ARDIO - PARU Materi Intensif wr Farwirtalia (Ta) “Cor Prudentis possidebit scientiam” “Hlati orang bijaksana penuh pengetabuan” 2081393 637 123 @ : SEBDOABE () ingen. : nganoleemingcente fi) ingenioteamingeenter 2: wansingenioteamingcenta: com fF]: nganio- earning centre | |: @ingenicllatang(PEMBAHASAN FASE INTENSIE {( ipp KARDIO PARU ) er) Topik Pulmonologi | | | | ASTHMA PEMBAHASAN FASE INTENSE COPD 58 camara a i ( ec ) PNEUMONIA 4a Zar wala asked ppern a Ryrntnd late (Patomekanisme ogolle Kardinal Sign A sma : ube 0 > juperebt? - brvaiee | 1 Gear pret ler 8 ab . ‘ersfat episod, reversibel dengan atau tanpa pengobatan ‘4, Gejala timbul / memburuk terutama maiam / dini hari | gear : perinfas pary ais Lume pas weg SUMS kronik dan episodik (eksaserbas! akut) ago! mapas, asidosis respirator (RRM 1's, NOT THAT Harp seriousty ! Page | 59GEMEEEMMMY 1 T'5 NOT THAT HaRD SERIOUSLY ! ING Ailagale od wait (hucgdl ate ) | Patomekanisme atifitas pe 1) ‘Segranulal se mast > * sontratat tot pois bronkus > sekres! mukur dan vasodata INGENID ERR, Line ada QO WS Pe ann 9s, + reie K, So lo Derajat Asma Berdasarkae Serangannya’ | Hipersensitifitas tipe 4 + Reaks! Fase Lambat(Hipersentiftastpe 4): tnbul_! WY rmastecl Gk we. AR Ceoxuacilebor °» Klasifikasi Berdasarkan Respon Terapi + Mild (Ringan) : Respon baik terhadap terapi 3x bronkholilator + Moderate : Respon parsial terhadap terapi 3x bronchodilator + Severe (berat): tidak berespon terhadap terapi 3x bronkhodilator - 4 faghy ° et Klassifikasi Asma (PDPI,2006) Status Asmatikus ‘+ Adalah asma akut berat yang mengancam jiwa penderita Suara napas lemah (silent cest)pays srervee Juco iiss verggeay be cut a mi Fseqem reaper dy nek Obat Reliever Asma auawuatilin gedaan LO ce / a4 oo, Manajemen Asma Com tate Une 1 Ale fer sigkenS - —* wl gters LO Ueno {alba INGEN/O = Terapi | prenerg(osvousm Bors) Scoomuregmee jes) | tet 2 mar snort cong! wesrreme veo WAS E |. Teotin ort =e" ae @xsm ___v bys ve | Gea. Obat Kontroler Asma = Skercil ly wy ben flo (60 ie yor FE Algoritma Reliever Asma : webul 3 giberk* ome ABABA Kervcayy 9 Wapelanlll sama) lag a u/ 4¢ aoe reeling (GREER b's Not THaT HaRD SERIGUSLY Page | 61 pacer atoll Vpr/t Ae uae Cy A >d16 2. reversible , U7 (ePO)c ter iow ‘cee 6 INGENIO Em A Fe Feira Re Step 4/4 ——— (mami soa Pry Jeu Aronson: atu ron ses (wneening 74S a temactnancman 2 tK_paru-Spelebaren ove ude tua aa deboolan deta bonkols termina, dae pent nna, Kas Fo Tersatancndngaveoh ror fants eonsememe Penyakt parukronik yang 45 tahun ) = Pajanan polutan < Defisiens! a1 antitripsin( Bay! dg BBLR } = Ufeks! sal napas berulang ( saat balita ) = Dit Fendah ikan laut, buah & antioksidan 2 | Klasifikasi PPOK | Grading PPOK | oa faite Modified Medical Research Council (mMRC) Leeacaarr pane TIRE GON pan iar annals oan | aeomraaioi | cor FARE Ton pen wena || Grade 2] Sya set era jalan terbur-buru tay menai (saber tae) | eee soxstev1 toe stor bh riba dar orang soba se | sear coiw | Gene sTpemreate | ARVIN «708 pos ronan arena sesa, kta alan basa kacana