Kardiomiopati
• EKG :
– LVH voltage
• Ekokardiografi :
– Dilatasi ruang jantung
– disfungsi sistolik dan disfungsi diastolik
Penatalaksanaan dan terapi
• Terapi simtomatik
– Diuretik
– ACE inhibitor
– Beta bloker
Kardiomiopati Hipertrofi
• Definisi
– Kelainan jantung yang ditandai oleh hipertrofi
miokardial tanpa diketahui etiologinya.
– Hipertrofi dengan atau tanpa obstruksi.
• Beberapa terminologi :
– Hypertrophic Obstructive Cardiomyopathy (HOCM)
– Hypertrophic Cardiomyopathy (HCM)
– Idiopatic Hypertrophic Subaortic Stenosis
– Asymmetrical Septal Hypertrophy
Figure 13-
3
Concentric
hypertrophy
Pressure Concentric
overload hypertroph
Elevated pressure (P) increases wall thickness (W)
relative to radius (R); wall tension (T) remains normal.
Kardiomiopati Dilatasi
• Asimtomatik
• Paling sering : sesak , sakit dada, pingsan
• Aritmia
• Sudden death
• Varian : hipertrofi apikal
Pendekatan diagnostik
• Anamnesis
• Pemeriksaan fisik
– Murmur sistolik ejeksi di area LSB
– Murmur sistolik di area mitral
• Radiologi
– Tidak ada tanda khas
• EKG
– Abnormalitas segmen ST dan gelombang T
– LVH
• Ekokardiografi
– LVH
– Disfungsi diastolik tapi fungsi sistolik normal
Penatalaksanaan dan terapi
• Medikal
– Menangani gejala obat inotropik negatif, obat pilihan : beta
bloker
– Hindari keadaan hipovolemi atau yang membuat hipekinetik
• Intervensi :
– Pacu jantung permanen
– Implant Defibrilator Kardioversi
– ablasi alkohol di septum ventrikel
• Pembedahan
– Subaortic miotomi , reseksi basal septum
– Koreksi katup mitral (kalau ada MR)
– Transplantasi jantung
Prediktor penderita HCM dengan
risiko tinggi
• Riwayat cardiac arrest
• Ventrikel takikardi
• Riwayat keluarga dengan sudden death
• Non sustained VT ditemukan dari pemeriksaan Holter
• Sinkope atau presinkope bukan neurogenik
• LVOT gradient > 50 mmHg
• Tebal dinding LV > 20 mm
• Dilatasi LA > 45 mm
• Respons hipotensi saat exercise
Definition
Restrictive cardiomyopahty
Characterized by restrictive filling and reduce
diastolic volume either or both ventricles with
normal or near normal systolic function and wall
thickness
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Investigation
• ECG ( lewis, 1992 )
Shows atrial enlargement in virtual
patient.
LVH is seen in less than half
Impaired AV conduction is frequently
reported
• Chest radiography
CTR greater than 0.5 ( lewis,1992)
Pulmonary venous congestion is a
Echocardiography Patologi anatomi
Investigation
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Investigation
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initial diagnosis*
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Prognosis
The probable outcome is poor, and
treatment is not usually very effective.
People with restrictive cardiomyopathy
may be candidates for heart transplant
Prognosis
• Median survival was 1.4 years,
six patient from eight died 0.2 to 7.0 years
after they were initially seen*
• Embolic events occurred in 33%**
• Markers for poor prognosis for sudden
death with presentation sign or symptom
ischemia***
Circulation 2002;105:2939-2942
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Clinical feature
• The chronic form
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hepatomegaly,
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are
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before
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• The sub acute form
HEART 2001;86:343-349
Follows an acute infectious illness by day
Management and Prognosis
• Pericardiectomy is the definitive treatment
for constrictive pericarditis in severe
constrictive with mortality 6 % to 19%
Circulation 2002;105:2939-2942
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