Gagal Jantung

dr Putra Hendra SpPD

UNIBA
Distribution of Blood in the Body
Organs

as therapy for
chronic heart
failure

Figure 15-13: Distribution of blood in the body at rest

The Heart:

2 sisi pompa jantung

Kanan
Mudah menyesuaikan
Bertekanan rendah
Volume bervariasi
Kiri
Kaku
Kuat
Bertekanan tinggi
Volume tetap
 Jenis
Systolic (masalah pompa) ketidakmampuan jantung
berkontraksi mendorong darah kedepan

Diastolic (masalah pengisian) ketidakmampuan

jantung kiri relax secara normal darah balik kembali ke
paru.

Left-sidedinability of the left ventricle to pump enough

blood, causing fluid back up into the lungs

Right-sidedinefficient pumping of the right side of the

heart, causing fluid buildup in the abdomen, legs, and
feet
 Acute vs. Chronic
Acutean emergency situation in which a patient was
completely asymptomatic before the onset of heart
failure; seen in acute heart injury such as MI

Chroniclong-term syndrome in which a patient

exhibits symptoms over a long period of time, usually as
a result of a preexisting cardiac condition
PATOFISIOLOGI
KLINIS
L heart failure

Butterfly
appearence
 LEFT-SIDED HEART FAILURE
DYSPNEA CHEYNE-STOKES
DRY COUGH RESPIRATIONS
FATIQUE
CRACKLES
WEAKNESS
WHEEZES
CYANOSIS
ORTHOPNEA
NOCTURIA
HEMOPTYSIS
TACHYCARDIA
Paroxysmal
NOCTURNAL Pulmonary Edema
DYSPNEA
R Heart failure
 RIGHT-SIDED HEART FAILURE
JUGULAR VEIN SPLENOMEGALY
DISTENSION HEPATOMEGALY
DEPENDENT GI DISCOMFORT
PERIPHERAL EDEMA NOCTURIA
ASCITES TACHYCARDIA
WEIGHT GAIN
FATIGUE
WEAKNESS
ETIOLOGI
 Many etiologies of CHF
Congenital heart disease
Coronary artery disease
Valvular heart disease
Cardiomyopathy
Arrythmia cordis
Hypertension
Peripartum cardiomyopathy
Lung disease
Thyroid
Anemia
Toxins
Many others
 Diagnosis jantung
Diagnosis anatomi :
- Kardiomegali
- Kelainan katup (MI,MS)
Diagnosis fungsionial:
- Dekompensasi kordis
Diagnosis etiologi
- Penyakit jantung rematik
(PJR)
- Penyakit jantung koroner
(PJK)
 ETIOLOGI

Penyakit jantung kongenital

Penyakit jantung rematik
Penyakit jantung Iskemik
Penyakit jantung tiroid
Penyakit jantung anemik
Penyakit jantung pulmonal
v
 Rheumatic Fever
Strep throat from the streptococcal
infection begins a disease process
where the heart valves are damaged.
This condition is called rheumatic fever
and it affects the connective tissues of
the body.
klasifikasi
 Heart Failure
Lifestyles, Fitness
and Rehabilitation
New York Heart Association (NYHA)
Functional Classification
Class % of Symptoms
patients
I 35% No symptoms or limitations in ordinary physical
activity
II 35% Mild symptoms and slight limitation during
ordinary activity
III 25% Marked limitation in activity even during minimal
activity. Comfortable only at rest
IV 5% Severe limitation. Experiences symptoms even at
rest
diagnose
 Diagnostic Investigations
Blood tests - CBC, liver biochemistry, urea
and electrolytes, cardiac enzymes , BNP or N-
terminal portion of proBNF (NPproBNP),
thyroid function.
Chest X-ray - cardiac size and evidence of
pulmonary congestion
Electrocardiogram - evidence of ischaemia,
arrhythmia, RAH, LAH, RVH, LVH
Echocardiography. To establish the
presence of systolic and/or diastolic
impairment of the left or right ventricle. They
may also reveal the aetiology
 Hypertrophy