saya harus | Nee berhen! berialer/stirahat arena stak le |___sowcrevicson _| IB Grade @ | Saya sera bahian tia melakukan athitas one ‘FEVINC< 70% post bronkodiator ringan seperti berpakaian, saya tidak mau keluar plea hse rumah karena pasti sesaknya ketika jalan sebentar Diagnosa Banding PPOK p ‘Gambaran Klinik puede i | | Diagnosa ‘Asma | Onset usia dini, Gejala bervariasi Bronkhiale | Sgejala timbul malam / dint hari Alergi, rhinitis, eksim (atopi) -Riwayat keluarga asma / alergi Obtruksi reversiblel! ar Diagnosa Banding Gambaran kiinis Onset semua usia “Sputum BTA, -Radiologi: ibroinfitrat (URE b's. Not THaT HARD SERIOUSLY ! ‘Riwayat terapi OAT Faal paru: obstruks (irreversible ) Radiolog!: fibrotk,kalsifikasisoem pe f° Diagnosa Banding Sot" jee are| qeenn ‘OP ROHO, Haan Penta Vana & previo, Sentai, mocath ante Gigante 3 per GOID idan MAC TE Tare Conta oad aetna bre ea GOD idan, mC HB apr eiak LABA oa ‘ntisinerpcorg 3c%6 | 606 Sean munca? ‘ele om sesak + Frthoserld (nvalus + (ABA cto atelier GOlD Sand MMIC Tale prn sink + ortbonerd Inbal» ABA dr/erou niin ong ANG 0 retasi Spirometri Set Ter atabarars | VB) 4) ret Tae Ton Tan Tone Neemal Te Trea leurs mat | pnmumothorme ha & amapaesmotnore YW uyruy_uruy (ERM r's Not THAT HARD SERIOUSLY Mal pose Intrepretasi Spirometri (NACE, 2010) = FEVITAVE <7 TTOR) post + Reversiitas FEV pasta + Reversibitas FEV paska Tronddiator «255 atau Kurang bronkhodiator 315% atau + Deraat PPOX verdasarkan FEV geetygel 9 PatyDefinisi Gow = WOTUR mecdivin = \ LE) alot frot8e pevaueaunsemeuas ] . a L selon i Mi pene resp 2 seas SATU Cerra) PR pOu PCIE a rexts> featlint rs ebeotnir & cow ud ee a TE Penge XO RA eratrrive 04 > mon + eees qudon yb oT wry lini % ea | ‘ssa | orp table | Pedol n OAT Kat 1 Dewasa FDC / KDT OAT Indonesia (WHO & ISTC) : gal ak 2 Anak MOR wannze(s> | fo anuz+ant | | + Sesual yi ARHZE +S sensitvitas (nya + Kanamisin, « Gagaltat 3 levotnaci, oe ‘apreomiin 7 at eee == vA NRE ANE ~Thab ta @ (ERED = a = “> (GRRE b's Not THaT Harp SERIOUSLY ! Page | 65“Dabl- So Titenst oe sce { INGENIO esseereeans y £iek 58 ed °F ome, lipoma one , Pedoman Ont rat 1 ora fombiak wtisper OAT Kat 2, FDC/KOT ee Tablet “Tablet ‘Tablet a a| wot |p ree | es Lnjtan Ban e 2 a e 3 a 2 3 a 2 Ja 3 2 sole feed] Side Effects OAT oe tt ec eamping aon) | Blind | arpa poe pakoss isk pangnan nl a ang Pedoman OAT Kat 2 Kombipak Tae | oo | at pin | rene (a | oe aay i [Roem [eau | As ndoon pgs geoinaa ae ae aw zt | 1] ot | 8 | | ace (ome | itu] tft | 3 | Prater | bail | Gagouenostontasina pangoian ung ha gk | ‘reporin (6) baeroal | Ryan atenpal satan, ganapa erembargan dan rn rajtan arth re, oo Ringkasan Keterangan Obat TB Pemeriksaan Dahak Ulang [nama Obat [Keartungon ‘(Rerun aon NH en TS uaa Meryebaban serena Profs T8paea | baat) bavanak Deft fit Rifampin ‘Obat TS tama joan danke | | | amma | Temaeruae | | prompt oan at amour iar NOT THAT HARD SERIOUSLY ! Page | 66MENTERI KESEHATAN REPUBLIK INDONESIA a ied Yolen pe rerctolak Alur diagnosis TB dan TB Resistan Obat di