interna prof. djanggan - kapita selekta

8/19/2019 Interna Prof. Djanggan - Kapita Selekta

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NamaNama : Prof. Dr. H. Djanggan Sargowo: Prof. Dr. H. Djanggan Sargowo, dr.,, dr., SpPDSpPD..,, SpJP(K),SpJP(K),

FIHA, FACCFIHA, FACC,, FESC,FESC, FCAPC, FASCCFCAPC, FASCC

empa!"g# #a$%r empa!"g# #a$%r : Sragen, &1 Sep!em'er 1*: Sragen, &1 Sep!em'er 1*

A#ama!A#ama! : +%#% Inda$ E-1 /a#ang, e#p. 01-&0: +%#% Inda$ E-1 /a#ang, e#p. 01-&0Pend%d%2anPend%d%2an ::

1.1. 34#4 Do2!er dar% 56/, !a$4n 1*34#4 Do2!er dar% 56/, !a$4n 1*

&.&. 34#4 Card%o#og%! dar% 5n%7. Indone%a, !a$4n 18034#4 Card%o#og%! dar% 5n%7. Indone%a, !a$4n 180

0.0. 34#4 In!ern%! dar% 5n%7. A%r#angga, !a$4n 18934#4 In!ern%! dar% 5n%7. A%r#angga, !a$4n 189

.. 34#4 Do2!or, 5n%7. A%r#angga, !a$4n 1934#4 Do2!or, 5n%7. A%r#angga, !a$4n 19

.. Ad7aned Card%o#og; Co4re, 5n%7. Hong2ong, !a$4n 18Ad7aned Card%o#og; Co4re, 5n%7. Hong2ong, !a$4n 189.9. Sen%or a;a

0.0. Ke!4a PE>KI Ca'ang /a#ang >a;aKe!4a PE>KI Ca'ang /a#ang >a;a

.. Anggo!a Ko#eg%4m Kard%o7a24#er Indone%aAnggo!a Ko#eg%4m Kard%o7a24#er Indone%a

.. De2an Fa2. Kedo2!eran 5De2an Fa2. Kedo2!eran 5n%7.n%7. ++%ja;a%ja;a KK44ma S4ra'a;a44ma S4ra'a;a9.9. Ke!4a Dewan Pen awa >4ma$ Sa2%! Pend%d%2anKe!4a Dewan Pen awa >4ma$ Sa2%! Pend%d%2an

Curriculum VitaeCurriculum Vitae


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CAPITA SELECTA

FAKULTAS KEDOKTERAN UNIVERSITAS WIJAYA KUSUMA

FAKULTAS KEDOKTERAN UNIVERSITAS WIJAYA KUSUMA

Djanggan SargowoDjanggan Sargowo


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Doctor-Patient relationship:

Empa!$; : the ability to recognize and to some extent share the emotions and

states of mind of another and to understand the meaning and significance of

that person's behavior. Empathy is different from ;mpa!$; in that to be empathetic one

understands how the person feels rather than actually experiencing those

feelings, as in sympathy.

Patient: human being mimics

feelings

ppreciate or honor each other

honest may be positive ! "egative


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Doctor-Patient Relationship

Interaction

#y feelings#y feelings

affect myaffect my

behaviour behaviour

#y behaviours#y behaviours

affect patient$saffect patient$s

feelingsfeelings

Patient$s behaviourPatient$s behaviour

affect my feelingsaffect my feelings

Patient$s feelingsPatient$s feelingsaffect theiraffect their

diseasesdiseases


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Examination of patientExamination of patient the central pointthe central point needs scientific bac%groundneeds scientific bac%ground

Phase & :Phase & : namnesis namnesis

Physical notes Physical notes (ata recording (ata recording

"eeds patience, discipline, sensitive, curious"eeds patience, discipline, sensitive, curious

Phase && :Phase && : (ata analysis (ata analysis

&ntegrating data &ntegrating data

(iagnosis, Prognosis, Process, (iagnosis(iagnosis, Prognosis, Process, (iagnosis

Phase &&& :Phase &&& : # anagement# anagement

)reatment )reatment*onsideration, experience, advice*onsideration, experience, advice

++Primum "on "ocerePrimum "on "ocere

(o "o -arm /Pertama 0angan mela%u%an tinda%an yang merugi%an.(o "o -arm /Pertama 0angan mela%u%an tinda%an yang merugi%an.


