Cor Pulmonale

R.Mohammad Yogiarto
BAG / SMF Ilmu Peny.Jantung dan Kedokteran Vaskuler

FK UNAIR / RSU dr.Soetomo SURABAYA

SESAK NAPAS

ADALAH KELUHAN YANG DISAMPAIKAN PENDERITA YANG MEMPUNYAI SIFAT SANGAT SUBYEKTIP sebagai :
PERASAAN YG TERTEKAN TERCEKIK PERASAAN YG MEMERLUKAN BERNAPAS LEBIH DALAM / LEBIH KUAT SERINGKALI DISERTAI RASA CEMAS

ETIOLOGI SESAK NAPAS I.PENYAKIT JANTUNG

1.KELAINAN MIOKARD -HIPERTENSI -PENY.JANTUNG KORONER -KARDIOMIOPATI -MIIOKARDITIS 2.KELAINAN KATUP JANTUNG 3.KELAINAN JANTUNG KONGENITAL 4.ARITMIA 5.INTOKSIKASI OBAT YG MEMBERI SIFAT INOTROPIK NEGATIP 6.ANEMIA 7.KELAINAN PERIKARD

ETIOLOGI SESAK NAPAS II. PENYAKIT PARU

1.PENY.PARENKHIM PARU 2.PENY.SALURAN NAPAS 3.PENY.VASKULER PARU 4.KOLAPS PARU 5.PENY.PLEURA

ETIOLOGI SESAK NAPAS

III.PENYAKIT METABOLIK
(Dm,Uremia,asidosis)

IV.PENYAKIT NEURO MUSKULER

(myastenia gravis)

V.PENYAKIT HEMATOLOGIK
(Anemia,leukemia,perdarahan)

VI.OBESITAS
VII.PSIKOSOMATIK

Summary of pressure within atria and ventricles

mm Hg
10 5 25 15 5 5 0 25 ac v x y v y c R T P T P a

d s d
ac

mm Hg SVC

Ao
<150 <90

d s d

150 100

PA
25 10

LA
10

50 10 0 a c v

15

RA
5

15
5

RV
25 0-5

WEDGE
12

LV
<150 <10 R T P T P

IVC

COR PULMONALE

DEFINISI
ETIOLOGI / PATOFISIOLOGI KLINIS / DIAGNOSIS PERAWATAN PENCEGAHAN

DEFINISI :
"COR - PULMONALE"
MPA AO LA RA LV RV

RVE RVH

FUNGSI STRUKTUR

PARU

ETIOLOGI
I. P.P.O.M.
II. HIPOVENTILASI KHRONIS III. KELAINAN PB. DARAH PARU

ETIOLOGI
I. P.P.O.M. : Bronkhitis chr. Emfisema P. Asma bronkh. TBC paru Pneumocon.

II. HIPOVENTILASI KHRONIS 1. Kel. DD. Torak Kipo skoliosis Obesitas Pektus ekskatus 2. Kel. pusat pernapasan

ETIOLOGI
III. KELAINAN PB. DARAH PARU 1. Intraluminer Emboli paru Trombosis > pada pembuluh art. pulm. Hipertensi pulm. primer vaskulitis difuse
2. Ekstra luminer TBC Fibrosis post radiasi Metastase Ca. Sarcoidosis Pneumococ.

SVC

Ao 150/90

LA 10
RA 5

25/0-5 RV
IVC

"WEDGE" 12

LV 150/0-0

"WEDGE 12 ~ PCWP ~ V.P ~ L,A ~ 10

BRONCH. PULM. DISEASE

SPASME BRONCH. VENTILASI HIPOKSEMI POLISITEMI OBSTRUKSI BRONCH. ALVEOLI PRESS VASOKONSTRIKSI PULM. HIPERTENSI PULM. RVH COR PULMONALE BR. MOTOR TONE VASCULER BED. PVR ATHEROSKLEROSIS

COMPENSATA

DECOMPENSATA

KLINIS :
I. AKUT : Emboli - paru masive
Trombosis besar (lebih jarang dijumpai) II. KHRONIS : Lebih sering dijumpai dalam klinik

DIAGNOSA
Ax : Penyakit Paru dasar / Batuk / Sesak Fisik : Sesak. Cyanosis Bendungan vena leher Barrel chest emfisema Ronkhi ~ peny. paru dasar Wheezing Jantung : S1 melemah S2 (hipertensi pulm.)

