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KEL.

JANTUNG DIDAPAT (ACQUIRED)


KELAINAN JANTUNG KARENA INFEKSI

DI INDONESIA YANG TERBANYAK:


1.DEMAM REUMATIK(DR), 2. DIFTERIA DAN
3.ENDOKARDITIS LENTA
1.DEMAM REUMATIK: OK MENYEBABKAN
KEL. JANTUNG KE-2 PADA ANAK SETELAH
KEL.JANTUNG KONGENITAL DI USA.
DI INDONESIA DR PENYEBAB UTAMA.
DR PERLU DIDIAGNOSA CEPAT, DAN DIOBATI
SEGERA DPT MENCEGAH KEL. KATUP J.
[BIAYA BANYAK & ANGKA KEMATIAN TINGGI]

INSIDENS 3% PADA MASA EPIDEMIK DAN


INSIDENSNYA 0.3% PD MASA ENDEMIK
ETIOLOGINYA:STREP. BETA HEMOL.GRUP A,
-DR SERING TERJADI BERSAMAAN URI
-ASRAMA MILITER, KELOMPOK MASY. YG
TERISOLIR SERING EPIDEMI.
-INSIDENS DR PARALEL DGN INSIDENS URI
OK GABHS.

Pathology :
-Aschoff bodies
antigen
presenting cells
- Acute phase : inflammation process
in pericard, myocard & pericard
- Chronic phase : injury of the valve
- Difference of clinical and pathologi
cal manifestation in some countries
- Host immunological response
take main role in clinical manifesta
tion

Diagnosis :
1944 : Dr.T.Duckett Jones : Jones Criteria
1955 : Modification of Jones Criteria
1965 & 1984 : Revised of Jones Criteria
1992 : Update Jones Criteria
Jones Criteria (focused)
Problems : over diagnosis or under diagnosis

Diagnosis

1965 Jones Criteria (revised)

Major manifestation
Carditis
Polyarthritis
Chorea
Subcutan nodule
Erythema marginatum
Evidence of previous
Strept. Infection
CULTURE / ASTO

Minor manifestation
Fever
Arthralgia
Prolonged PR interval
ECG
Increase BSR
C reactive protein (+)
Leucocytosis
Previous history RF /
RHD inactive

Diagnosis

1992 Jones Criteria (Updated)


Major manifestation
Carditis
Polyarthritis
Chorea
Subcutan nodule
Erythema margina tum

Minor manifestation
Fever
Arthralgia
Increase BSR
C reactive protein (+)
Leucocytosis
Prolonged PR interval ECG

Evidence of previous
Strept. infection

13.

19.
GABHS Cardiogenik
Rheumatic fever / RHD - pathogenesis

Jones Criteria Mayor CAPOCHES

Treatment RF & RHD


1. Primary preventions :
to eradicate Streptococcal infectcion :
during acute RF attack
2. Secondary prevention :
to prevent relaps of cute RF
3. Relief the symptoms :
- carditis / CHF
- arthritis
- