KEL.

JANTUNG DIDAPAT (ACQUIRED)

KELAINAN JANTUNG KARENA INFEKSI
DI INDONESIA YANG TERBANYAK:
1.DEMAM REUMATIK(DR
REUMATIK(DR),
), 2. DIFTERIA DAN
3.ENDOKARDITIS LENTA
1.DEMAM REUMATIK: OK MENYEBABKAN
KEL. JANTUNG KE-
KE-2 PADA ANAK SETELAH
KEL.JANTUNG KONGENITAL DI USA.
DI INDONESIA DR PENYEBAB UTAMA.
DR PERLU DIDIAGNOSA CEPAT, DAN DIOBATI
SEGERA DPT MENCEGAH KEL. KATUP J.
[BIAYA BANYAK & ANGKA KEMATIAN TINGGI]
INSIDENS 3% PADA MASA EPIDEMIK DAN
INSIDENSNYA 0.3% PD MASA ENDEMIK
ETIOLOGINYA:STREP. BETA HEMOL.GRUP A,
-DR SERING TERJADI BERSAMAAN URI
-ASRAMA MILITER, KELOMPOK MASY. YG
TERISOLIR SERING EPIDEMI.
-INSIDENS DR PARALEL DGN INSIDENS URI
OK GABHS.
Rheumatic fever-
fever-pathogenesis
Rheumatic fever-
fever-pathogenesis
 Group A Streptococcus = GAS
1. Ada 4 Lapisan GAS.
1. Capsule (Hyaluronic acid)
2. 2. Cel wall ( M - protein and
M Asosiated protein )
3. 3. Gtoup Carbohydrate
(N-Acethyl Glucisamine
4. Ribosome)
4. Protoplast membrane
(Protein, Lipid and Glucose)
Structur Antigen GAS sama dgn structur dari sel-sel:
1. Sendi (synovial membrane)
2. Sel-sel myocardium
3. Sel-sel Valvula / katup jantung
4. Sarcolema myocardium dan Sarcolema dari
Subthalmic brain dan Nucleus caudatus
Dr.Babu UthmanDone by: Samya : RF and RHD 2007.
Rheumatic fever-
fever-diagnosis

Subcutaneous nodules
(nodules of rheumatoid arthritis are larger)
Rheumatic fever-
fever-diagnosis
Erythematous patches
with central clearing

Erythema marginatum
Pathology :
-Aschoff bodies antigen
presenting cells
- Acute phase : inflammation process
in pericard, myocard & pericard
- Chronic phase : injury of the valve
- Difference of clinical and pathologi
cal manifestation in some countries
- Host immunological response
take main role in clinical manifesta
tion
Diagnosis :

1944 : Dr.T.Duckett Jones : Jones Criteria

1955 : Modification of Jones Criteria

1965 & 1984 : Revised of Jones Criteria

1992 : Update Jones Criteria

Jones Criteria (focused)

Problems : over diagnosis or under diagnosis

Diagnosis

1965 Jones Criteria (revised)

Major manifestation Minor manifestation
Carditis Fever
Polyarthritis Arthralgia
Chorea Prolonged PR interval
Subcutan nodule ECG
Erythema marginatum Increase BSR
C reactive protein (+)
Leucocytosis
Evidence of previous Previous history RF /
Strept. Infection RHD inactive
CULTURE / ASTO
Diagnosis

1992 Jones Criteria (Updated)

Major manifestation Minor manifestation
Carditis Fever
Polyarthritis Arthralgia
Chorea Increase BSR
Subcutan nodule C reactive protein (+)
Erythema margina tum Leucocytosis
Prolonged PR interval ECG

Evidence of previous
Strept. Infection
Culture / ASTO
Treatment RF & RHD (DR & Peny J.Re)
1. Primary preventions :
to eradicate Streptococcal infectcion :
during acute RF attack
2. Secondary prevention :
to prevent relaps of cute RF
3. Relief the symptoms :
- carditis / CHF
- arthritis
- Chorea
Treatment RF & RHD (DR & Peny. J.Rema)

