&
KESEHATAN
JANTUNG
Pusat Jantung Nasional Harapan Kita
UPF Prev-Rehabilitasi Medik
Jakarta
Definisi
Hiper : Berlebihan
Tensi : Tekanan/Tegangan
Hipertensi :
Gangguan sistem peredaran darah yang
menyebabkan kenaikan tekanan darah
diatas nilai normal.
Tekanan Darah
HHS =House Hold Surveys, * WHO Geneva. The world health report 1998. Life in the 21 st century a vision for all
Cardiovascular Non Cardiovascular
Sumber: Kusmana D, Disertasi 2002
1.1
1.0
K E S IN TA S A N
.9
.8
Tekanan darah
Tingkat-3
.7
Tingkat-2
Tingkat-1
.6
Gambar 4.8.3.
Normal tinggi
.5 Normal
-2 0 2 4 6 8 10 12 14
Kurva kesintasan dan
WAKTU (TAHUN)
rasio bahaya tekanan darah
hubungannya dengan
kematian kardiovaskular
.7
.6
.5
R A SIO B A H A YA
.4
.3
Tekanan darah
.2 Tingkat-3
Tingkat-2
.1
Tingkat-1
0.0
Normal tinggi
-.1 Normal
0 2 4 6 8 10 12 14
WAKTU (TAHUN)
Faktor Risiko Utama Penyakit Kardiovaskular
Hipertensi
Kegemukan
Kurang aktivitas fisik
Merokok
Peminum alkohol ( > 3 gelas perhari )
Dislipidemia ( Kolestrol tinggi )
Diet tinggi kandungan garam
Kencing manis – DM
Obat-obatan ( mis : steroid )
Mikroalbuminuria
Usia ( wanita > 55 thn & pria > 45 tahun )
Riwayat keluarga : hipertensi , stroke
Penyebab
Hipertensi Primer
± 90% Tidak diketahui penyebabnya
Hipertensi Sekunder
± 10% Berhubungan dengan:
Kelainan Ginjal
Kelainan Hormonal
Kelainan Pembuluh Darah
Dll.. : - Kehamilan
- Alat kontrasepsi
- Rokok
Klasifikasi Hipertensi
Diagnosispasti:
Diagnosis pasti Mengukur
: Mengukurtekanan
tekanandarah
darah!!!
Gejala lain
(+ Penyakit lain)
Lemah Mimisan
Penglihatan kabur Gelisah/perubahan
Sakit dada mental
Napas pendek Kesadaran turun
Mual/muntah Kelumpuhan
Berdebar
Komplikasi
Kerusakan berbagai organ tubuh
Jantung
LVH (serambi kiri jantung »)
Angina - infark otot jantung
sumbatan koroner
Gagal jantung
Komplikasi
Otak
Stroke
TIA
Ginjal
Penyakit ginjal kronis
Pembuluh darah perifer
Mata
Retinopati
Ginjal
Insufisiensi ginjal
Jantung Otak
Hipertrofi ventrikel kiri Hipertensi
Gagal jantung kronik Stroke
Infark miokard
Penyakit jantung
kongestif
Aritmia
Pembuluh darah
Arteriosklerosis
Penyakit pembuluh darah perifer
Penyakit jantung koroner
Paradigma Perjalanan Penyakit Kardiovaskular
Medikamentosa : Obat
penurunan
TD
2 –6 –4 –3
3 –8 –5 –4
5 –14 –9 –7
Keuntungan menurunkan
tekanan darah
T H A N K Y O U
...It is nice to be an important person but it is important to be a nice person...
Algorithm for Treatment of
Hypertension
Lifestyle Modifications
or combination.
Not at Goal
Blood Pressure
HYPERTENSIVE CRISIS
is determined :
- by the rate of BP-rise, rather than actual BP,
- by vascular and organ status.