Pemeriksaan penunjang :
EKG : RAD / RVH Aritmia S.V / V.
R DL : Paru ~ penyakit paru dasar Cor. RVH

: Polisitemia Pa O2 , Pa CO2 Tes fungsi paru yg menurun Echocardiogram.

PERAWATAN COR PULM.

I. TERHADAP PENYAKIT PARU
II. TERHADAP HIPERTENSI PULMONAL

III. TERHADAP JANTUNG

PERAWATAN PENYAKIT PARU

1. Antibiotika (infeksi) 2. Oksigen Hipoksemi / asidosis Dosis 02 1-3 L/m/15 jam/hari Low flow bila : Pa 02 < 50 mmHg, Payah jantung kong. Polisetimia Kognitif Pa 02 > 50 mmHg, Aktifitas Insomnia IPPB 3. Bronchodilator 4. Mucolytic / expect 5. Corticosteroid 6. Fisioterapi

PERAWATAN KARDIOLOGIS
1. TIRAH BARING
2. DIET R.G. 3. DIURETIKA 4. DIGITALIS 5. VASODILATOR

HIPERTENSI PULMONAL
O2 VASODILATOR

VASOKONSTRIKSI HIPOKSEMIA
02 TERAPI : Vasodilator HP Toleransi aktivitas S.T Neurologis Polisitemia Phlebotomi Viskositas Hip. pulm.

PCV > 50 %

Penyakit jantung

Sesak napas Nyeri dada Batuk darah Batuk

Penyakit paru

Hipertensi LVH S3 gallop Ronki

Sesak napas

Perokok Bronkitis kronis R : Cor N Hiperinflasi

BB >, usia pertengahan Perokok, bronkitis kronis Hipertensi ringan

Dx

RPD DP, Lab.

KAUSA

SESAK NAPAS
Faal paru Dx BGA EKG exercise Kateterisasi Echo

Tx

- istirahat - exercise

Bronkodilator Hasil baik P. Paru Hasil jelek Diuretik + digitalis Hasil baik Congestive H.F

Summary of pressure within atria and ventricles

mm Hg
10 5 25 15 5 5 0 25 ac v x y v y c R T P T P a

d s d
ac

mm Hg SVC

Ao
<150 <90

d s d

150 100

PA
25 10

LA
10

50 10 0 a c v

15

RA
5

15
5

RV
25 0-5

WEDGE
12

LV
<150 <10 R T P T P

IVC

Alveolar-capillary membrane
Perivascular Space
Bronchiole Venule Arteriole Tight Interstitial Space

Alveolus

Lymphatic Channel

Hydrostatic Pressure 10-12 mmHg

Oncolic Pressure 25 mmHg

Capillary Lumen

Evolution of cardiogenic pulmonary edema

Alveoli

Alveoli

Alveoli

Hydrostatic Pressure 18 mmHg

Hydrostatic Pressure > 25 mmHg

Systemic Venous Pressure

Hydrostatic Pressure > 28-30 mmHg

Capillary Lumen

Capillary Lumen

Capillary Lumen

A. Interstitial Edema
Stage II

B. Early Alveolar Edema

C. Complete Alveolar Flooding

Stage III

CONGESTIVE HEART FAILURE

RIGHT HEART DYSFUNCTION

CLINICAL INDICATORS

Systemic Congestion Sugular venous distention Volume in distensible organs Right Systemic Systemic venous Renal retention Hepatomegaly BACKWARD Emptying ventricular venous pressure & volume salt & water diastolic Splenomegaly right heart EFFECTS pressure & volume & volume Serous effusion pressure Peripheral edema Ejection Renal retention Diminished Systemic Perfusion Organ C.O into FORWARD salt & water perfusion Weakness aorta EFFECTS Fatigue Volume to C.O Organ Exercise tolerance left heart perfusion Excertional dyspnea FORWARD Emptying into pulmonary artery Mental confusion EFFECTS Tissue hypoxia Metabolic acidosis Pulmonary Congestion Left ventricular Emptying BACKWARD Volume to Dyspnea diastolic volume of EFFECTS lungs left heart & pressure Orthopnea Interstitial & Pulmonary alveolar edema artery pressure Alveolar ventilation Diminished Pulmonary Perfusion Dyspnea Tachypnea Alveolar perfusion Hypoxia Cyanosis

LEFT HEART DYSFUNCTION