Patient with cardiac disease but without resulting limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation,dyspnea or anginal pain NYHA Class II Patient with cardiac disease resulting in slight limitation of physical activity. They are comfortable at rest. Ordinary physical activity result in fatigue, palpitation,dyspnea or anginal pain

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NYHA

Class III

Patient with cardiac disease resulting in marked limitation of physical activity. They are comfortable at rest. Less than ordinary physical activity result in fatigue, palpitation,dyspnea or anginal pain
Patient with cardiac disease resulting in inability to carry on any physical activity without discomfort. Symptoms of cardiac insufficiency or of the anginal syndrome may be present even at rest. If any physical activity is undertaken, discomfort is increased.

NYHA Class IV

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