Form : HYPERTENSIVE EMERGENCY
( Life threatening, uncontrolled hypertension
with acute end-organ damage )
HYPERTENSIVE URGENCY
( Severe but not live threatening )
DEFINITION :
HYPERTENSIVE CRISIS
A severe elevation in BP, generally a SBP > 220 mm Hg and / or
DBP > 120 mm Hg. (JNC-VII, 2004)
1. HYPERTENSIVE EMERGENCIES
Severe elevation in BP complicated by acute target organ
dysfunction, such as coronary ischemia, stroke, intracerebral
hemorrhage, pulmonary edema, or acute renal failure.
2. HYPERTENSIVE URGENCIES
Severe elevations in BP without evidence of target organ
deterioration. Colhum DA. Oparil S, New Engl. J. Med, 323 : 1177, 1990
Risk factor :
Characteristics that related to Increasing
Risk Become Sick / Illness
Risk Factors
Fatty streak
Smoking
Hypertension
Hyperlipidemia
Homocysteinemia Hypertension
Gender
Diabetes
Obesity Infection?
Genetics Age
Atherotrombotic Manifestations
(MI, Ischemic stroke, Vascular death
American Heart Association, Heart and Stroke facts: 1997 Statistical supplement;
Wolf Stroke 1990;21 (SUPPL 2):II-4II-6;Laurila et al. arterioscle TrombVasc bio 1997;17:2910-2913;Grau et
al. Stroke 1997;26;1724-1729; Graham et al JAMA 1997;277: 1775-1781;Brigden Postgrad
Med;101(5);249-262
MAJOR RISK FACTORS FOR CHD
The NCEP Adult (treatment panel identifies Positive Risk Factors (RF)
for CHD
Risk Factors
• Family history of early CHD
parent or sibling <55 years of age if male, <65 years of age if female
• Age :
male >45 years
Female >55 years or premature menopause without estrogen replacement
therapy (ERT)
• Hypertensive (BP > 140/90 mmHg or taking antihypertensive medication)
• Curent smoker
• Type 2 diabetes
• Low HDL-cholesterol (<35 mg/dl)
• Negative Risk factor
• If HDL-C is >60 mg/dl substract one risk factor
Non traditional Risk factors
Antioxidants
Studies have generally shown reduced CHD risk in individuals
consuming foods high in antioxidant vitamins;
Fibrinogen
Factors associated with elevated fibrinogen include cigarette smoking,
sedentary lifestyle, and high triglyceride levels. Fibric acid
derivatives, estrogen administration, cigarette smoking cessation,
and aerobic reduce fibrinogen levels.
Homocysteine
Deficiencies in folate intake and reduced serum levels elevated
homocystein
Levels. Folate therapy shown to reduce homocysteine levels and improve
Endothelial function. Some hyperhomocysteinemic patients with other
enzyme abnormalities require pyridoxine or vitamin b12
Infectious agents
Local arterial infection (include Chlamydia pneumonia, Helicobacter
pylori, Cytomegalovirus and other herpes virus) cause coronary
atherosclerosis and postangioplasty restenosis.
Causative mechanism include endothelial injury, local inflammation,
smooth muscle proliferation with p53 inactivation, and autoimmunity
Coronary Heart Disease Risk Factors
AHA scientific position
U.S. Department of
The Seventh
Report of the
Health and Human
Services
Joint National
Committee on
National Institutes
Prevention,
of Health
Detection,
Evaluation, and
Treatment of
National Heart, Lung,
and Blood Institute High Blood
Pressure (JNC 7)
CVD Risk Factors
Hypertension*
Cigarette smoking
Obesity* (BMI >30 kg/m2)
Physical inactivity
Dyslipidemia*
Diabetes mellitus*
Microalbuminuria or estimated GFR <60 ml/min
Age (older than 55 for men, 65 for women)
Family history of premature CVD
(men under age 55 or women under age 65)
*Components of the metabolic syndrome.
Chain of events leading to endstage
heart disease
Myocardial
infarction
Coronary Arrhythmia & Sudden death
thrombosis loss of muscle
Myocardial Silent
ischaemia Angina Remodelling
Hibernation
Ventricular
CAD dilatation
Stroke
Atherosclerosis Congestive
LVH heart failure