06 - 218CME - Definisi Etiopatogenesis Dan Diagnosis Kardiomiopati Peripartum
06 - 218CME - Definisi Etiopatogenesis Dan Diagnosis Kardiomiopati Peripartum
ABSTRAK
Kardiomiopati peripartum (peripartum cardiomyopathy, PPCM) adalah keadaan kardiomiopati idiopatik, berhubungan dengan kehamilan,
bermanifestasi sebagai gagal jantung karena disfungsi sistolik ventrikel kiri, biasanya terjadi selama 1 bulan terakhir kehamilan sampai 5
bulan postpartum. Merupakan diagnosis eksklusi pada wanita tanpa penyakit kardiovaskular lain, tidak harus disertai dilatasi ventrikel kiri,
namun fraksi ejeksi biasanya selalu <45%. Etiopatogenesis PPCM berupa hipotesis yang mencakup peranan stres oksidatif, hormon prolactin,
miokarditis, proses autoimun dan mungkin berhubungan dengan gen. Presentasi klinis PPCM kurang lebih sama dengan gagal jantung sistolik
sekunder terhadap kardiomiopati dan diklasifikasikan berdasarkan NYHA. PPCM adalah diagnosis eksklusi, semua pasien harus telah diperiksa
dan penyebab lain selain kehamilan disingkirkan. Gold standard penentuan PPCM adalah echocardiography. Prognosis PPCM tergantung pada
kembalinya fraksi ejeksi ke angka normal.
Kata kunci: Kardiomiopati peripartum, kardiovaskuler, kehamilan
ABSTRACT
Peripartum cardiomyopathy (PPCM) is a condition of idiopathic cardiomyopathy, associated with pregnancy, manifested as heart failure caused
by left ventricle systolic dysfunction, usually within last month of pregnancy till 5 months after delivery.The etiopathogenesis is a hypothesis of
oxidative stress, role of prolactin, myocarditis, autoimmune reaction and may also involved gene activities. The clinical presentations are similar
to systolic heart failure secondary to cardiomyopathy and classified according to NYHA criteria. PPCM is a diagnosis of exclusion after every
possible causes other than pregnancy have already been considered. Gold standard of diagnosis uses echocardiography. Prognosis depends
on the improvement of ejection fraction. Monique Setiantiningrum, Vallentino Rehatta. Definition, Etiopathogenesis and Diagnosis of
Peripartum Cardiomyopathy.
Kata kunci: Peripartum cardiomyopathy, cardiovascular, pregnancy
PENDAHULUAN
Kardiomiopati
peripartum
(peripartum
cardiomyopathy, PPCM) adalah penyakit langka
yang masih sedikit diketahui penyebabnya.
Terdapat banyak hipotesis etiologi dan
patogenesis PPCM. Definisi PPCM berbeda
berdasarkan organisasi pembuatnya, definisi
terbaru mengacu kepada 4 kriteria dengan
PPCM merupakan diagnosis eksklusi. Etiologi
dan perjalanan penyakit masih hipotetis
membuat PPCM suatu penyakit gagal jantung
dalam kategori tersendiri.
DEFINISI
Terdapat berbagai definisi PPCM yang diulas
lengkap.1 European Society of Cardiology
on the classification of cardiomyopathies
Alamat korespondensi
492
email: mhsetiant05@gmail.com
493
494
Pencitraan Jantung
Pencitraan jantung diindikasikan untuk semua
wanita peripartum dengan tanda dan gejala
gagal jantung untuk menegakkan diagnosis
dan prognosis.1,5
Ekocardiografi
Ekocardiografi merupakan
diagnosis PPCM.1
baku
emas
Patchy infiltrates
di
daerah
paru
bawah, dengan vascular redistribution/
cephalization, kardiomegali, dan efusi pleura,
mengindikasikan adanya gagal jantung
kongestif. Harus dipertimbangkan bahwa
noncardiogenic pulmonary edema dapat
ditemukan jika wanita hamil terkena infeksi
berulang, juga pada keadaan tekanan
jantung normal dan tidak ditemukan adanya
cephalization pembuluh darah.5
Elektrokardiografi (EKG)
Pada dua penelitan melibatkan 97 pasien
Afrika Selatan, didapatkan 66% mempunyai
hipertrofi ventrikel kiri dan 96% mempunyai
gelombang ST-T abnormal. Kadang terdapat
aritmia kordis kronis.1 Studi lain menemukan
QRS kompleks memanjang lebih dari 120
ms pada EKG pasien PPCM sebagai prediktor
mortalitas.9
DAFTAR PUSTAKA
1.
Sliwa K, et al. Position statement on current state of kowledge on aetiology, diagnosis, management, and therapy of peripartum cardiomyopathy: a position statement from the Heart
Failure Association of the European Society of Cardiology Working Group on Peripartum Cardiomyopathy. European J. Heart Failure 2012;12:767-78.
http://eurjhf.oxfordjournals.org/content/12/8/767.full.pdf+html
2.
