Riwayat Hidup

• Nama : Dr. Djallalluddin, M.Kes, PKK, SpPD, KKV, FINASIM

• Tempat Lahir : Grobogan
• Alamat : Jl Libra Raya 22 Bumi Cahaya Bintang Kota
Banjarbaru
• Pendidikan
– Lulus SD Mangunrejo 1 Tahun 1980
– Lulus SMPN Wirosari Tahun 1983
– Lulus SMA 3 Semarang Tahun 1986
– Lulus Fakultas Kedokteran UNDIP Tahun 1994
– Kedokteran Keluarga tahun 2000
– Lulus Magister Epidemiologi FK UGM 2003
– Lulus Spesialis ilmu penyakit dalam FKUNDIP 2009
– Konsultan kardiovaskular-Ilmu Penyakit Dalam FK UI/RSCM
• Daftar Riwayat Pekerjaan:
– Dokter PTT di Propinsi Jawa Tengah tahun 1996-1998
– Dosen bagian IKM FK Unlam tahun 1999 sampai 2009
– Bagian Ilmu Penyakit dalam FK UNLAM 2009 sampai sekarang
 Introduction
• Practice guidelines have always been a part of medical
practice.
• Practice guidelines are simply an explicit set of steps
that when followed will result in the best outcome.
• Practice guidelines are used for a variety of purposes.
• Primarily they ought to be used as a template for
optimal patient care.
• Practice guidelines should be developed using a preset
process called the evidence- and outcomes-based
approach.
 Definition
HF is a clinical syndrome characterized by typical
symptoms (e.g. breathlessness, ankle swelling
and fatigue) that may be accompanied by signs
(e.g. elevated jugular venous pressure,
pulmonary crackles and peripheral oedema)
caused by a structural and/or functional
cardiac abnormality, resulting in a reduced
cardiac output and/or elevated intracardiac
pressures at rest or during stress.
 Epidemiology
• Approximately 1–2% of the adult population in
developed countries.
• ≥10% among people ≥70 years of age.
• Among people > 65 years of age presenting to
primary care with breathlessness on exertion, one in
six will have unrecognized HF (mainly HFpEF).
• Patients with HFpEF are older, more often women
and more commonly have a history of hypertension
and atrial fibrillation (AF), while a history of
myocardial infarction is less common.
 Epidemiology (cont)
• The most recent European data (ESC-HF pilot study)
demonstrate that 12-month all-cause mortality rates
for hospitalized and stable/ambulatory HF patients
were 17% and 7%, respectively, and the 12-month
hospitalization rates were 44% and 32%, respectively.
• In patients with HF (both hospitalized and
ambulatory), most deaths are due to cardiovascular
causes, mainly sudden death and worsening HF. All-
cause mortality is generally higher in HFrEF than
HFpEF
 Sign & symtom
• Symptoms are often non-specific and do not, therefore, help
discriminate between HF and other problems.
• Symptoms and signs of HF due to fluid retention may resolve
quickly with diuretic therapy.
• Signs, such as elevated jugular venous pressure and
displacement of the apical impulse, may be more specific, but
are harder to detect and have poor reproducibility.
• Symptoms and signs may be particularly difficult to identify
and interpret in obese individuals, in the elderly and in
patients with chronic lung disease.
 CHF
•Diagnosis of CHF requires the simultaneous presence of at least 2 major
criteria or 1 major criterion in conjunction with 2 minor criteria.
•Major criteria:
–Paroxysmal nocturnal dyspnea
–Neck vein distention
–Rales
–Radiographic cardiomegaly (increasing heart size on chest radiography)
–Acute pulmonary edema
–S3 gallop
–Increased central venous pressure (>16 cm H2O at right atrium)
–Hepatojugular reflux
–Weight loss >4.5 kg in 5 days in response to treatment
Minor criteria:
–Bilateral ankle edema
–Nocturnal cough
–Dyspnea on ordinary exertion
–Hepatomegaly
–Pleural effusion
–Decrease in vital capacity by one third from maximum recorded
–Tachycardia (heart rate>120 beats/min.)
 NYHA
• Class I: patients with no limitation of activities; they
suffer no symptoms from ordinary activities.
• Class II: patients with slight, mild limitation of
activity; they are comfortable with rest or with mild
exertion.
• Class III: patients with marked limitation of activity;
they are comfortable only at rest.
• Class IV: patients who should be at complete rest,
confined to bed or chair; any physical activity brings
on discomfort and symptoms occur at rest.
Other pharmalogical treatments HF
FC II-IV with HFrEF
• Diuretics
• angiotensin receptor nephylisin inhibitor
• If Chanel inhibitor
• ARB
• Hydralazyne (Iia) & ISDN (IIb)
• Digoxin (IIb) & N 3 PUFA
• Harm (TZD, Diltiazem, ARB on ACE1)
 VT on HF and AF on Chronic
• Cardioversion if Contributung haemodinamics
• HF IV iv amiodarone or digoxin
• HF I-III beta-blocker first
• Av node ablation?
Prevents thrombo embolism in HF
NYHA II-IV
• CHA2DS2-VASc and HAS-BLED
• Oral anticoagulant.
• LWMH
ACUTE HEART FAILURE
• Inhibition of neurohumoural pathways such as
the renin angiotensin aldosterone and
sympathetic nervous systems is central to the
understanding and treatment of heart failure
(HF)
 Ivabradine
• Ivabradine is a heart-rate-lowering agent that acts by
selectively and specifically inhibiting the cardiac
pacemaker current (If), a mixed sodium-potassium
inward current that controls the spontaneous diastolic
depolarization in the sinoatrial (SA) node and hence
regulates the heart rate.
• The molecular channel belongs to the HCN family.
• Inhibition of this channel disrupts If ion current
flow,thereby prolonging diastolic depolarization,
slowing firing in the SA node, and ultimately reducing
the heart rate