Indonesia “Terduga TS Pasion dengan rwayat pengobatan TB, pasien dengan rlwayat ————————} kontak erat dengan pasien TB RO, paslen dengan HIV (4) "es Gopat tolekuler FCM) BTA AToM {e AT spunlen Catat) te Gene acon baru, )aak ada raat pengobatan TB, dak ada rwayat Kontak erat RO, pasen dengan HIV [atu ak ketal status HIV ne x Pemeriksaan Klnis dan Pemerikszan bakterologis dengan Mikrockop atau Tes Copat aR ‘untuk ToM TB y Pemeriksaan TCM TS Tidak meme akses untuk TOM TS Porertsson troakona va SP waa Pos Tare on, i ware Posi] [MTB New senitve Indeterminate eysance ; I Paseo — ’ BIAS ne TORR Foto Toros etontinaal Bemertsoon z eet rom a I deveenatr 1 oda est Pengobatan ‘ual Pengobatan a RO; Lakakan || _pemericaan | phen | pemeitsan Bakan dan Ut Kepekaan || kop BTA COAT Unt dan U2 nest C3) / Ticak Ada t + + verootan | Ta Ra TB Pre TB xDR Minis ada ; rinse | Te oR XOR 7 ao Ya, dan ass ‘chs ieee |] ome coir re penvebob £ dengan Paduan Bary penyabit lala 78 Teskontrmas : tis Pengobatan 78 Unit Pemerksaen jambahon peda semua posien TB yong terkonfirmadl alk secare bokteriologs maupun Kins adalah pernericaan Hiv dan gula darah. Pemerksaan lain ditakukan sestal incici misalrya fungs! hat, fangs! anja, dl)VV VUUUBRUBUYUVESEUUUUUUeed id Babas gak 2 PAY INGENIG a . we OAT + Steroid cig terold oh es TB eytea naruberat : ME TB, ee cefusi pleura, laringtis TB, “ arbi Fences OAT + Steroid [ream] ALGORITMA PASIEN YANG BEROBAT TIDAK TERATUR TO Miler, alerg/hipersensitif ‘Anak = 2rmg/kg@8 pagi hari Dewasa: 30-60 mg pagi hari & hua R sda 3 CIT Tauck iol \ hepakviGlnk <, npawh ¥ | Uaerunr Barey OADCSU Pgagel 1 gagat eB ka sidod 9 ROWE (neurope peri pO) Logatorarnl W/ Bo Ixs0-3e4y Z Std 5 Wapatrimesh 22> per wena | Drug induced hepatotoxi <7 E STATI > gay poy tintr , deren 7 STOP ESE alan af 9 (GL a pusey ber ter _— vic s fobolsik + wyer tpt sable Haperrl ada? ceipera ben bndole fompouninan taker t = WOpatesplunem krn atotoksik bag! janin ,gacjal qageal + TB miller, meningitis TB: 2RHZES/4-7RH + steroid + TB dengan gagal ginjal : tanpa S dan E~>nefrotoksik + SProfilaksi TB anak (jika lahir dari ibu TB) > INH + Thpada anak > tanpa E > buta warna | Definisi + ada anak disebut 8? (bronkhopneumonia) 44 Lyin Lalas ant wy ORF Codey 5) valor st, Fs A Hagle Sot funda saucpey OAT cleat a® 3o0 di deaf yo (xeon | (eee desl ie Pi ae “wi Etiologi Pneumonia Dewasa INGENIO ces xceuried ria) He ast eae | reMBanasan rASEIRTENSIE Prenmro’s Rauler ak plal adeetr g ‘nat ~ Lo bipitar 1 ogee + cap commun aque preumonia Sep Puma (2), cress nope uene ea ererebcrs9> oma | «Nowra ama gn CAP terantung peta aan RS peudoonsi 1 fase qupttemp dan open dana sien ()> pnemon tie> re eee Scola eld spn con oss oplemen Sinapiom murotersenslkeeels anigenura CM L> Kesud)preumeoe cor! —y JRMUP. ( PCP) + asus Khusus: aspirasl pneumonia (peptostreptococcus), chemical ( pAewang preorae ot eee wee Pat eae t parr ‘ a8 eb bay Les Brosts ess eg acd Tes 4,08" ecapa Kciteria Pneumonia Nosokomil (HAP=hospital acquired | pneumonia/VAP=ventilator aquired