Kehamilan & penyakit

jantung

Pendahuluan
Fisiologi
Hamil

Perubahan dalam KVS

- Hidremia puncak 32 34 mg
- Anemia dilusional (vol plasma 30 % + sdm
18 % + Hb 19 %)
- Postpartum imbibisi ekstravaskuler ke
intravaskuler vol plasma ( 2 minggu)
- Frekuensi nadi , prekordium bergeser ke kiri,
bising sistolik di apeks + katup pulmonal

Pendahuluan
Fisiologi
Hamil

Penyakit Jantung

- Hamil 32 36 mg
- Partus Kala II
- Postpartum

Key Cardiovascular Changes During

Pregnancy
Blood Flow to Other Organs

Increased

Peripheral Vascular Resistance

Decreased

Blood Pressure

Mid pregnancy decrease

Pulmonary Blood Pressure

Unchanged

Heart Size

Increased

Cardiac output

Increased

Stroke volume

Increased

Systolic murmurs

Common

Diastolic murmurs

Potentially pathological

EKG changes

LAD, low voltage

Cardiac Changes in Pregnancy

Cardiac output : 50 %
Fase aktif : 40%
Segera post partum : 10-20%
Cardiac exam is different during pregnancy
Many patients will have an S3 after
midpregnancy
Diastolic murmurs are usually considered
serious
Systolic murmurs (flow murmurs) common
Displacment of heart is to right and upwards
EKG shows left axis deviation and low
voltage QRS complexes

Cardiac Changes in
Pregnancy

Hemodynamic Changes in
Pregnancy

Penyakit jantung dalam

kehamilan
Frekuensi : 12 % ( >> demam
rheuma dahulu) + kelainan
kongenital ( 50 %) + Hipertensi
heart disease (peripartum)
Mortalitas : 8 -15 %

Penyakit jantung dalam

kehamilan

Deaths due to Congenital Cardiac

Disease
Primary Pulmonary H.T.

Pulmonary H.T. cause

unknown

ASD: Eisenmengers
ASD closed residual
pulmonary HT

2
1

Bicuspid aortic valve;

endocarditis

Coartation repair;
endocarditis

Previous ASD; arrythmia

Deaths from Acquired

Cardiac Disease
Puerperal
Cardiomyopathy

Cardiomyopathy and
myocarditis

Aneurysm thoracic aorta 5

Myocardial Infarction

Endocarditis normal
valve

Heart Failure cause

unknown

Penyakit jantung dalam

kehamilan
Penyakit jantung Hipoksia + sianosis
- Hasil konsepsi (abortus)
- Hasil konsepsi hidup
Prematur
IUGR
Gawat janin

Penyakit jantung
dalam kehamilan
Diagnosa (sulit)
- Anamnesis : riwayat sakit jantung
- Pemeriksaan fisik :
Bising diastolik, presistolik,
pansistolik
Pembesaran jantung
Bising jantung nyaring (thrill)
Aritmia berat

Diagnosa
Symptoms
-

Progressive dyspnea or orthopnea

Nocturnal cough
Hemoptysis
Syncope
Chest pain

Diagnosa
Clinical findings
-

Cyanosis
Clubbing of fingers
Persistent neck vein distention
Systolic murmur grade 3/6 or greater
Diastolic murmur
Cardiomegaly
Persistent arrhytmia
Persistent split second sound
Criteria for pulmonary hypertension

Risiko
Ringan :
ASD / VSD
PDA
Tetralogi fallot yang terkoreksi

Sedang :
MS, AS
Riwayat infark miokard
Tetralogi fallot yang tidak terkoreksi

Risiko
Berat :
Pulmonary hipertension
Marfan syndrom dengan aorta yang terganggu

Prognosis
Kapasitas fungsi jantung
Komplikasi peningkatan beban jantung
Kualitas pelayanan kesehatan

Klasifikasi
Kelas I
No limitation of physical activity
Kelas II
Slight limitation of physical activity
Kelas III
Marked limitation of physical activity
Kelas IV
Inability to performed any physical
activity without discomfort

Penatalaksanaan

Kelas I & II
- Preventif & pengenalan dini tanda CHF
- Cegah bakterial endokarditis Preventif
terhadap infeksi, Smoking, obat suntik dkk
- Batasi obat
- Labor & delivery

Penatalaksanaan
Kelas I & II
- Labor & delivery :
Partus pervaginam (kecuali indikasi
obstetri
Kurangi rasa nyeri/painless labor
Observasi ketat tanda vital
(kontraksi)
Intrapartum heart failure (udem paru
hipoksia hipotensi) tatalaksana
sesuai penyebab

Penatalaksanaan
Kelas I & II
- Puerperium:

HPP, infeksi, anemia &

tromboemboli komplikasi
yang serius
Sterilisasi stabilisasi KU

Penatalaksanaan
Kelas III & IV
- Continued or terminated ?
- Vaginal delivery is preferred with
epidural analgesia
- Surgical procedure could be done in
facility with experience with
complicated cardiac disease