PENYAKIT JANTUNG DIDAPAT

PADA ANAK
Anindita Soetadji
• Pengertian:
– Penyakit jantung didapat pada prinsipnya adalah
penyakit jantung pada anak yang pada awalnya
memiiki jantung normal
Prevalence RHD
• Pembagian:
– Rematik
– Non-rematik
Rematik Non-rematik
• Demam rematik akut • Kardiomiopati
• Penyakit jantung rematik • Perikarditis TB
• Miokarditis ok infeksi
virus/bakteri
 Rematik
• Demam rematik akut:
– Reaksi imun yang berlebihan terhadap infeksi
kuman Streptokokus ß hemolitikus grup A, yang
mengakibatkan peradangan di arteri-arteri organ
tubuh tertentu

• Penyakit jantung rematik:

– Kerusakan katup jantung yang disebabkan oleh
demam rematik akut sebelumnya
 Gejala klinis
Kriteria mayor: Kriteria Minor:
• Arthritis (radang sendi): di • Demam
sendi besar (lutut, tumit) • Artralgia
berpindah-pindah • AV blok
• Karditis (radang di jantung • LED, Lekosit, CRP
dan lapisan-lapisannya)
• Khorea
• Eritema marginatum
• Nodul subkutan

+ Bukti adanya infeks streptokokus sebelumnya

 Karditis
Karditis bila tidak sembuh sempurna akan
memberikan cacat pada katup-katup jantung
 menetap.

Bila ditatalaksana dengan baik sembuh

Kuman Streptokokus ß hemolitikus
 Regurgitasi mitral

Kardiomegali
Revised
Jone’s
criteria
Diagnosis
• Primary Prevention of Rheumatic Fever
• Group A streptococcus (GAS) infections of the
pharynx are the precipitating cause of
rheumatic fever.
• Proper diagnosis and adequate antibiotic
treatment of GAS infections can prevent acute
rheumatic fever in most cases.
 Viral vs GAS
Features suggestive of viral infection Features suggestive of GAS infection
• Characteristic enanthems • Beefy, swollen, red uvula
• Fever
• Characteristic exanthems • Headache
• Conjunctivitis • History of exposure to GAS
• Nausea, vomiting, and abdominal
• Coryza pain
• Cough • Pain with swallowing
• Diarrhea • Patient 5 to 15 years of age
• Presentation in winter or early
• Hoarseness spring (in temperate climates)
• Scarlet fever rash
GAS = group A streptococcus. • Soft palate petechiae (“doughnut
Adapted from Gerber MA, Baltimore RS, Eaton CB, et al.
Prevention of rheumatic fever and diagnosis and treatment of
lesions”)
acute Streptococcal pharyngitis: a scientific statement from the • Sudden onset of sore throat
American Heart Association Rheumatic Fever, Endocarditis, and
Kawasaki Disease Committee of the Council on Cardiovascular • Tender, enlarged anterior cervical
Disease in the Young, the Interdisciplinary Council on Functional nodes
Genomics and Translational Biology, and the Interdisciplinary
Council on Quality of Care and Outcomes Research: endorsed by
• Tonsillopharyngeal erythema
the American Academy of Pediatrics. • Tonsillopharyngeal exudates
Circulation. 2009;119(11):1543.
 Evidence
Agent Dosage rating*
Penicillins
Amoxicillin 50 mg per kg (maximum, 1 g) 1B
orally once daily for 10 days
Penicillin G benzathine Patients weighing 27 kg (60 lb) or 1B
less: 600,000 units IM once
Patients weighing more than 27
kg: 1,200,000 units IM once
Penicillin V potassium Patients weighing 27 kg or less: 1B
250 mg orally 2 or 3 times daily
for 10 days
Patients weighing more than 27
kg: 500 mg orally 2 or 3 times
daily for 10 days
 For patients allergic to penicillin
Narrow-spectrum Varies 1B
cephalosporin (cephalexin
[Keflex], cefadroxil
[formerly Duricef])†
Azithromycin (Zithromax) 12 mg per kg (maximum, 500 mg) 2aB
orally once daily for 5 days
Clarithromycin (Biaxin)‡ 15 mg per kg orally per day, divided 2aB
into 2 doses (maximum, 250 mg twice
daily), for 10 days
Clindamycin (Cleocin) 20 mg per kg orally per day 2aB
(maximum, 1.8 g per day), divided
into 3 doses, for 10 days
NOTE: The following agents are not acceptable for primary prevention of rheumatic fever: sulfonamides, trimethoprim (formerly Proloprim), tetracyclines,
and fluoroquinolones.
IM = intramuscularly.
*—American Heart Association evidence ratings: 1B = evidence from a single randomized trial or nonrandomized studies that a procedure or treatment is
beneficial, useful, and effective; 2aB = weight of evidence from a single randomized trial or nonrandomized studies favors usefulness/effectiveness.
†—Avoid in persons with immediate (type 1) hypersensitivity to penicillin.
‡—Avoid in persons taking other medications that inhibit cytochrome P450 3A, such as azole antifungal agents, human immunodeficiency virus protease
inhibitors, and some selective serotonin reuptake inhibitors.
Adapted from Gerber MA, Baltimore RS, Eaton CB, et al. Prevention of rheumatic fever and diagnosis and treatment of acute Streptococcal pharyngitis: a
scientific statement from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on
Cardiovascular Disease in the Young, the Interdisciplinary Council on Functional Genomics and Translational Biology, and the Interdisciplinary Council on
Quality of Care and Outcomes Research: endorsed by the American Academy of Pediatrics. Circulation. 2009;119(11):1544.
 Secondary Prevention of Rheumatic
Fever
Evidence
Agent Dosage rating*
Penicillin G benzathine Patients weighing 27 kg (60 lb) or 1A
less: 600,000 units IM every 4
weeks†
Patients weighing more than 27 kg:
1,200,000 units IM every 4 weeks†
Penicillin V potassium 250 mg orally twice daily 1B
Sulfadiazine Patients weighing 27 kg or less: 0.5 g 1B
orally once daily
Patients weighing more than 27
kg: 1 g orally once daily
Duration of Secondary Prophylaxis for
Rheumatic Fever
Duration after last
Type attack Evidence rating*
Rheumatic fever with 10 years or until age 40 1C
carditis and residual heart years (whichever is
disease (persistent longer); lifetime
valvular disease†) prophylaxis may be
needed
Rheumatic fever with 10 years or until age 21 1C
carditis but no residual years (whichever is
heart disease (no valvular longer)
disease†)
Rheumatic fever without 5 years or until age 21 1C
carditis years (whichever is
longer)
Cardiomyopathy in children
• Definition and Classification
– Cardiomyopathies are defined as diseases of the
myocardium associated with cardiac dysfunction.