pneumonia) [sean tn dps apis: || _eerdasar bate penyebab cocatenta as > Poon “ramones tate] || Goapee a emo ——- i Gags apes don memeran timbul in eFERTAB 9m 3 |) | aurora apa, debebkan + Foto thorax: infitrat baru atau |] 02 > 35% untuk. Rs) ; ‘Mycoplasma, Legionella dan progresif mempertahankan saturasi O2 + preumonia asplras! Chlamydia, a le 2 dari gejala :tax>38., sekret |] > 90% heonceepeteoeatens || Poona nee atdeteoatas |). pernanan othr ae Poms aati Bo ||+ trons bt do ses penderita dengan daya tahan Temah ammunocompromised) (inmunocomeramsed) orctio EEE b's Noor THaT HarRD SERIOUSLY ! Page | 68SSNBVNUYVYUYUYVURUERUUYUDUUUE indkast MRS Pneumonia (PORT Score) =a saa sae En Tete eat ch ar Sear Seng | Terapi Antibiotik spektrum| sesval indikasi kuman | Terapi Pneumonia MDR cme sefsporn ant noon espa ‘eeudemorsl fin, ‘seas strom) ‘tov tarapenern eropenem) ‘otra Simtomatis {antiofamas, ‘mucolitk, antipretik al) Psedomonal/Klebsiella/MRSA/Acinobacter spp Unezo toy vaste Terapi Antibiotik Pneumonia. «ci., wie MOB E vosskomiat | [Atk Prascomonasaci || Seerspo eos | | Seta 1 bri nald Komplikasi Peumonia icf" MBM 13's Not tHat HARD SERiOUSLY | Page | 69 |wae dni Abses Paru ) i © | ) * Gx klinis = pneumonia % | * Khas: Ro ada kavitas | dinding tebal, ar fluid level | } ) | Se enmcemniiiiaman | [ — rene ty bart fe benkee | WPA date : : Definisi Gejala Klinis | ene + Proses radang akut yang pada umumnya aoa || 7 Bae daa rn | disebabkan olet( virus, yD PA MC HE WAT! + sattangort a + ayer dada | + Akhir - akhir ini ternyata banyak juga disebabkan ae e ‘oleh Mycoplasma dan Chlamydia bronkospasme. st Ful, + ‘emam tidak teria tines + Pameritsaan fii JBN RPL, aa RE gd, Bey paler aT ——| ah tusi( marche rants (4 tole sant dal Terapi eye byt + Simtomatis dabint ) “ * Bila infeksi karena Mycoplasma atau Chlamydia dapat '* Foto rontgen toraks. = Pemeriksaan - Pada bronchitis akut serologi untuk \ + Tetrasiklin 4 x 500 mg atau tak tertnat meta inet Ne + Doksisiin 2 #100 mg teu seein rove ou ; ee a ene se + Entromisin 4 500 my | trons Suecope” ' “ot ranean Sombraate Pemeriksaan Penunjang GRE 3's Not THAT HARD SERIOUSLY | Page | 70 See C8 8 OP OO ee eeINGENIO® CARDIOLOGY AT A GLANCE: INGeNIO PEMBAHASAN FASE INTENSIF A UveUiit) [i] Re} ei ) Olen: Tm Ingenio ROP STOR AP stor oe — Rose ~ 720" erespon — asistol ww" ech AE asistol 7 es ggpruor® 2 GH gee = oe Klasifikasi Aritmia Ce) : ) _& i 3 N= Nels) (=) revmnvasanraseimense 7,0. 7% | sn Ae cardi acrest , vias ese grt | 7 gaunt pine: \ ; poimoyit, (ned pertes) : uy { NGEN , < ryt bo See + RAE 1S ~2 att @ teat 30, | AV Blok Derajat 1 preunk meng PR INTERVAL MEMANJANG KONSTAN Page | 72S00] nh © 2015 American Heart Association Maintain patent airway Oxygen (if hypoxemi Cardiac monitor to identify rhythm; {It Bradycardia With a Pulse Algorithm Assess appropriateness for clinical condition. Heart rate typically <50/min if bradyarrhythmia. 