Right atrial enlargement (RAE/RAH)

Left atrial enlargement (LAE/LAH)
Right ventricular hypertrophy (RVH)
Left ventricular hypertrophy (LVH)

For more presentations

www.medicalppt.blogspot.com
 RAH
Right atrial enlargement
To diagnose RAE you can use the following criteria:
II P > 2.5 mm, or
V1 or V2 P > 1.5 mm > 1 boxes (in height)

Remember 1 small
> 2 boxes (in height)
box in height = 1 mm

A cause of RAE is RVH from pulmonary hypertension.

For more presentations
www.medicalppt.blogspot.com
 LAH

Left atrial enlargement

To diagnose LAE you can use the following criteria:
II > 0.04 s (1 box) between notched peaks, or
V1 Neg. deflection > 1 box wide x 1 box deep

Normal LAE
A common cause of LAE is LVH from hypertension.
For more presentations
www.medicalppt.blogspot.com
 RVH

Right ventricular hypertrophy

Compare the R waves in V1, V2 from a normal ECG and one from
a person with RVH.
Notice the R wave is normally small in V1, V2 because the right
ventricle does not have a lot of muscle mass.
But in the hypertrophied right ventricle the R wave is tall in V1,
V2.

Normal RVH
For more presentations
www.medicalppt.blogspot.com
 LVH
Left ventricular hypertrophy
To diagnose LVH you can use the following criteria*:
R in V5 (or V6) + S in V1 (or V2) > 35 mm, or
avL R > 13 mm

S = 13 mm
* There are several
other criteria for the
diagnosis of LVH.

R = 25 mm
A common cause of LVH
is hypertension.

For more presentations

www.medicalppt.blogspot.com
Diagnosis of CHF (Framingham) requires the simultaneous
presence :
at least 2 major criteria
1 major + 2 minor criteria.
Major criteria:
Paroxysmal nocturnal dyspnea
Neck vein distention
Rales
Radiographic cardiomegaly (increasing heart size on chest radiography)
Acute pulmonary edema
S3 gallop
Increased central venous pressure (>16 cm H2O at right atrium)
Hepatojugular reflux
Weight loss >4.5 kg in 5 days in response to treatment
Minor criteria:
Bilateral ankle edema
Nocturnal cough
Dyspnea on ordinary exertion
Hepatomegaly
Pleural effusion
Decrease in vital capacity by one third from maximum recorded
Tachycardia (heart rate>120 beats/min.)
pengelolaan
 Three Basic Treatment
Strategies
Pharmacologic management

Devices and surgical management

Lifestyle management
 Pengelolaan gagal jantung
Bed Rest (Acute Stage) ,Later On
Decreased Physical Activity
Oxygen Therapy
Low Salt Diet
Diuretics
ACE Inhibitors
Beta blockers (Under Certain Conditions )
Digitalis
Anticoagulation
Implantable ICD
Cardiac Transplantation
 Sifat sifat otot Jantung
1. Inherent rhythmycity ( chronotropic )
kesanggupan jantung dengan cara otomatis dan secara
periodik merangsang dirinya sendiri.

2. Conductivity ( dromotropic )
kesanggupan jantung untuk menghantar rangsang, baik dari
jaringan kusus penghantar rangsang maupun dari ototnya.

3. Exitability ( bathmotropic )
kemampuan jantung untuk dapat dirangsang.

4. Contractility ( inotropic )
kemampuan jantung untuk berkontraksi.
 Sifat obat jantung
Inotropik: Kronotropik:

(+) : Adrenergik (+) : Adrenergik

Digitalis
(-) : beta bloker (-) : Digitalis
Beta bloker
 Stage D
Patients with Refractory End-Stage HF
LVAD
The promise of stell cell research.