ROLE OF RAAS-BLOCKERS :

FOCUS ON RAMIPRIL
dr. Ferry Usnizar, SpPD, KKV, FINASIM

KLUB EKG SRIWIJAYA

2019
 Gagal Jantung
Per Definisi?

Sindroma klinis yang memiliki gejala dan tanda yang khas yang
disebabkan oleh kelainan struktur dan/atau fungsi jantung yang
mengakibatkan turunnya curah jantung dan atau peningkatan
tekanan pengisian jantung baik pada saat istirahat maupun pada
kondisi stress fisik
Klasifikasi Gagal Jantung
(Berdasarkan fungsi LV)
Patofisiologi Gagal Jantung

Dua sistem neurohormonal dalam gagal jantung:

sistem saraf simpatis dan sistem RAA
 Patofisiologi Gagal Jantung
SNS
Epinephrine α1, β1, β2
Norepinephrine receptors
Vasoconstriction
RAAS activity 
Vasopressin 
NP system HF SYMPTOMS
& PROGRESSION Heart rate 
NPRs NPs Contractility 
Vasodilation
 Blood pressure
 Sympathetic tone RAAS
 Natriuresis/diuresis
 Vasopressin Ang II AT1R
 Aldosterone Vasoconstriction
 Fibrosis Blood pressure 
 Hypertrophy Sympathetic tone 
Aldosterone 
Hypertrophy 
Fibrosis 
Sodium and water retention 
Renin-Angiotensin-Aldosterone System
Efek RAAs Terhadap Jantung

• Activity of RAAS system in heart

failure can be maladaptive
• It leads to adverse effect such as
Cardiac Remodelling
• Ang. II is believed to influence a
number of molecular and structural
changes in the heart, mostly
mediated through the AT1-receptor.
 Progresivitas HF

• Tiap rekurensi episode akut HF akan meningkatkan risiko mortalitas dan

perburukan gagal jantung
• Dibutuhkan terapi yang bersifat menghambat progresifitas penyakit
Where It Is in The Guideline?
 HOPE TRIAL
Heart Outcomes Prevent Evaluation trial
 Cara Pemberian

KONTRAINDIKASI PEMBERIAN ACE-INHIBITOR

• Riwayat Angioedema
• Stenosis renal bilateral
• Kadar kalium serum > 5,0 mmol/L
• Serum kreatinin > 2.5 mg/dL
• Stenosis aorta berat

Sampai sekarang penggunaan ACE-I hanya terbukti efektif pada

kelompok HFrEF (EF <40%)
 ACE-I as Prevention

• Initiation of ACE-I after a myocardial infarction, especially when it is associated with LV

systolic dysfunction, reduces the rate of hospitalization for HF and mortality
• In asymptomatic patients with chronically reduced LVEF, regardless of its etiology, ACE-I
can reduce the risk of HF requiring hospitalization