2 Identify and treat underlying cause assist breathing as necessary monitor blood pressure and oximetry Persistent bradyarrhythmia causing: + Hypotension? Acutely altered mental status? Signs of shock? ischemic chest discomfort? te heart failure? ieee hia ear ase eee es Atropine IV dose: First dose: 0.5 mg bolus. Repeat every 3-5 minutes. Maximum: 3 mg. Dopamine Iv infusion: Usual infusion rate is 2-20 meg/kg per minute. {trate to patient response; taper slowly. Epinephrine tv infusion: 2-10 meg per minute infusion. Titrate to patient response Sadie If atropine ineffective: + Transcutaneous pacing Expert consultation Transvenous pacingGat tsa AV blok sera rt PR interval semakin prelate till Wines I sik T Prey, lantien— 7 ae vy JNGeNIO ada drop beak SPY Au plotrdarajat t= Art P-P sama benite derajat Il Mobitz 2 4° y PR interval memanjang Konstan, ibe tiba muncul drop beat Fagus 9 0g trend err _ ty 9 nie ~~ AV blok derajat mS QSscept Reg = Soe T Cov bya put soustnbcs) GS sewn lme » (29-200 5 7 @eg Lanes © Re c NBRS Rear trr0y ane ve Nee gorithm > VoOreph RNOO, Corkoverg fergulucty feo 5 kee. “rorser epee vd giver CUT VT Same, Vase Mame — ~ayiiodeon Gon unr ] Sie Wy wv _ ete, bir had z =Dilhare/BB | ‘ Adsnci oat (ith eo manner 1 =age din 1O-W* EO ae tl Wieaccny Ree iota Klasifikasi Aritmia Takikardia = eae GEMM 0's Not THAT Haro SERIOUSLY ! Page | 73Page | 90 Perform immediate ‘cardioversion Getablon tv access and give aon > Bdenosing, digoxin _ Baer Yerseanin, SEMEN 3's Not THAT HARD SERIOUSLY ! Goontry supraventricular taonyouraia) 1B NIECE NS tenet or CHP) “ me Bbicckers) :t Tachycardia With a Pulse Algorithm appropriateness for clinical condition. Assess Heart rate typically 2150/min if tachyarrhythmia. Identify and treat underlying caus Maintain patent airway; assist breathing as necessary tachyarrhythmia causing: + Hypotension? * Acutely altered mental status? 4 7 | Synchronized cardioversion * Consider sedation * If regular narrow complex, Yes * IV access and 12-lead ECG if available * Consider adenosine only if regular and monomorphic. Consider antiarrhythmic infusion ee * WVaccess and 12-lead ECG if available * Vagal maneuvers * Adenosine (if regular) ‘* B-Blocker or calcium channel blocker 3, Consider expert consultation ae sss (© 2015 American Heart Association [eye r ae ‘Synchronized cardioversio: Initial recommended doses: * Narrow regular: 50-100 J * Narrow irregular: 120-200 J__ biphasic or 200 J monophasic : jular: 10 : Wide regular: defibrillation dose (not synchronized) Adenosine IV dose: First dose: 6 mg rapid {V push; follow with NS flush. Second dose: 12 mg if required. Antiarrhythmic Infusions for Stable Wide-QRS Tachycardia Procainamide IV dose: 20-50 mg/min until arrhythmia suppressed, hypotension ensues, QRS duration increases >50%, or maximum dose 17 mg/kg given. Maintenance infusion: 1-4 mg/min. Avoid if prolonged QT or CHF. Amiodarone IV dose: First dose: 150 mg over 10 minutes. Repeat as needed if VT recurs. Follow by maintenance infusion of 1 mg/min for first 6 hours. Sotalol IV dose: 100 mg (1.5 mg/k i Avoid if proinesdee 5 minutes. Page | 91 TT’S NOT THAT HARD