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Epidemiologi
Gagal jantung mempengaruhi >20 juta pasien di dunia Meningkat seiring pertambahan usia, dan mengenai pasien usia lebih dari 65 tahun sekitar 6-10% laki-laki > wanita.
Classification
a. Location: left-side heart failure, right side heart failure or biventricular. b. Function : - Sistolic (contraction) : MI, Cardiomyopathy - Diastolic function (relaxtation or filling) : valve MS, LVH
c. Blood volume : - low output: Myocardial Infarction, MR, AS - high output: Anemia, Hyperthyroid
Acute decompensation
Chronic stable heart failure may easily decompensate , This most commonly results from an intercurrent illness (such as pneumonia), myocardial infarction (a heart attack), arrhythmias, uncontrolled hypertension, or a patient's failure to maintain a fluid restriction, diet, or medication. Other well recognized precipitating factors include anemia and hyperthyroidism which place additional strain on the heart muscle.
Dyspnea Fatigue Diaphoresis Paroxysmal nocturnal dyspnea Chest pain as the initial complaint Swelling in the legs Discomfort in the upper abdomen the right
Diagnosis
Gold standard ? "Framingham criteria, the "Boston criteria, the "Duke criteria and (in the setting of acute myocardial infarction) the killip class
Framingham criteria
requires the simultaneous presence of at least 2 of the following major criteria 1 major criterion in conjunction with 2 of the following minor criteria
Major criteria:
Cardiomegaly on chest radiography S3 gallop a third heart sound Acute pulmonary edema Paroxysmal nocturnal dyspnea Crackles on lung auscultation Central venous pressure of more than 16 cm H2O at the right atrium Jugular vein distension Positive abdominojugular test Weight loss of more than 4.5 kg in 5 days in response to treatment (sometimes classified as a minor criterium
Minor criteria
Tachycardia of more than 120 beats per minute Nocturnal cough Dyspnea on ordinary exertion Pleural effusion Decrease in vital capacity by one third from maximum recorded Hepatomegaly Bilateral ankle edema
II
35%
III
25%
IV
5%
Imaging
Echocardiography : EF 50-80%
Electrophysiology
Arrhythmias Ischemic heart disease Right and left ventricular hypertrophy presence of conduction delay or abnormalities (e.g. left bundle branch block)
Blood tests
electrolytes (sodium, potassium) measures of renal function, liver function tests, thyroid function tests, a complete blood count, and often C-reactive protein if infection is suspected. An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure, with a sensitivity of 85% and specificity of 84% in detecting heart failure
Angiography
Management
1 Diet and lifestyle measures
1.1 Fluid restriction 2.1 Angiotensin-modulating agents : ACE inhibitor 2.2 Diuretics : Furosemide, HCT, Spironolactone 2.3 Beta blockers : bisoprolol 2.4 Positive inotropes: digoxin 2.5 Alternative vasodilators :ISDN, Hydralazine 2.6 Aldosterone receptor antagonists :spironolactone 2.7 Recombinant neuroendocrine hormones :Nesiritide 2.8 Vasopressin receptor antagonists :Tolvaptan
2 Pharmacological management