ANAMNESIS
SR, rate 84x/menit, axis N, p wave N, PR int SR, 94x/menit, axis LAD, p wave N, PR int 0.18,
0.16, qrs dur 0,08, T inv v1-v3 qrs dur 0,08, no ST-T changes
FOTO THORAX
KASUS 1 KASUS 2
2.7 cm
2.8 cm 4 cm
10.3 cm
4.2 cm
10.2 cm
CTR 70%, segmen aorta kalsifikasi, elongasi dan • CTR 60%, segmen aorta elongasi, segmen
dilatasi, segmen pulmo normal, pinggang jantung pulmo normal, pinggang jantung +, apex
mendatar, apex downward, kongesti +, infiltrat - downward, kongesti +, infiltrat -
PEMERIKSAAN LAB
Kasus 1 Parameter Kasus 2
12.6 Hemoglobin 14.4
39 Hematokrit 42.8
6320 Leukosit 8610
229000 Trombosit 229000
101 Gula Darah 131
28.3 Ureum 90.2
0.75 Kreatinin 2.3
79 CCT (Cockroft) 20
141 Natrium 138
4.1 Kalium 4.3
101 Klorida 98
PEMERIKSAAN ECHOCARDIOGRAPHY
Kasus 1 Parameter Kasus 2
Normal 4 ruang jantung Dimensi Normal 4 ruang jantung
44 EDD 39
29 ESD 21
61% EF 78.5%
2.07 TAPSE 2.1
54 LAVI 19.5
95 LV Mass Index 159
7.5 Mean e’ septal-lat 5.1
7.6 Mean E/e’ septal-lat 9.9
Global normokinetik Wall Motion Global normokinetik
Baik Katup Baik
KASUS 1 KASUS 2
DIAGNOSIS DIAGNOSIS
• ADHF wet dan warm ec Penyakit • ADHF wet dan warm ec Penyakit
Jantung Hipertensi Jantung Hipertensi
• Hipertensi Emergensi • Hipertensi grade II
• Post IPKK 1 DES RCA pada CAD 1VD • Insufisiensi renal
(2014)
KASUS 1 KASUS 2
TATALAKSANA TATALAKSANA
UGD : ISDN 5mg SL , extra furosemide UGD : extra furosemide 40mg
40mg Terapi Awal :
Terapi Awal : Inj furosemide 2x40 mg, atorvastatin
Inj furosemide 2x40mg, valsartan 2x160 1x20 mg, spironolakton 1x12.5 mg,
mg, amlodipin 1x5mg, bisoprolol ramipril 1x2.5 mg, amlodipin 1x5 mg
1x1.25mg, spironolakton 1x25mg,
simvastatin 1x20mg, clopidogrel 1x75mg,
ISDN 5 mg k/p
KRITERIA DIAGNOSIS
HFpEF
• Tanda dan Gejala Gagal
Jantung, EF >50%
• Terdapat peningkatan BNP
>35pg/mL dan/atau NT-
proBNP >125pg/mL
• Terdapat gangguan
struktur jantung (LVH atau
LAE) atau disfungsi
diastolik
Zakeri R, Cowie MR. Heart failure with preserved EF : Controversies, challenges and future. Heart 2018; 0: 1-8
KASUS 1
TANDA DAN GEJALA
KASUS 2
Ponikowski, Piotr, et al. 2016 ESC Guidelines for The Diagnosis and Treatment of Acute and Chronic Heart Failure. 2016
PARAMETER EKOKARDIOGRAFI
Poin Inti Gangguan Struktural
DAN/ATAU
KASUS 1 KASUS 2
Poin Inti Gangguan Fungsional
E/e′ mean ≥13
Mean e’ atau Mean e’
septal – mean e’ septal-lateral wall sept-lateral
lateral 7.5 < 9 cm/s 5.1
Ponikowski, Piotr, et al. 2016 ESC Guidelines for The Diagnosis and Treatment of Acute and Chronic Heart Failure.
TARGET TERAPI
“No treatment has yet been shown, convincingly, to reduce morbidity or mortality
in patients with HFpEF or HFmrEF…….an important aim of therapy may be to
alleviate symptoms and improve well-being” – ESC 2016
Tujuan Terapi
• Mengurangi gejala
• Screening dan atasi komorbid
• Meningkatkan Quality of life
Yancy CW, et al. 2013 ACCF/AHA Guideline for the Management of Heart Failure. 2013
Ponikowski, Piotr, et al. 2016 ESC Guidelines for The Diagnosis and Treatment of Acute and Chronic Heart Failure. 2016
TERIMAKASIH