SERIOUSLY !ia peta in 1rd massage fe retlat2> aa Vi (ventricular tachycardi) VF (ventricular fbrias) etn lar! stam i pan et | + Bia takstbicardoves Lihak tend © pris, > Vi-Ve PVC / VES /eratassst vet (premature ventricular contraction/ventrikelekstrasistol) sous Tx under ang mek amare Pea era mnt daar eran voug waders plea fdr mca Tent undergo Gan > saleutowol Digoxily auivorilin : roceriid—Wipolaltaanr: Teal mark pee a GEESE v's Not THAT HARD SERIOUSLY ! Page | 74INGEN PVC yg balteyn -9 PV BLEEMINI Pola PVC n v AG IN PW Okasional: muncul sekali-dua kali tanpa pola khusus \n. i : Bigemin: glombang nprmal dan PUCReselang seling. Normal \\ NG : : Nerang aie ee 3 WC ee : + Teigemini: normal-normal-pve-normal-normal-pve { ‘couplet: PVC ada dua berjejeran. normal-pve-pve-normal-pve-pve tiple: PVC ada 3 gelombang berjejeran. Normal-pvc-pve-pve- reve mepNenormal 9 JiGurian jadl YT 4 4 VT Cuonsustetn VT) wR PVE uC NIC 8) -9) go te Nee 9 Ue ou eeee ———______ Qeint mentee e Gor erik Ws 7 MF Rin eV jundle Branched Block “ eel Wolf Parkinson White Syndrome Hyubipnyhart dx ORS Uorrplel Oral yerasmyn SUT OY PRT (eens) Hallmark + aRs>032 600m ans 02 desk + alinanbawaan ec ada + Vi gel lebar dan dalam “+ VIER pattren, ST depres reeks aur asesors : Nermtsmtran aan gu) | Bhédetia ne i SOS] | + eins tart (ord bar- y ee eebareaUxint WN er ce, ce Awe AVRT ahr st | di Vi 2 RBBE Leary Vanes) AL ables, devar®, bere GUleher Ve 93s. Leary L AN ear lame gaat — SS Ch hUhlhlUh/}S Hallmark + Morflog! VT poimorfi, Bent sepertkumparan, ampltogo ORS omplelstadang tn 205 kadar be awa + etolog hpotaemi, Kok: pots, sinkap, esa, eng cing, ee —-— o—- lel Te S NOT THAT HARD SERIOUSLY | Page | 75PACs * Gelombang P non-sinus Abnormal yang diikuti Kompleks QRS. * Gelombang P PAC memiliki morfologi yang berbeda dengan Gelombang P Sinus. * Gelobang P abnormal akan Nampak tersembunyi dan menyatu dengan T sebelumnya, sehingga akan tampak gambaran “peaked” atau “camel hump appearance” > seperti Punuk Unta. i LAY gpencure— Pome coke dak pernal, elicwak P (peumalyr da be . cr sve tebe * PAC -QRssemst | we ebeleeS tee /\— Cetetopitratkivn) FF Djawali Get. P hyarall . Comparafery paurenyn & full 22 PSP he ax Roe inn Sy Tea PULL CETL ~ te[ — rece re TeSt PAC 4 futuliuu, 7 + beltin gluat ditebiak op VT poburor ee bagge MR anae (GRRE) 's. Nor THAT HARD SERIOUSLY ! Oleh: Tim ingests Page | 76Heart Failure (Gagal Jantung) ~ ‘Tanda khas:taktardia, takipneu, ron Tanda obyektit:cardiomegall Jantung bergeser ke lateral su rosea plush VE perifer, hepatomegali 7 Peningkatakan 8 type-natriuretic Jantung 3 (53), gallop, murmur,lf sin wore peptide (BNP) ‘echocardlografi > akinesia ventrikel * Atasi bendungan Furosemide dosis awal 20-40 me. ine paar Oo Cave), iataal dengan golongan ” hee .RB krn menghambat remodellin ‘ote aiberan tertare |] ID dengan tondiAr. + Jangan beri CoB! JB\gan digoksinty 2 > Furosemide kontraindikasi arena memperparah hipotens! + Gunakan agen inotropik seperti digoksin untuk rmengatasi bendungan bisa menggunakan bo cepa