SYOK

KARDIOGENIK
M. Rizki Akbar
Dep. Kardiologi & Ked. Vaskular
FK Universitas Padjadjaran
Bandung

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 Kegawatdaruratan Kardiovaskuler
• Sindroma Koroner Akut
• Edema Paru Akut
• Syok Kardiogenik
• Hipertensi emergensi
• Aritmia
• Diseksi Aorta
• Tamponade

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 Syok - Pendahuluan
• Tekanan darah (BP) adalah hasil perkalian dari
cardiac output (CO) dan systemic vascular
resistance (SVR)
• BP = COXSVR

• Bagaimana melakukan modifikasi tekanan

darah ?

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 Syok - Pendahuluan

CO SVR

Preload Vasokonstriksi

Kontraktilitas Vasodilatasi

Afterload

Denyut
jantung

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 Syok - Pendahuluan
Tekanan perfusi (jaringan) ?

• Tekanan darah yang normal atau tinggi dapat

dihasilkan pada keadaan cardiac output yang rendah
selama SVR cukup tinggi
• Cardiac output yang “cukup” dibutuhkan untuk
menghasilkan tekanan perfusi yang baik

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 Syok - Pendahuluan
• Pengukuran
– Tekanan darah : TDS - TDD
– Tekanan perfusi: MAP – mean arterial pressure
• Mean arterial pressure (MAP)
– (TDS + 2 TDD) / 3
– TDD + [(TDS – TDD}) / 3]
• MAP yang diperlukan untuk mempertahankan
tekanan perfusi tetap baik adalah ≥ 65 mmHg [Graham
& Parke, 2005]

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 Syok - Pendahuluan
• Hipotensi ?
– TDS < 90 mmHg (selama minimal 30 menit) [Califf &
Bengston, 1994]
– Penurunan TDS 30 mmHg selama 30-60 menit
[Hasdai, 2000]
– Penurunan MAP 30 mmHg [Nieminen et al]

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 Syok - Pendahuluan
Hipotensi

Hipoperfusi jaringan 1. Akral dingin

2. Perubahan mental
3. Sianosis
4. Oliguria
SYOK

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 Syok
• Apa yang dimaksud dengan Pre-syok?
• Pre-syok :
– Tanda hipoperfusi
– TDS > 90 mmHg

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 Syok – Definisi
• Shock: The state in which profound and widespread
reduction of effective tissue perfusion leads first to reversible,
and then if prolonged, to irreversible cellular injury (Kumar
and Parillo, 1995)
• Shock is defined as a clinical syndrome due to inadequate
tissue perfusion that results in end-organ dysfunction.

• Klasifikasi :
– Syok hipovolemik
– Syok kardiogenik
– Syok obstruktif ekstra-kardiak
– Syok distributif

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 Syok Kardiogenik
Cardiogenic Shock
Due to cardiac pump failure related to loss
myocardial contractility / functional
myocardium or structural / mechanical failure
of the cardiac anatomy and characterized by
elevations of diastolic filling pressures and
volumes

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 Syok Kardiogenik
 Syok + ”cardiac event”

Harus disingkirkan penyebab hipotensi lain :

Hipovolemia, perdarahan, sepsis, emboli paru,
tamponade, diseksi aorta, kelainan katup

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 Syok Kardiogenik
Kriteria hemodinamik
• Hipotensi menetap
(TDS < 90 mmHg, minimal 30 menit)
• Cardiac index menurun (<2,2 L/menit/m2)
• Pulmonary capillary wedge pressure
meningkat (>15 mm Hg)

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 Syok Kardiogenik
Gejala klinis
• Hipotensi + perfusi jaringan ↓
– Oliguri
– Sianosis
– Ekstremitas dingin
– Perubahan mental

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 Syok Kardiogenik
Penatalaksanaan
• Atasi syok
• Atasi etiologi

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 KLINIS : Syok, Hipoperfusi, Gagal Jantung Bendungan, Edema Paru Akut
Kelainan dasar yang paling mungkin ??

EDEMA PARU AKUT HIPOVOLEMI LOW OUTPUT ARITMIA

Volume problem Pump problem Rate problem

Oksigen, intubasi bila perlu

Nitrogliserin SL,
kmd 10-20 mcg/mnt IV Cairan
bila TDS > 100 mmHg Transfusi darah Cek
Furosemide IV 0,5-1 mg/kg Intervensi penyebab Tekanan Darah Bradikardi Takikardi
Morfin IV 2-4 mg Pertimbangkan
Dopamin 5-15 mcg/kg/mnt VASOPRESOR
Bila ADA tanda SYOK, Algoritma
TDS 70-100 mmHg
Dobutamin 2-20 mcg/kg/mnt
Bila TIDAK ADA tanda SYOK,
TDS 70-100 mmHg
TDS 70-100 mmHg TDS 70-100 mmHg
TDS > 100 mmHg TDS < 70 mmHg
Tanda SYOK (-) Tanda SYOK (+)

Cek Tekanan Darah

Nitrogliserin IV Dobutamin IV Dopamin IV Norepinefrin IV

TDS > 100 mmHg & tidak kurang 10-20 mcg/menit 2-20 mcg/kg/mnt 5-15 mcg/kg/mnt 0.3-30 mcg/mentt
dari 30 mmHg di bawah baseline
Norepinefrin IV *) Dopamin IV

•Pertimbangkan diagnostik dan terapetik lanjutan

ACE inhibitor short acting (pada keadaan hipovolemik)
Mis : Captopril •Diagnostik : kateter A. pulmonalis, ekokardiografi, angiografi,
•Terapetik : IABP, reperfusi / revaskularisasi

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 TERIMA
KASIH
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