HOSPITAL

HOSPITAL
JANTUNG
Jantung terdiri dari otot-otot (miokard)
Mendapat aliran darah dari arteri koroner
Berdenyut 100.000!hari
Memompakan "!- #000 galon ($%.000 &)!'ari
ESTROGEN
PROGESTERONE
RENIN ALDOSTERON
CORTISOL
Physiologic Changes in Pregnancy
Plasma Heart Stroke Cariac
!ol"me Hate !ol"me O"t#"t
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Non0 / , 1+ 1. +* +/ +, '+ '. Post0
PlInsma !ol"me Pregnant Gestation Onireeksi
eli2ery
3lea it 3l ate
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Str
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Parameter Trims4 I Trims4II Trims4III Persalinan
Pasca
#ersalinan
Nai 5 )01*6 51*01)6 51)0+*6 5+*0'*6 7
C"rah
8ant"ng
5 )0'*6 5 '*0/*6 5 9/*6 5 )*6 7
Tek4Darah
sistolik
: ata" 7 7 : ata" 5 5 ;aseline
Tek4Darah
iastolik
: ata" 7 7 7 ata" : 5 ;aseline
Resistensi
#%4Darah
7 1*0'*6 7'*0/*6 7'*0/*6 5 ;aseline
Anemia relati< an 5 <aktor koag"lasi arah
o Hi#ertensi
TDS =1/* mmHg or TDD =>* mmHg
o Penyaki t 8ant"ng %a?aan $ASD@!SD&
o Penyaki t 8ant"ng remati k
o Aariomio#ati #eri#artal
Aom#likasi kario2ask"lar
a#at ter8ai #aa
kehamilan tan#a kelainan
8ant"ng se%el"mnya
10/6
B Ce#at ca#ai
Sesak
;ere%ar
Pen"r"nan ka#asitas eCercise
;engkak t"ngkai
B S"ara 8ant"ng tam%ahan
Per"%ahan EAG D ACisE re#olarisasiE !ESE S!ES
Peningkatan imensi r"ang0r"ang 8ant"ng
Reg"rgitasi kat"# 8ant"ng
Peng"m#"lan cairan i kant"ng 8ant"ng
Aes"litan %erna<as
Pingsan
Deny"t 8ant"ng ce#at an tiak terat"r
Nyeri aa
;at"k malam hari
T"ngkai %engkak an nyeri
o Anamnesi s an Pemeri ksaan <i si k
o EAG @ Holter monitoring
o Echokariogra<i
o Treamilltest
B Hi#ertensi
Dia%etes
O%esitas
Aehamilan kem%ar
F"lti#ara
Gsia H+* thn ata" 9') thn
I Cyosis $O+H>*6& or NJHA <4c49II
PRECONCEPTION
a L t %ti
E!ALGATION @
2entric"lar ys<"ncton
$
COGNSELI NG
0
arr hy
i k o D * 4 ) 6
1 /+(6
9 1 / ()6
Aontrol kehamilan secara terat"r
Teta# akti2 an %erolahraga secara terat"r
C"k"#i ke%"t"han n"trisi $mineral @
2itamin&
Fem%atasi as"#an garam $Soi"m&
Fonitor kenaikan ;; $ 11 01. Ag&
o
Hinari stres an rasa cemas %erle%ihan
o
Hinari rokokE alkohol an o%at0o%atan4
$kec"ali o%at atas saran okter&
B Pertahankan ke%iasaan %erolahraga engan
intensitas le%ih ringan
F"lai #erlahan0lahan $'C1) menit / /C'*menit&
Tiak %erle%ihan $ Nai H1/*CKmenit&
Pemanasan @ #eninginan
Hinari %erolahraga i "ara yang #anas
C"k"# min"m
Hinari eCercise engan #osisi
terlentang $91 . Fingg"&
LalanE ;erenangE se#ea statis
lo? im#act aero%ic
F a b ! e 3 E s t i m a t e d f e t a l a n d u n a . t e r n a . l . e f f e c t i v e d c i s e s fir va.ricus
dia.gnoistic and interventional ira.dioitiogy prccediires
P r o c e d u r e et all exposure
1601-a ternal.
exposure
Chest racliograph (!"
and lateral)
##$#. # % &

n'$

$..#
<0.0 I mSv C._ P mGy 0. I m5v
C( chest
) #. i

F%*#.