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$e Card%o7a4#ar Da!a =ae

1. Pa!%en! $%!or;

&. P$;%a# e?am%na!%on

0. E#e!roard%ogram

. C$e! @-ra;

. >o4!%ne '#ood e?am

9. Add%!%ona# e!:

1. wo-d%men%ona# e$oard%ograp$; w%!$ Dopp#er !4d%e

&. E?er%e !readm%# EC6 !e!0. Am'4#a!or; Ho#!er /on%!or%ng

. N4#ear %mag%ng

. Card%a a!$e!er%a!%on


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C#a%f%a!%on of Common Hear! D%eae

(aord%ng !o !$e a4e)

2 *ardiovascular malformations congenital heart

disease

3 &nvolving the valve, heart structure, and other large vessels,

etc.2 c4uired heart disease

3 rtery thrombosis disease : leading to ischemia or infarction,

such as coronary heart disease

3 5heumatic heart disease: heart inflammation, valvulardisease

2 -ypertension: primary, hypertensive heart disease


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(aord%ng !o !$e a4e)

2 AB4%red $ear! d%eae 3 p4#monar; and p4#monar;-7a4#ar $ear!

d%eae: p4#monar; $ear! d%eae, p4#monar;

$;per!en%on, p4#monar; em'o#%m, e!.

3 Infe!%on: 'a!er%a, 7%r4e %n7ade !$e $ear!

3 D%eae of o!$er ;!em %n7o#7e !$e

$ear!: $;per!$;ro%d%m, anem%a, ma#n4!r%!%on,

%mm4ne a'norma#%!%e, p$;%a# and $em%a#damage, men!a# fa!or, e!.


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(aord%ng !o pa!$o#og; )

2 Endoard%a# d%eae 3 Endoard%!%, 7a#74#ar d%eae, e!.

2 /;oard%a# d%eae

3 Inf#amma!%on, %$em%a or nero%, $;per!rop$;,f%'ro%, damage, e!.

2 6rea! 7a4#ar d%eae 3 A!$ero#ero%, d%e!%on, %nf#amma!%on, !$rom'o%,

ang%oma, em'o#%m, e!.

2 Per%ard%4m d%eae 3 Inf#amma!%on, p#o! (ga, wa!er, '#ood, p4, e!),

oar!a!%on, e!.


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(aord%ng !o pa!$op$;%o#og; )

2 Hear! Fa%#4re 3 3ef! $ear!, r%g$! $ear! a4!e, $ron% ;!o#%,

d%a!o#%

2 S$o22 D;f4n!%on of oronar; %r4#a!%on2 Pap%##ar; m4#e d;f4n!%on 2 Arr$;!$m%a

2 Card%a !amponade 2 !$er: $%g$ or #ow '#ood pre4re (of ;!em% or

p4#monar; 7a4#ar), $4n!, e!.


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Forma! of Hear! D%eae D%agno%

2 E!%o#og%a# d%agno% 3 S4$ a r$e4ma!% $ear! d%eae, oronar;

ar!er; d%eae

2 Pa!$o#og%a# or ana!om%a# d%agno% 3 S4$ a m%!ra# !eno%

2 Pa!$op$;%o#og; d%agno%

3 S4$ a $ear! fa%#4re, a!r%a# f%'r%##a!%on,p4#monar; $;per!en%on


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/e!$od of Card%o7a4#ar D%eae

D%agno%

2 Pa!%en! $%!or; 3 preen! $%!or;, pa! $%!or;, perona# $%!or;,

!$e $%!or; of 4rger;, 7a%na!%on $%!or;,marr%age and prorea!%on, fam%#; $%!or;, e!.

2 P$;%a# e?am%na!%on 3 S;mp!om and %gn

2 3a'ora!or; e?am%na!%on 3 =#ood, 4r%ne, faee, ero4 eff4%on (from

per%ard%a# eff4%on), p4!4m, '%op;, e!.

2 EB4%pmen! %npe!%on 3 @-ra;, 4#!rao4nd (e$oard%ograp$;),

e#e!roard%grap$;, rad%on4#%de, ang%ograp$;,e!.


