PRESENTASI KASUS PERIPARTUM CARDIOMYOPATHY

Oleh: SABILA EVASWANTRY Pembimbing: dr. HAMI ZUL I!LI ABBAS" S#.P$" MH. e%" !INASIM dr. SIBLI" S#.P$

Peripartum Cardiomyopathy
Defini i! "ardiomiopati idiopati" den#an menife ta i "$ini #a#a$ %antun# pada a"hir "ehami$an ampai & 'u$an pertama ete$ah me$ahir"an( Tanpa ada "e$ainan %antun# yan# menda ari e'e$umnya( Etio$o#i! idiopati" PPCM )NYHA* !
C$a I! a imptomati C$a II! imptom mun+u$ pada "e#iatan 'erat C$a I,! imptom mun+u$ pada "e#iatan rin#an C$a ,! imptom mun+u$ aat i tirahat

Car inoma o-arium

Defini i! per"em'an#an a'norma$ e$. e$ o-arium( Epidemio$o#i! "an"er merupa"an penye'a' "ematian utama /01 didunia dari e$uruh penye'a' "ematian )2HO 3445*( morta$ita 67851 tertin##i 0 ete$ah "an"er payudara dan er-i9 di Indone ia

IDENTITAS PASIEN
Nama Umur ! Ny :d ! 3< tahun ;eni Ke$amin ! Perempuan A$amat ! Du"u Puntan# Pe"er%aan ! I'u rumah tan##a A#ama ! I $am Statu Perni"ahan ! Meni"ah T#$( Ma u" RS T#$( Ke$uar RS ! 33 No-em'er 34/0 ! 3& No-em'er 34/0

KE=UHAN UTAMA

Se a" nafa yan# mem'erat e%a" 0 hari e'e$um ma u" rumah a"it

RI2AYAT PENYAKIT SEKARAN>

PEMERIKSAAN :ISIK
Ke adaran ! Compo menti ! Sedan# Keadaan umum ! Tampa" a"it edan# Keadaan a"it ?erat 'adan ! <& "# Tin##i 'adan ! /&& +m S&'&(% gi)i : *+", -g.m* : b'i Te"anan darah ! /34@54 mmH# Nadi ! /44 9@menit Pern'/'%'n : 01 2.meni& S(h( : 03"4 56

EPALA
Ben&(- ! Norma$7 imetri R'mb(& ! Hitam7 tida" mudah ronto" M'&' ! Kon%un#ti-a anemi .@.7 +$era i+teri+ .@.7 ref$e9 +ahaya ) A *7 pupi$ i o"or "anan B "iri Teling'! ?entu" norma$7 erumen ) . *7 mem'rane timpani inta" Hid(ng! ?entu" norma$7 eptum diten#ah7 tida" de-ia i M(l(&! ?entu" norma$7 $idah tida" "otor7 tida" hiperemi

LEHER

Ke$en%ar #etah 'enin# tida" tera'a Tra+hea 'erada di ten#ah Tida" ada pem'e aran "e$en%ar tiroid ;,P menin#"at

PARU7PARU
In pe" i!

:ANTUN;
In pe" i ! I+tu +ordi tida" ter$ihat Pa$pa i! I+tu +ordi tera'a pada ICS & $inea mid+$a-i+u$a ini tra
?ata ata ! ICS 0 $inea para terna$i ini tra ?ata "anan ! ICS < $inea terna$i de9tra ?ata "iri ! ICS & $inea mid+$a-i+u$a ini tra

?entu" dada imetri "anan dan "iri7 Per#era"an dindin# dada imetri "anan dan "iri7 Tida" terdapat retra" i otot.otot intra+o ta$ Pa$pa i! :remitu ta"ti$ "aB"i dan -o+a$ imetri "aB"i 7 Tida" ada "repita i Per"u i!

Per"u i

Sonor e$uruh $apan# paru7 Peran%a"an paru )A* Au "u$ta i! ,?S A@A7 r8n-hi 9.9" CheeDin# .@.

Au "u$ta i! ?unyi %antun# I.II murni re#u$ar7 murmur ) .*7 #a$$op ) A *

AB$OMEN
In%#e-%i! ?entu" a'domen +em'un#7 $em'ut A(%-(l&'%i! ?i in# u u ) A * norma$ Per-(%i! Terden#ar uara timpani mendomina i $apan# a'domen

E STREMITAS

A"ra$ han#at Udema .@. CRT F 3G

Superior

A"ra$ han#at Udem' 9.9 CRT F 3G

Inferior

P'l#'%i :
Hepar tera'a 0 %ari ?PE =ien tida" tera'a ?a$$otment ) . * ,e i+a urinaria tida" tera'a Ter'b' m'%' regi8 %(#r'#(bi-" #erm(-''n li<in Nyeri te"an ) . * A%i&e%=9>

;ENITALIA

Tida" diperi" a

Result WBC LYM MON 7,4 1,2 1,0 4.8 27.8 7.6 64.6 3(!) +(0 !-(0 )+(& 27,0 30,9 17,5 324 7,3 0,345 12,7
84 mg/dl

Flags

Unit 103/l 103/l 103/l 103/l % % %

Normal Limits 4,0 10,0 1,0 5,0 0,1 1,0 !,0 ",0 !&,0 &0,0 2,0 10,0 &0,0 '"0,0 4,0 - 6,20 11,0 17,0 35,0 55,0 90,0 100,0 26,0 34,0 31,0 35,5 10,0 16,0 150 400 7,0 11,0 0,200 0,500 10,0 18,0