).3 m+v ( #!###... , m+

Coronary
angiagraphy.&
&- *y
%.
m
%
,
.$ .
#.
-,
... Fri
1
.-3 y
, r!S.,.
!C% or ra.cliofre/uency
catheter ablation0
3 m*y 3 m . 1- n.

'.

#. % - ####
p o mi r e di p r i ds ci n t "e num#er o pr - n- $ e- c t i c i ns or v i e2a
' computed torno%mp"&' P! ( po-

terin arrte ri r# !CE ' percurin-eaus coron_ar& l r)t_

3is4 class
5o detectable %ncreased ris4 of maternal rnortalicy and no1mild
increase in morbidity.

+mall i ncreased ri s4 of maternal mortal i ty or moderate increase in

morbiclicy.
+i gni fi cantl y i ncreased ri s4 of maternal mortal i ty or severe morbidity. E6pert
counselling re/uired.. %f pregnancy is decided upon7 intense specla8ist
ca.rcliac and obstetric monitoring needed throughout pregnancy.7 chilc%birdi and the puerperium..
E6tremel y high ris4 of maternal mortali ty or severe morbidity9 pregnancy
contraindicated.. %f pregnancy occurs terrnination should be discussed$ %f pregnancy continues7
care as for class ill.
III
Lv.
3i s4 of pr egnancy by medi cal condi t i on
* a # l e : ;o d i f i e d <= O c l a s s i f i c a t i o n o f ma t e r n a l
cardiovascular ris4# principles
(able , ;odified +,- classi ficati on of maternal cardiovascular ris4# application
Conditions in ."ic" pre%nanc& ris) is +,- &
> ?ncomplicated7 small or
mild - pulmonary stenosis
- patent ductus artertosus -
mitral valve prolapse
Successfully repaired simple lesions (atrial or ventricular septa)
defect, patent ductus arteriosus, anomalous pulmonary venous
drainage).
"trial or ventricular ectopic beats7 isolated
Conditions in ."ic" pre%nanc& ris) is +,- 11 or Ill
1
16
WHO 11 Of otherwlge well and uncomplIcared)
?noperated atrial or ventricular septa) defect
3epaired tetralogy of Fallot
/ost arrhythmias
WHO II-111 (depending on indivldual)
.. Mild left ventricular Impairment
=ypertmphic cardiomyopathy
5ative or tissue valvular heart disease not considered <=O & or
01
;arfan syndrome 2ithout aortic dilatation
Aorta <! mm In aortic disease associated "it# $icuspid aortic valve
. 3epaired coarctation
%&' &I
. ;echanical valve
. +ystemic right ventricle
. Fontan circulation
. Cyanotic heart disease (unrepaired)
. Other comple6 congenital heart disease
. Aortic dilatation (-! mm in Marian syndrome
. Aortic dilatation !-!( mm in aortic disease associated ")t#
$icuspid aortic valve
Conditions in 2hich pregnancy ris4 is <=O
%@ (pregnancy contraindicated)
*ulmonary arterial #ypertension of any cause
. +evere systemic ventricular dysfunction (A@EF B3)C7 5D=" &&&
E%@)
*revious peripartum cardlomyopat#y "it# any residual impairment
of left ventricular function
. +evere mitral sten.osFs7 severe symptomatic aortic geniis
. Marian syndrome "it# aorta dilated +! mm
. Aortic dilatation +!( mm in aortic disease associated "it#
$icuspid aortic valve
i 5atve severe coarctation
%
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)
G
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C
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C
r li?i
minium!'
muumuu
muumuu
A$ortions
i scar riage s
,ompleted
pregnanci-s
Penyakit Lant"ng ;a?aan Pita
Oiling T"a
Perseata se Resiko Penyakit l% F"g @Fall
Pak ;ayi Fin Satn Orang Tim Fencierita
Penyakit Lantiiiig ;al2a an
Pira" antra kariak
De<ek se#t"m atri"m ' M11
De<ek se#tt"n 2entrikel
4 22
D"kt"s anterios"s #ersisten /411
O%stniksi %agian kanan
' M ++
el in yang kom#leks
Tetralogy 3allot /01)
Anomali E%stein
Tidal: dapat ditentukan
Tranpoii pea !ula dara" !ear Tidak dapat ditentukan
#ardo$iopati "ipet opik den an "ipertrofi eptu$
yang ai$etri:%
&0
Sindroina niarfan
)*
PRECONCEPTION
E!ALGATION @
COGNSELING
RisikoD * I )6
1 I +(6
91 I ()6