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E7a#4a!%on of !$e /e!$od %n

Card%o7a4#ar D%eae D%agno%

2 H%!or; and p$;%a# e?am%na!%on

3 'a% 2%##, f%r!-$and %nforma!%on, man;

d%eae an 'e d%agnoed !$ro4g$ !$%

2 3a'ora!or; e?am%na!%on 3 /o! 4ppor!%7e, '4! ome an 'e 4ed !o ma2e

a def%n%!e d%agno%, 4$ a m;oard%a#

nero% mar2er, =NP, e!.


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E7a#4a!%on of !$e /e!$od %n

Card%o7a4#ar D%eae D%agno%

2 EB4%pmen! %npe!%on

3 /ajor me!$od for ard%o7a4#ar d%eae d%agno%,

D%7%ded %n!o %n7a%7e and non-%n7a%7e me!$od.

3 non-%n7a%7e me!$od an ea%#; 'e aep!ed '; pa!%en!,and % afe, $owe7er, !$e %nforma!%on ma; 'e #%m%!ed

(eg. EC6, e$oard%ograp$;)

3 In7a%7e me!$od: !$e oppo%!e !o non-%n7a%7e one (eg.

Card%a a!$e!er%a!%on) 3 Sem%-%n7a%7e e?am%na!%on， 4$ a !$oe 7%a !$e

eop$ag4 eg. )ransesophageal echocardiography


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Basic skillBasic skill

Inpe!%on: S2%n, m4oae, mo7emen! of

$e! wa##Pa#pa!%on : - Sen%!%7%!; of !$e $and"f%nger

- /4#e !one

- 4mor

Per4%on : Sonor, d4#ne, !%mpan%A44#!a!%on : So4nd"


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Problem Oriented Medical Record

P/> % or%en!ed !o pro'#em

1.=ae#%ne da!a

&.Pro'#em #%!0.Pro'#em or%en!ed med%a# reord

.S4mmar; of pro'#em


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Common symptoms and signs related toCardiovascular problem

! Chest pain"! Dyspnea#! Syncope$! Palpitations

%! Lo&er e'tremity edema(! )eart murmur*! )ypertension+! ,ever associated &ith cardiac symptoms and

signs


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C$e! Pa%n


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Dierential diagnosis o chest pain

S;!em %n7o#7ed Pa!$o#og;

Card%a /;oard%a# %nfar!%on

Ang%na pe!or%Per%ard%!%Pro#ape of !$e m%!ra# 7a#7eamponade

ep%ra!or; (a## !end !o g%7e r%e !op#e4r%!% pa%n)

P4#monar; em'o#4Pne4mon%aPne4mo!$ora?P4#monar; neop#am

6a!ro%n!e!%na# Eop$ag%!% d4e !o ga!r% ref#4?Eop$agea# !ear Pep!% 4#er =%#%ar; d%eaePanrea!%!%


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Dierential diagnosis o chest pain


/44#o2e#e!a# Cer7%a# ner7e roo! ompre%on ';

er7%a# d%Co!oandr%!%Fra!4red r%'

Ne4ro#og%a# Herpe o!er

>ep%ra!or; (a## !end !o g%7e r%e !op#e4r%!% pa%n)

P4#monar; em'o#4Pne4mon%aPne4mo!$ora?P4#monar; neop#am

P;$ogen% An?%e!;Pan% d%order Con7er%on d%order

/a#%nger%ng


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(yspnea(yspnea


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Dierential diagnosis o dyspnea:


Card%a Card%a fa%#4re

Coronar; ar!er; d%eae


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Dierential diagnosis o dyspnea:


!$er 'e%!; (#%m%!%ng $e! wa## mo7emen!or #eep apnea)

Anem%aP;$ogen% $;per7en!%#a!%on, pan%

a!!a2, an?%e!;.A%do% (eg ap%r%n o7erdoe,

d%a'e!% 2e!oa%do%)


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6yncope6yncope

Di i l di i


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Dierential diagnosis o syncope :


Card%a a$;arr$;$!m%a- 4pra7en!r%4#ar or 7en!r%4#ar =rad;arr$;!$m%a- %n4 'rad;ard%a, omp#e!e or

eond-degree $ear! '#o2, %n4 arre!S!o2e-Adam a!!a2- ;nope d4e !o !ran%en! a;!o#e3ef! 7en!r%4#ar o4!f#ow !ra! o'!r4!%on- aor!%

!eno%, HC/ ($;per!rop$% o'!r4!%7e

ard%om;pa!$;)P4#monar; $;per!en%on


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Dierential diagnosis o syncope :

S;!em %n7o#7ed Pa!o#og;

C%r4#a!or; Po!4ra# $;po!en%on 44a##; d4e !o an!%$;per!en%7edr4g or d%4re!% a#o a4ed '; a4!onom%ne4ropa!$; a %n d%a'e!e

P4#monar; em'o#4 ma; or ma; no! preeded ';$e! pa%n

Sep!% $o2 e7ere per%p$era# 7aod%#a!a!%on re4#!