gaeeacecentiens elrctry heat Hace equi specced interventions plusel cualen] (oo 250 eduna pein -All yes , Ut ported cass Tak bergeaa Neiman ordinary phys enrise doesnot cause Unde tq, dypnoes oe palpitations, Lf ta ita oeratpeu “Apa eiminton pla actor a ret But ordinary aco ests fatigue sono, oF seis 100m) ipeaon ‘emai Sag | Maddison of pica acy comfortable at axowaslogobies | (States tana acy mls oat in (20 00m) | trae anahsaay wot ccass-1 | azar symtoms of hear ture ae ree even sranauaua berg | ares witnessed domo ft ay she sco. Alo Blides Rove Manifestas! Klinis He IRI HF KANAN + Jantunghit gag memompsdacah + Jantunglaran gas! mompa dah reasemie apart + Main p> SESAK(ayepneu effort) + Main gaDedeme tng + Sontecn (ete ngeaema) Sette peer % poral be) Tiago lei) AULA ‘CHF(ADHE WF kanan +r couyat rnp Te TL Botan © (eaivan) 2. ¥ Goban demand C2 3.4 Bebair Yonbat lites co -— = @© we &eea wa = ff | Tx HF | ska 70 stabi daTOwse + Atasibendungan dengan Furosemide kntaindkas | | Furosemide arena memperparah | [+ wrrdiatasi dengan golongan || hipotens! ACE/AR® ken menghambat remodelling + Jangan beri CcBItl + Gunakan agen inotropik seperti digoksin untuk ‘mengatasi bendungan + ska gagal bisa menggunakan drip dopamin, dobutamin atau NE GREY t's Not THAT HARD SERIOUSLY ! sens wih Try esd aI Nea mrenomaton Hallmark MF = + Seas stv (pone de fon) sonaiu uae 8 cr + tae tangle peel Se + Ronhipawte) Hoe dy spre Oren congeti epatcrep, poral ft agement Bg akrive fwenk Estimasi EKG cardiomegali + Ppulmonal(P sangat ting; >2,5 kotak kell) Phipertrop! atrium kanan +P mitral (Plebar 23 kotak kecil dan bertakik, membentuk huruf M)->hipertropi atrium kiri ‘+ Rtinggi<27 kotak kell, dominan di Vi ->hipertrapi ventrikel anan AR tinggi 227 kotak kecil dl VS-V6-> hipertropi ventrikel kc + Gelombang $>7 kotak besar di V1-V2->hipertropi ventikel ket Page | 77oekduly HiPoTENSI” SS Dogar in Dorrbeaiin ise IH -weo wd * TOS Joo wBANG 2 IDS Fo-100 mit ~ WS etomm ‘ 4 - - cepralt «Ser LTANPA SYOK SYOKD b _ dig tribusi syoe, do 2-20 meg. 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Diabetes oF CKO present 7 re eer CKD present with or ene nates INGEN/O EEE iiercseaaee Bearers 7a ures Nenblack i Initiate thiazide, ACEI, ARB, ‘of CCB, alone or in combo x a 3 g z Ww = — te - [ ‘At blood pressure goal? + Smoking Cessation 5 + Control blood glucose and lipids z = + Diet < eee US Reintoree iifestyle and adherence at Wee Eat healthy (ie., DASH diet) z “Thrate medications to maximum doses or consider adding another medication (ACEI, ARB, OCB, Thiarlde) _ | Moderate alcohol consumption E I Reduce sodium Intake to no z ‘At blood pressure goal? ee more than 2,400 mg/day. E + Physical activity e ¥ Moderate-to-vigorous activity a 3-4 days a week averaging 40 i min per session. ag & Yer fF - At blood pressure goal? | — ~ Ne Ti] Reteronce: ames PA, Ont £, etal. 2014 evidence based guidetine forthe! “© Relnforee tifestyle and adherence lot ngn blood pressure in adults. 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