Darah rutin 30 No34/0

GR L#$ % MON % GR % RBC *GB *C, $C. MCH MCHC !"# PL$ MP% PC$ P"#
&"'

L L L L

106/l g/dL % m3 P g/dL % 103/l m3 % %

!(ng%i H'&i *1 N8?ember *+,0

/emeri0saan 2G3, '&P$ +l,-m./

*asil &4 25 3.06

$eto1e ()CC2 ()CC2 0C& +l, Pl-1

Nilai Normal 0-38,0 0-41 3,5-5,0

2atuan */( */( */(

Pemeri-%''n !(ng%i gin@'l *1 N8?ember *+,0

Pemeri-%''n Ureum Kreatinin H'%il </ 4765 Nil'i N8rm'l /474.&474 476./70H S'&('n m#@d$ m#@d$

T(m8r m'r-er *1 N8?ember *+,0

Pemeri-%''n C+ 125 (( H'%il 142,8 Nil'i N8rm'l 0-35 S'&('n U@m$

EK> 3< No-em'er 34/0

Sinu Ta"i"ardi ) HR! //49@menit* =eft ,entri+u$ar Hypertrophy

INTEPRETASI! Efu i P$uera 'i$atera$ Hepatome#a$i rin#an Su p( Ma a Peritonea$ 'aCah dd@ a ite en+ap u$ated

RESUME
Se a" nafa 7 perut mem'e ar7 "a"i 'en#"a"7 po t partum 3 'u$an )>/P/A4*7re pira i 0<9@menit7 ;,P menin#"at7 rhon"i A@A7 #a$$op A7 hepar tera'a 3 %ari7 tera'a ma a re#io uprapu'i"7 a ite 7 edem tun#"ai7 H? 8(47 S>OT &< UI7 CA /3& II! /<37HU@m$7 EK> inu ta"i"ardi7 =,H7 US> efu i p$eura 'i$atera$7 hepatome#a$i rin#an7 u p ma a peritonea$ 'aCah dd@ a ite en+ap u$ated(

DA:TAR MASA=AH

PERIPARTUM CARDIOMYOPAT HY )PPCM*

SUSPEK TUMOR O,ARIUM

PEN; A:IAN

Peripartum Cardiomyopathy
Tanda.tanda >a#a$ %antun# A / 'u$an e'e$um me$ahir"an or & 'u$an eta$ah me$ahir"an
Kriteria :remin#ham! Mayor! Paro9y ma$ no+turna$ di pnea Di ten i -ena.-ena $eher ;,P menin#"at Ron"i Kardiome#a$i Edema Paru A"ut >a$$op Ref$u" hepato%u#u$ar A

Penya"it %antun# e'e$umny a

Kriteria :remin#ham! Minor! Edema e" tremita ?atu" Ma$am Se a" pada a"ti-ita Hepatome#a$i Efu i p$eura Kapa ita -ita$ 'er"ura# /@0 norma$ Ta"i"ardi )I/349@menit*

A%%e%men&:
Peripartum Cardiomyopathy )po t partum A "riteria fremin#ham < mayor7 & minor7 tida" ada riCayat penya"it %antun#*

Pl'nning:
Dia#no i ! Ront#en Thora97 E+ho+ardio#ram Treatment! Non.farma"o$o#i ! O" i#en Tidur po i i foC$er Diet rendah #aram / #r@hari Kontra ep i IUD Treatment! :arma"o$o#i ! Infu R= /4 #tt :uro emid 39 3&4 m# KSR /9/ Di#o9in 394(& m#

Su pe" +ar inoma o-arium

Tera'a ma a re#io uprapu'i"7 US>! ma a peritonea$ a'domen 'aCah7 Tumor mar"er Ca /3&! /<37 H )menin#"at* A e ment! Su pe" tumor mar"er

P$annin#! Kon u$ do"ter "andun#an

DA:TAR PUSTAKA
2an# mery( Peripartum Cardiomyopathy! Ca e Report( The Premanete ;ourna$( :a$$ 3448( ,o$ /0( No <( Pear on >D7 ,ei$$e ;C7 Rahimtoo$a S7 H ia ;7 Oa"$ey CM7 Ho enpud ;D7 An ari A7 ?au#hman K=( Peripartum +ardiomyopathy! Nationa$ Heart7 =un#7 and ?$ood In titute and Oi +e of Rare Di ea e )Nationa$ In titute of Hea$th* Cor" hop re+ommendation and re-ieC( ;AMA 3444J3H0!//H0K//HH( 2ein M(N(7 De+ >(2(7 =i$$y =(S( The Cardiomyopathie ( Da$am( =i$$y =(S(7 editor( Pathophy io$o#y of Heart Di ea e ! A Co$$a'orati-e Pro%e+t of Medi+a$ Student and :a+u$ty7 :ourth Edition( USA ! =ippin+ott 2i$$iam L 2i$"in 7 3445J Ha$ 3&3 K 36H( Choure A(7 >rii n ?(P(7 Raymond R( Pre#nan+y and Cardio-a +u$ar Di ea e ( Da$am( >rii n ?(P(7 Topo$ E(;(7 Nair D(7 A h$ey K(7 editor( Manua$ of Cardio-a +u$ar Medi+ine Third Edition( USA ! =ippin+ott 2i$$iam L 2i$"in 7 3448J Ha$ &06 K &&3 Ma#ro e" -era re#i tD et a$( ESC >uide$ine on mana#ement of +ardio-a +u$ar di ea e durin# pre#nan+y( European Heart ;ourna$ )34//* 037 0/<5K0/85