%n $;po!en%on

Cere'ra7a4#ar ran%en! %$em% a!!a2


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PalpitationsPalpitations

l i i


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Palpitations :

Palpitations may be caused by any disordercausing a change in cardiac rhythm or rateand any disorder causing increased stro.e

volume

l i i


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Palpitations :

/apid Palpitations:!/egular palpitations may be a sign o:

! Sinus tachycardia"! Atrial lutter#! Atrial tachycardia$! Supraventricular re-entry tachycardia

"!Irregularly irregular palpitations may indicate:! Atrial ibrillation"! 0ultiple atrial or ventricular ectopic beats#! 0ultiocal atrial tachycardia 10AT2: usually ound in

patients &ith lung pathology

P l i i


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Palpitations:

Slo& palpitations: patients oten describe these as missedbeats or orceul beats 1ater a pause the ne't beat is otenmore orceul due to a long illing time and thereore ahigher stro.e volume2!

Causes o slo& palpitations:

!Sic. sinus syndrome"!Atrioventricular bloc.#!3ccasional ectopics &ith compensatory pauses


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"ormal E*7

2 5ate 898 bpm

2 5egularity regular

2 P waves normal

2 P5 interval 9.1; s

2

Normal Sinus Rhythm


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6inus )achycardia

2 Etiology: 6 node is depolarizing faster

than normal, impulse is conducted

normally.

2 5emember: sinus tachycardia is a

response to physical or psychological

stress, not a primary arrhythmia.


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trial ?ibrillation

2 (eviation from "65

3 "o organized atrial depolarization, so no

normal P waves impulses are not

originating from the sinus node.

3 trial activity is chaotic resulting in an

irregularly irregular rate. 3 *ommon, affects ;@A, up to 19A if B

=9 years old


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trial ?lutter

2(eviation from "65 3 "o P waves. &nstead flutter waves

note +sawtooth pattern are formed ata rate of ;9 C9 bpm.

3 Dnly some impulses conduct throughthe node usually every otherimpulse.


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Fower Extremity EdemFower Extremity Edemaa


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D%fferen!%a# d%agno% of #ower

e?!rem%!; edema

Pa!$o#og; Ca4e

Conge!%7e $ear!fa%#4re

/;oard%a# %nfar!%on, re4rren! !a$;arr$;!$m%a(par!%4#ar#; a!r%a# f%'r%##a!%on), $;per!en%7e$ear! d%eae, m;oard%!%, ard%om;opa!$; d4e!o dr4g and !o?%n, m%!ra#, aor!% or p4#monar;

7a#7e d%eae

>%g$! $ear! fa%#4reeondar; !op4#monar;$;per!en%on (orp4#mona#e)

C$ron% #4ng d%eae, pr%mar; p4#monar;$;per!en%on

H;poa#'4m%nem%a E?e%7e pro!e%n #o (d4e !o nep$r%!%;ndrome, e?!en%7e '4rn, pro!e%n #o%ngen!eropa!$;), red4ed pro!e%n prod4!%on (d4e!o #%7er fa%#4re), or %nadeB4a!e pro!e%n %n!a2e (d4e!o pro!e%n-energ; ma#n4!r%!%on)


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e?!rem%!; edema

Pa!$o#og; Ca4e

>ena# d%eae An; a4e of rena# %mpa%rmen! ( e.g. $;per!en%on,d%a'e!e me##%!4, a4!o%mm4ne d%eae, %nfe!%on)

3%7er %rr$o% A#o$o#, $epa!%!% A, =, C, e!, a4!o%mm4ne$ron% a!%7e $epa!%!%, '%#%ar; %rr$o%, +%#ond%eae, $emo$roma!o%, dr4g

Id%opa!$% Premen!r4a# edema

Ar!er%o#ar d%#a!a!%on(e?po%ng !$eap%##ar%e !o $%g$

pre4re, !$4%nrea%ng%n!ra7a4#ar$;dro!a!% pre4re)

