SIMTOM KARDINAL

DYSPNEU EDEMA CEPAT LELAH BATUK HEMOPTOE PALPITASI SINKOPE NYERI DADA

DYSPNEU
DYSPNEU DEFFORT PAROXYSMAL NOCTURNAL DYSPNEU DYSPNEU ISTIRAHAT

BATUK - HEMOPTOE
BATUK DENGAN DAHAK ENCER, BERBUIH BATUK DARAH

PALPITASI
DEBAR JANTUNG YANG KUAT DENYUT JANTUNG YANG CEPAT DISRITMIA KORDIS

SINKOPE
KEHILANGAN KESADARAN AKIBAT GANGGUAN PERFUSI OTAK OBSTRUKSI PERFUSI OTAK DISRITMIA

SISTEM KARDIOVASKULAR

Prof Dr dr RJ Sri Djokomoeljanto, SpPD-KEMD

RUANG-RUANG JANTUNG

Gagal Jtg kanan : edem perifer, jvp, hepatomegali, asites, dll Gagal Jtg kiri : edem paru, takikardi, acral dingin, sinkop, dll

GAMBARAN GAGAL JANTUNG AKUT

GAMBARAN GAGAL JANTUNG KRONIS

GAGAL JANTUNG KONGESTIF

GAMBARAN KHAS NYERI ANGINA

LOKASI NYERI ANGINA

Infark : 2 dari 3 (Angina, EKG khas, Enzim ) Lansia dan atau DM sering tak terasa nyeri

PENYEBAB KENAIKAN PRESSURE LOAD / AFTERLOAD

right

left

Right atrium

Left ventride

Permukaan anterior jantung, didominasi Ventrikel kanan dan arteri pulmonalis. Pada batas kiri jantung dapat dilihat ujung V.kiri & aurikula atrium kiri.

HANTARAN LISTRIK PADA JANTUNG

NSA NAV His (LBB & RBB) Purkinje

EKG MULTI SADAPAN

Berguna terutama untuk kasus disritmia, iskemia, infark. Untuk kelainan anatomis kadang kurang tepat

KOMPLEKS EKG

EFEK HIPERTROPI ATRIUM & VENTRIKEL PADA EKG

P Pulmonal ~ RAH

P Mitral ~ LAH

RAD, R>S di V1 ~ RVH

R V5/6 + S V1/2 35mm ~ LVH

MENCOCOKKAN DENYUT A.RADIALIS DENGAN A.FEMORALIS

SALAH SATU CARA MERABA DENYUT NADI

Bandingkan kanan-kiri, bisa tidak sama, misal pada : Arteritis Takayashu, Koarktasio aorta, oklusi

MERABA DENYUT A.BRACHIALIS

FAKTOR YANG MEMPENGARUHI BENTUK GELOMBANG NADI

GELOMBANG NADI

BERBAGAI JENIS DENYUT ARTERI

P.Parvus (kecil, lemah) : MS,AMI P.Tardus : lambat mencapai puncak Sistolik P.Alternans : amplitudo naik/turun

ABNORMALITAS DENYUT YANG TERABA PADA A.BRACHIALIS

MENGUKUR TINGGI JVP PENYEBAB KENAIKAN TEKANAN V.JUGULARIS

MERABA DENYUT A. KAROTIS

PERBEDAAN DENYUT A.KAROTIS DENGAN V.JUGULARIS

BERBAGAI TIPE DENYUTAN APEKS

MERABA APEKS JANTUNG

Berbaring telentang, Tentukan lokasi apeks, Lalu tentukan kualitas denyut

SUARA TAMBAHAN PADA AUSKULTASI JANTUNG

BISING LOKASI FASE PUNKTUM MAKSIMUM PENJALARAN INTENSITAS (1-6) KUALITAS

Sambil mendengarkan denyut jantung, raba pula denyut nadi untuk menentukan bunyi pada sistolik / diastolik

Intensity of murmur
The 6 categories are defined as follows : Grade 1 - very faint, heard only after the listener has tuned in; may not be heard in all positions Grade 2 - quiet but heard immediately upon placing the stethoscope on the chest Grade 3 - moderately loud Grade 4 - loud Grade 5 - very loud, may be heard with a stethoscope partly off the chest Grade 6 - may be heard with the stethoscope entirely off the chest

STENOSIS KATUB MITRAL

Mitral stenosis of rheumatic etiology. A. Fish-mouth malformation of the valve as viewed from the left atrium. B. Note the tight stenosis of the mitral orifice, dilatation of the left atrium, and atrial mural thrombi.

BISING PANSISTOLIK PADA INSUFISIENSI / REGURGITASI MITRAL

REGURGITASI / INSUFISIENSI AORTA

BEBERAPA BISING JANTUNG DAPAT TERDENGAR LEBIH BAIK PADA POSISI TERTENTU

Bising diastolik aorta duduk condong ke depan, ekspirasi

Bising diastolik mitral paling baik didengar dengan bagian Bell stetoskop. Miring ke kiri

BISING JANTUNG SELAMA RESPIRASI

ATRIAL SEPTAL DEFECT

S1 Exp

A2

S1

P2

Insp.

Atrial Septal Defect

BISING PANSISTOLIK PADA DEFEK SEPTUM VENTRIKEL (VSD )

S1

S2

S1

S3

Cardiac findings of Patent Ductus Arteriosus

AUSKULTASI JANTUNG

SPLINTER HAEMORRHAGI

Merupakan mikrotrombi, sering pada SBE (Endokarditis Infeksi)

TEMPAT PENYEBARAN BISING

Pathophysiologic sequence of cardiac tamponade

Increased systemic and pulmonary venous pressure Decreased end systolic volume

Decreased ventricular end-diastolic volume

Decreased ventricular stroke volume

Decreased cardiac output Decreased arterial blood pressure

Tachycardia

Increased peripheral resistance

Systolic murmurs are further divided into two principal categories : Amidsystolic murmur begins after S1 and stops before S2. Brief gaps are audible between the murmur BISING and the heart sounds. S1 S2 S1 Apansystolic (holosystolic) murmur, FASE PUNKTUM MAKSIMUM in contrast, starts with S1 and stops at S2, without a gap between murmur PENJALARAN INTENSITAS (1-6) and the heart sounds. S1 S1 S2 KUALITAS

Diastolic murmurs are divided into 3 categories :

S2

S1

S2

S1

An early diastolic murmur starts immediately after S2, without a discernible gap, and then usually fades into silence before the next S1. A middiastolic murmur starts a short time after S2. It may fade away, as illustrated, or merge into a late diastolic murmur.. A late diastolic (presystolic) murmur starts late in diastole and typically continues up to S1.

S2

S1

VARIATIONS AND ABNORMALITIES OF THE VENTRICULAR IMPULSES

When a ventricle works under conditions of chronic pressure overload (increased afterload), its walls thicken. Volume overload (increased preload), in contrast, produces dilatation of the ventricle as well as thickening of its walls. A hyperkinetic impulse results from an increased stroke volume. An impulse may feel hyperkinetic when the chest wall is unusually thin.

15

RAPIDLY DEVELOPING PERICARDIAL EFFUSION

SLOWLY DEVELOPING PERICARDIAL EFFUSION

10

0 200 400 600 800 1000

INCREASING PERICARDIAL FLUID VOLUME (ml)