– They are classified as dilated cardiomyopathy,

hypertrophic cardiomyopathy, restrictive
cardiomyopathy, and arrhythmogenic right
ventricular cardiomyopathy.
 Dilated Cardiomyopathy
• Dilated cardiomyopathy is characterized by dilatation and
impaired contraction of the left ventricle or both ventricles.

• It may be idiopathic, familial/genetic, viral3 4 5and/or

immune,6 7 alcoholic/toxic, or associated with recognized
cardiovascular disease in which the degree of myocardial
dysfunction is not explained by the abnormal loading
conditions or the extent of ischemic damage (see below).

• Histology is nonspecific. Presentation is usually with heart

failure, which is often progressive. Arrhythmias,
thromboembolism, and sudden death are common and
may occur at any stage.
 Hypertrophic Cardiomyopathy
• Hypertrophic cardiomyopathy is characterized by left
and/or right ventricular hypertrophy, which is usually
asymmetric and involves the interventricular septum.8

• Typically, the left ventricular volume is normal or reduced.

Systolic gradients are common.
• Familial disease with autosomal dominant inheritance
predominates.
• Mutations in sarcomeric contractile protein genes cause
disease.9
• Typical morphological changes include myocyte
hypertrophy and disarray surrounding areas of increased
loose connective tissue.
• Arrhythmias and premature sudden death are common.10
 Restrictive Cardiomyopathy
• Restrictive cardiomyopathy is characterized by
restrictive filling and reduced diastolic volume
of either or both ventricles with normal or
near-normal systolic function and wall
thickness.
• Increased interstitial fibrosis may be present.
It may be idiopathic or associated with other
disease (eg, amyloidosis; endomyocardial
disease with or without hypereosinophilia).
• Perjalanan penyakitnya lambat,
penyembuhannya lama
• Gejala dan tanda klinis sesuai dengan tanda-
tanda gagal jantung kongestif
• Terapi medikamentosa sesuai dengan terapi
gagal jantung
• Perlu pembatasan aktivitas