D%$;drop;r%d%ne a#%4m $anne# '#o2er ( e.g.n%fed%p%ne, am#od%p%ne)


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e?!rem%!; edema

Pa!$o#og; Ca4e

Sod%4m re!en!%o C4$%ng d%eae re4#!%ng %n e?e%7em%nera#oor!%o%d a!%7%!;, or!%o!ero%d

3oa# a4e Ce##4#%!%, 7eno4 !$rom'o%, #;mp$edema


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-eart #urmur -eart #urmur


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D%fferen!%a# D%agno% of Hear! /4rm4r P$aeof

ard%a;#e

Na!4re ofm4rm4r


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ard%a;#e

Na!4re ofm4rm4r

)

F4n!%ona# /> d4e !od%#a!a!%on of m%!ra# 7a#7eann4#4

: r$e4ma!%

fe7er, %nfe!%7eendoard%!%, m%!ra# 7a#7epro#ape, $orda# r4p!4re,pap%##ar; m4#e %nfar!

r%4p%d

reg4rg%!a!%on(>)

F4n!%ona# >

: r$e4ma!%fe7er, %nfe!%7eendoard%!%


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ard%a;#e

Na!4re ofm4rm4r


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D%fferen!%a# D%agno% of Hear! /4rm4r P$ae ofard%a

;#e

Na!4re ofm4rm4r

$e4ma!% fe7er, ongen%!a#

r%4p%d!eno% (S)

>$e4ma!% fe7er

3ef! and r%g$!a!r%a# m;?oma

4mor o'!r4!%on of 7a#7eor%f%e %n d%a!o#e

Con!%n4o4 PDAAr!er%o7eno4f%!4#aCer7%a# 7eno4

$4m

Congen%!a#


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H;per!en%onH;per!en%on


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(ifferential diagnosis of

hypertension2 6ystemic hypertension may be classified

as:

3 Primary essential hypertension, for which

there is no identified cause. )his accounts for8A of cases.

3 6econdary hypertension, for which there is a

clear cause


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Glood Pressure *lassification

Normal 100

BP Classification SBP mmHg DBP mmHg

H"* &&


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Ca4e of eondar; $;per!en%on

/e$an%m Pa!$o#og;

>ena# >ena# paren$;ma# d%eae (e.g.$ron% a!rop$% p;e#onep$r%!%,$ron% g#omer4#onep$r%!%), rena#ar!er; !eno%, ren%n-prod4%ng!4mor, pr%mar; od%4m re!en!%on

Endor%ne Aromega#;, $;po- and$;per!$;ro%d%m, $;pera#em%a,adrena# or!e? d%order (e.gC4$%ng d%eae, Conn;ndrome, ongen%!a# adrena#$;perp#a%a), adrena# med4##a

d%order (e.g p$eo$romo;!oma)


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Page 8

Ca4e of eondar; $;per!en%on

/e$an%m Pa!$o#og;

Inreaed %n!ra7a4#ar 7o#4me Po#;;!$em%a (pr%mar; oreondar;)

Dr4g A#o$o#, ora# on!raep!%7e,monoam%ne o?%dae %n$%'%!or,g#4oor!%o%d

P;$ogen% S!re

Ne4ro#og%a# Inreaed %n!raran%a# pre4re


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Fe7er ao%a!ed w%!$ aFe7er ao%a!ed w%!$ a

ard%a ;mp!om or %gnard%a ;mp!om or %gn


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(ifferential diagnosis of fever

2 &nfective endocarditis bacterial or fungal infection

within the heart

2 #yocarditis involvement of the myocardum in an

inflammatory proess, which is usually viral

2 Pericarditis inflammation of the pericardium whichmay be infective, postmyocardial infarction or

autoimmune

2 Dther rare conditions such as cardiac myxoma


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Page 1

6ummary

1. *linical diagnosis for patient with

cardiovascular disease needs

comprehensive approach.

;. *ardiovascular data base includes

patient history, physical examination,

electrocardiogram, chest Iray, 5outine

blood exams and additional tests


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6ummary

C. *omponents of a complete cardiac

diagnosis include etiologic diagnosis,

pathologic or anatomical diagnosis, and

pathophysiologic diagnosis.

@. #any of symptoms and signs may lead to

differential diagnosis.


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interna prof. djanggan - kapita selekta

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