1. Primary prevention :
1. Benzatine PNC G injection 1 X / i.m.
(BW > 27 kg 1,2 million unit)
(BW < 27 kg 600.000 unit)
2. Pencilline V : 250 mg/400.000 unit QID
/ oral : 10 days
Erythromycine : 40 mg /kg BW / day
TID-QID / oral : 10 days
Clindamycine, Nafcillin, Amoxycillin,
Cefalexin
Treatment RF & RHD

Duration secondary prevention

Categori Duration

RF with carditis & permanent minimal 10 years

valve abnormalities until 40 yrs or
longlife

RF with carditis without perma 10 years or until

nent valve abnormalities adult

RF without carditis 5 years or until

21 years
Treatment RF & RHD

Relief the symptoms

A. Carditis :
Anti inflammatory
- Carditis : Prednison : 2 mg/kg BW/day tapp.
2-6 weeks off
- Mild Carditis : Aspirin 90-100 mg/kg BW 4-6
4-8 weeks week
B. Arthritis
- Aspirin : 100 mg/kg BW/ day : 2 weeks
2-3 weeks : doses decrease
Treatment RF & RHD

C. Heart Failure :
- Bedrest - Digoxin
- Diuretics - Vasodilator
- Fluid & salt restriction
D. Chorea :
- Physical stres & emotional must be controlled
- Anti inflammation drug : controversial
- Phenobarbital : 15-30 mg TID-QID
- Haloperidol : 0,5 mg ---> 2 mg TID
- Valproic acid / Chlorpromazine / Diazepam
Table. Guidelines for Bed Rest and Ambulation and Recommended
antiinflammatory agents

Arthritis Carditis Carditis Carditis

alone minimal moderate severe
Bed Rest 1-2 wk 2-3 wk 4-6 wk 2-4 mo
Indoor ambulation 1-2 wk 2-3 wk 4-6 wk 2-3 mo
Outdor activity 1-2 wk 2-3 wk 4-6 wk 2-3 mo
(school)
Full activity 1-2 wk 2-3 wk 4-6 wk 2-3 mo

Prednisone 0 0 2-4 wk 2-6 wk

Aspirin 0 0 2-4 wk 2-6 wk
Minimal Carditis Questionable cardiomegaly ; Moderate carditis definite but mild cardiomegaly,
Severe carditis, marked cardiomegaly or CHF
Surgical treatment and invasive intervention

Surgical treatment :
1. Valve Replacement :
- MR
- MS
- AR
2. Valvuloplasty

Invasive Intervention :
- Ballon Mitral Valvuloplasty (BMV) with
Inoue ballon : MS
 DC
Decompensatio Cordis
Gagal Jantung
 Conto: Mitral insuffisiensi
Setiap ventric.sist, ada darah naik
ke Atrium Kilama2
Stagnasi di Atrium Ki
V.Pulm. vasc.paru pe-
numpukan cairan inf. Batuk kronik.

darah masuk ke Ao Jantung kerja keras (HR =Tachycardia)

Jantung membesar (Cardiomegali), Bila kerja,perlu O2 banyak napas
(Dyspnoe deffort, sampai orthopnoe ). Tanda2 DC kiri
 PS darah berkurang masuk ke
A.Pulm. Darah banyak ter
kumpul dalam V.Ka A.Ki VCS
(TVC ) VCI (Hepatomegali)
Edem pretibial, Edema dorsal
pedis, Ascites Jantung kerja
keras (Cardiomegali) dan Kalau
kerja sesak napas (Tachypnoe).
Freq.Jantung naik (Tachycardi)

Tanda DC Kanan
 PENGOBATAN DC
1. DIGITALIS
2. DIURETIK

Dosis dan cara pemberian

harus diperlajari baik-
baik-baik

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