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Remodeling
PJK
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Gagal Jantung
Proses evolusi Gagal Jantung Ischemic Events
Progression of CAD
Chronic Hypoperfusion
Normal
Tidak ada keluhan Disfungsi V ki yang
Aktivitas normal
Fungsi V ki normal asimptomatik
Tidak ada keluhan
Aktivitas normal GJ kongestif Kompensata
Fungsi V ki abnormal
Tidak ada keluhan GJ kongestif
Aktivitas
Fungsi V ki abnormal Dekompensata
Keluhan (+)
aktivitas GJ kongestif refrakter
Fungsi V ki abn
Keluhan tidak berkurang
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Terminologi :
1) Gagal Jantung Kiri
2) Gagal Jantung Kanan
3) Gagal Jantung Akut
4) Gagal Jantung Kronik
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• Poole-Wilson :
– Sindrom klinik yang disebabkan oleh kelainan
jantung dan dapat dikenali dari :
• Respon Hemodinamik
• Respon Renal
• Respon Neural
• Respon Hormonal
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3
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ANAMNESA
DYSPNEA # HYPERNEA
HYPERNEA = TACHYPNEA =
HYPERVENTILATION
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ANAMNESA
KRITERIA DYSPNEA
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FOTO THORAX
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ECHOCARDIOGRAPHY
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C) Presentasi Klinik
1) Gagal Jantung Akut
2) Gagal Jantung Kronik
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Keluhan :
Dyspnea on effort (DOE)
• Dyspnea Orthopnea
Paroxysmal Nocturnal Dyspnea (PND)
Gejala :
• Tanda bendungan/retensi cairan :
– Edema kaki-tungkai-scrotum-labia mayor
– Ascites
– Hepato-splenomegali
– Distensi Vena Jugularis
Pemeriksaan
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FISIOLOGI JANTUNG
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Beban Kontraktilitas
Awal Miokard
Pompa
Jantung
Beban Denyut
Akhir Jantung
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Kontraktilitas Miokard :
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Denyut Jantung :
• - Irama jantung
• - Frekwensi / laju jantung per menit
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RAAS
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Renin-Angiotensin Cascade
Angiotensinogen
Non-renin Renin
(e.g. tPA)
Angiotensin I Bradykinin
Non-ACE
(e.g. chymase) ACE
Angiotensin II Inactive
peptides
AT1 AT2
ATn
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10 % RAS 90 %
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Mod. from Dzau V, Arch Intern Med 153 (1993)
ACE Aldosterone
Angiotensin I Na+-retention
K+-loss
Renin Renin
macula
densa
Blood pressure
Angiotensinogen
Na+
Sympathetic system
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Adapt. from Dominiak & Unger (eds.) in Ang II-AT1-Receptor Antagonists, Steinkopff (1997)
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Normal LV Function
C.O.
Depressed LV Function
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penurunan
kontraktilitas
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2. Hipertrofi Ventrikel
• awalnya bermanfaat
– Cenderung memperlambat pengisian saat
diastolik
– Predisposisi iskemia subendokardium
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3. Kompensasi Neurohormonal
Penurunan curah jantung
CURAH JANTUNG
edema perifer
dan
peningkatan bendungan paru
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Prinsip Terapi
Mengurangi “Preload”
1) MORFIN IV
- Venodilatasi
- me tekanan kapiler paru
- me kecemasan
2) FUROSEMID IV
Efek : - Venodilatasi Langsung
- Diuresis
Me “Left Ventricular”
“Filling Pressure”
(5-15’)
3) NITRAT : - IV
- SL
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1. Dobutamin
2. Dopamin
3. Digoksin
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• ACE inhibitors :
– relief of signs and symptoms of heart failure
– prolongation of life
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ACE INHIBITORS
Dzau-Braunwald
Dzau-Braunwald model
Thrombosis
Thrombosis
Sudden
Sudden death
?
Ischemia Infarction
Re-infarction
Loss of muscle
Atheroma
Remodeling
RISK FACTORS
Hypertension LV failure
LVH
= ACE inhibitor effect
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Terapi lain :
1) Pengobatan Aritmia :
– Anti Aritmia
– Pacu Jantung
2) Pengobatan Bedah
3) Transplantasi Jantung
4) Pengobatan metabolik
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Bradikardi Takikardi
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