sistem kardiovaskular
TRANSCRIPT
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PATOLOGI
KARDIOVASKULERdr. Cut Warnaini
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ANATOMI
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SISTEM KONDUKSI IMPULS
JANTUNG
SA node
AV nodeBundle of His
Serabut Purkinje
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VASKULARISASI
Arteri coronaria Vena coronaria
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a. coronaria kiri (sirkumfleksa dan
desending anterior)
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a. coronaria kanan dan a. desending
posterior)
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HEART SOUNDS
• S1 :
– closure of mitral and tricuspid valves
– Early sistole
–Single sound
– Apex
• S2 :
– Closure of aortic and pulmonic valves
– Diastole
– Physiologic splitting
– Pulmonic area
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Cont.
• Extra systolic HS
– Ejection click
– Mid/late extra systolic HS
• Extra diastolic HS
– Opening snap
– S3
– S4
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Cont.
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SINDROM KORONER AKUT
• >90% dari ruptur plak aterosklerosis
• Partial occlution (unstable angina, NSTEMI)
•
Complete obstruction (STEMI)• Angina : “ pressure”, “discomfort ”, “tightness”,
“heaviness”, “constriction”
•
Nyeri retrosternal, menjalar; diffuse; jarangbertahan lebih dari 5-10’; tidak hilang dengan
istirahat
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Cont.
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Cont.
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Cont.
• ST elevation
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Cont.
• Faktor risiko: dislipidemia, merokok,
hipertensi, DM, menopause
• Diagnosis :
– Anamnesis
– Pemeriksaan fisik
– Pemeriksaan penunjang : EKG, marka jantung
(Troponin, CK-MB)
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GAGAL JANTUNG
The inability of the heart to pump blood
forward at a sufficient rate to meet themetabolic demands of the body ( forward failure), or the inability to do so only if the cardiac filling pressures are
abnormally high (backward failure)
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Disfungsisistolik
Disfungsidiastolik
GagalJantung
Kiri
Jantung
Paru
Gagal jantung
Kanan
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Manifestasi Klinis
• Gagal jantung kiri : Dyspnea, ortopnea, PND,
fatigue, Cahexia, dusky, diaphoretic, akral
dingin, takipnea, pernapasan Cheyne-Stokes,
takikardia, Pulmonary rales, ronchi , wheezing,
efusi pleura
• Gagal jantung kanan : Edema perifer, RUQ
discomfort (hepatomegali), JVP meningkat,efusi pleura
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Diagnosis
• Anamnesis
• Pemeriksaan fisik
•
Pemeriksaan penunjang : rontgen thoraks,echocardiography , kateterisasi jantung
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HIPERTENSI
• Kondisi dimana tekanan sistolik ≥ 140 mmHg
dan atau tekanan diastolik ≥ 90 mmHg
• Hipertensi :
1. H. Esensial/primer (95%)
2. H. Sekunder
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Classification of Blood Pressure in
Adults
Category Systolic Pressure
(mmHg)
Diastolic Pressure
(mmHg)
Optimal <120 And <80
Normal <130 And <85
High-normal 130-139 Or 85-89
Hypertension
Stage 1 140-159 Or 90-99
Stage 2 160-179 Or 100-109
Stage 3 ≥180 Or ≥110
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Clinical clues
1. Usia : < 20 atau > 50 tahun HS
2. Severity : HE (stg.1&2), HS (stg.3)
3. Onset : HE (gradual), HS ( present abruptly from previously a normotensive patient )
4. Riwayat keluarga : HE (riw.keluarga), HS
(sporadis)
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Organ Target
1. Jantung
2. Cerebrovascular
3. Aorta dan pembuluh darah perifer4. Ginjal
5. Retina
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Krisis Hipertensi
• Suatu keadaan emergensi ditandai denganpeningkatan tekanan darah yang berat
• TTIK Hypertensive encephalopathy
(headache, blurred vision, confusion,somnolence, coma)
• Retina Funduskopi : perdarahan, aksudasi,
papilledema• Angina
• Edema paru
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CONGENITAL HEART
DISEASE
Acyanotic
Cyanotic
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Acyanotic
1. Atrial Septal Defect (ASD)
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2. Ventricular Septal Defect (VSD)
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3. Patent Ductus Arteriosus (PDA)
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4. Congenital Aortic Stenosis
5. Pulmonic Stenosis
6. Coarctation of the Aorta
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Cyanotic
1. Tetralogi Fallot
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2. Transposisi Arteri Besar
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DEMAM REMATIK/PENY.
JANTUNG REMATIK• Inflamasi
• Jantung, kulit, jar.ikat
• Post Streptoccus sp. Infection
• Merupakan suatu proses imonulogi, BUKAN
infeksi langsung Streptococcus sp. pada katup
jantung
• Gejala : demam, menggigil, arthralgia, fatigue
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Jones’ Criteria Major criteria
Carditis
Polyarthritis
Syndenham’s chorea
Erythema marginatum
Subcutaneus nodule
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Cont.
Minor criteria
Migratory arthralgias
Fever
Increase acute phase reactants (ESR,leukocytosis)
Prolonged PR interval on ECG
Evidence of streptococcal infectionAntistreptolysin O antibodies
Positive throat culture for Streptococci group A
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Diagnosis
2 kriteria mayor, atau 1 kriteria mayor
ditambah 2 kriteria minor
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Daftar Pustaka
Lilly, Leonard S. Pathophysiology of Heart
Disease.4th Ed.Philadelphia:Lippincott William
& Wilkins,2007.