Departemen/SMF Kardiologi dan Kedokteran Vaskular

RSUD MOHAMMAD ZYN KABUPATEN SAMPANG

September 2020
 GAGAL JANTUNG
:masalah kesehatan yang
progresif, mortalitas &
morbiditas tinggi
Di Indonesia : usia
penderita relatif lebih
muda, tampilan klinis
lebih berat dibanding di
US dan Eropa

-Konsumsi obat jangka waktu panjang

Peran FasKes primer
penting dalam - Terapi lain akibat komorbid yang dimiliki
tatalaksana pasien
penderita gagal - Beban pusat rujukan besar sehingga
jantung penderita yang stabil dirujuk kembali ke
fasilitas kesehatan (faskes) primer
 Kejadian gagal jantung meningkat seiring bertambahnya
usia, dari sekitar 20 per 1000 orang usia 65-69 tahun
menjadi
> 80 per 1000 orang diantara mereka yang berusia 85
tahun
Transplantation L,Yancy C W,Jessup M, Bozkurt B,Butler J,Casey DE,et al. 2017 ACC/AHA?HFSA Focused Update of the 2013
ACCF/AHA Guideline for the Management of Heart Failure.2017;70(6)

 Prevalensi gagal jantung sekitar >= 10 % pada orang yang

berusia > 70 tahun

 1 dari 6 orang yang datang ke faskes primer dengan

keluhan sesak napas saat beraktivitas, mengalami gagal
jantung
Ponikowski P,Voors AA,Anker SD,Bueno H,Cleland JGF,Coats AJS etal.2016 ESC Guidelines for the
diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016;37(27):2129-2200
ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008
ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008
 Berdasarkan ventrikel : gagal jantung kiri,gagal jantung
kanan, gagal jantung kongestif

 Berdasarkan waktu : gagal jantung akut,gagal jantung kronis

 Berdasarkan derajat kompensasi : gagal jantung

terkompensasi , gagal jantung dekompensasi

 Berdasarkan cardiac output : gagal jantung “low output”,

gagal jantung “high-output”

Santosa F,Strodter D. State of the art Treatment of Heart Failur.UNII-MED.Bremen.2016

 Berdasarkan gejala : forward failure, backward failure

 Berdasarkan fungsi ventrikel : gagal jantung sistolik, gagal

jantung diastolik

 Berdasarkan guideline: New York Heart Association (NYHA),

ACCF/AHA (American Heart Association), ESC (European
Society of Cardiology)

Santosa F,Strodter D. State of the art Treatment of Heart Failur.UNII-MED.Bremen.2016

 Heart failure

NYHA classes Haemodynamics

I none during activity normal

II during ordinary activity at rest normal

III during light activity at rest during activity

IV at rest at rest at rest

Santosa F,Strodter D. State of the art Treatment of Heart Failur.UNII-MED.Bremen.2016

Santosa F,Strodter D. State of the art Treatment of Heart Failur.UNII-MED.Bremen.2016
 Increased Afterload/chronic
Impaired Contractility : pressure overload:
1. Coronary Artery Disease 1. Advanced aortic stenosis
2. Chronic Volume Overload 2. Uncontrolled severe
3. Dilated Cardiomyopathy hypertension

Reduced Ejection Fraction /

Systolic Dysfunction

Heart
Failure
Preserved Ejection Fraction /
Diastolic Dysfunction

Impaired Diastolic filling :

1. Left Ventricle Hypertrophy
2. Restrictive cardiomyopathy
3. Myocardial fibrosis
4. Transient Myocardial ischemi Buku Ajar Ilmu Penyakit Jantung dan Pembuluh
Darah.Airlangga University Press.2020
5. Pericardial constriction
ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2016
 Treatment of heart failure

Cardiac Output = Stroke Volume x Heart Rate

Preload Diuretics,nitrates, ACEi, ARB, ARNI

Afterload ACEi, ARB, ARNI, dihydralazine

Contractility Inotropik agents

Heart Rate Beta blocker, ivabradine

Santosa F,Strodter D. State of the art Treatment of Heart Failur.UNII-MED.Bremen.2016

Santosa F,Strodter D. State of the art Treatment of Heart Failur.UNII-MED.Bremen.2016
2017 ACC/AHA Focused Update on 2013 ACCF/AHA Guidelines on Management of Heart Failure
ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2016
ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2016
ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2016
 Manajemen perawatan mandiri
 Ketaatan pasien berobat
 Pemantauan berat badan
 Asupan cairan
 Latihan fisik

Buku Ajar Ilmu Penyakit Jantung dan Pembuluh Darah.Airlangga University Press.2020
DAFTAR OBAT PRB-BPJS

Massey C V. Division of Cardiology. University of Alabama.USA

DAFTAR OBAT PRB-BPJS

Massey C V. Division of Cardiology. University of Alabama.USA

 Definisi
 Klasifikasi
 Anamnesa dan Pemeriksaan fisik
 Pemeriksaan Penunjang
 Terapi