Pearson GD, et al. Peripartum cardiomyopathy: National Heart, Lung, and Blood Institute and Office of Rare Diseases (National Institutes of Health) Workshop Recommendation and
Review. JAMA 2000; 283(9):1183-8.
http://jama.jamanetwork.com/article.aspx?articleid=192436
3.
Mishra VN, Mishra N, Devanshi. Review article: Peripartum cardiomyopathy. JAPI 2013;61:268-73.
http://www.japi.org/april_2013/06_ra_peripartum_cardiomyopathy.pdf
4.
Lim CP, Sim DKL. Peripartum cardiomyopathy: experience in an Asian tertiary centre. Singapore Med J 2013;54(1):24-7.
http://www.sma.org.sg/UploadedImg/files/SMJ/5401/5401a1.pdf
5.
6.
Elkayam U, et al. Heart Failure; Pregnancy-asscociated cardiomyopathy: Clinical characteristics and a comparison between early and late presentation. Circulation 2005;111:2050-5.
http://circ.ahajournals.org/content/111/16/2050.full.pdf+html
495
Hasan JA, et al. Peripartum cardiomyopathy characteristics and outcome in a tertiary care hospital. J. Pak. Med. Assoc. 2010;60(5):377-80.
http://www.ncbi.nlm.nih.gov/pubmed/20527612
8.
Huang GY, Zhang LY, Long-Le MA, Wang LX. Clinical characteristics and risk factors for peripartum cardiomyopathy. African Health Sci. 2012;12(1):26-31.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3462514/pdf/AFHS1201-0026.pdf
9.
Ramachandran R, Rewari V, Trikha A. Anaesthetic management of patients with peripartum cardiomyopahty. J. Obstetr. Anaesth. Crit. Care 2011;1(1):5-12.
http://www.joacc.com/article.asp?issn=22494472;year=2011;volume=1;issue=1;spage=5;epage=12;aulast=Ramachandran
10. Chopra S, Verghese PP, Jacob JJ. Bromocriptine as a new therapeutic agent for peripartum cardiomyopahty. Indian J. Endocrinol. Metabolism 2012;16(7):60-2.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3354950/
11. Patten IS et al. Cardiac angiogenic imbalance leads to peri-partum cardiomyopathy. Nature 2012;485(7398):333-8.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3356917/
12. Ramaraj R, Sorell VL. Peripartum cardiomyopathy: Causes, diagnosis, and treatment. Cleveland Clinic J. Med. 2009;76(5):289-96.
http://www.ccjm.org/content/76/5/289.long
13. Sliwa K et al. The addition of pentoxifylline to conventional therapy improves outcome in patients with peripartum cardiomypathy. Europ. J. Heart Failure 2002;4:305-9.
http://eurjhf.oxfordjournals.org/content/4/3/305.long
14. Shah T et al. Peripartum Cardiomyopathy: a contemporary review. Debakeyheartcenter.com/journal 2013;MDCVJ-IX(1):38-43.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3600883/pdf/MDCVJ-09-038.pdf
15. Van Spaendonck-Zwarts KY et al. Peripartum cardiomyopathy as a part of familial dilated cardiomyopathy. Circulation 2010;121:2169-75.
http://circ.ahajournals.org/content/121/20/2169.full.pdf+html
16. Okeke TC, Ezenyeaku CCT, Ikekako LC. Peripartum cardiomyopathy. Ann. Med. Health Sci. Res. 2013;3(3):313-9.
http://www.amhsr.org/temp/AnnMedHealthSciRes33313-8157122_223931.pdf
17. Maroo A, Raymond R. Pregnancy and heart disease.
http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/cardiology/pregnancy-and-heart-disease/
18. Krejci J, et at. The variable clinical course of peripartum cardiomyopathy. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2012;156(XX):1-6.
http://biomed.papers.upol.cz/getrevsrc.php?identification=public&mag=bio&raid=413&type=fin&ver=2
19. Givertz MM. Perpartum cardiomyopathy. Circulation 2013;127:e622-6.
http://circ.ahajournals.org/content/127/20/e622.full.pdf+html
20. Johnson-Coyle L, Jensen L, Sobey A. Peripartum cardiomyopathy: review and practice guidelines. Am J Crit Care 2012;21:89-98.
http://ajcc.aacnjournals.org/content/21/2/89.full.pdf+html
21. Terata M et al. Detection of peripartum myocardial burden by vector-projected 187 channel electrocardiography and serum NT-proBNP. Int Heart J 2013; 54(3):140-5.
https://www.jstage.jst.go.jp/article/ihj/54/3/54_140/_pdf
496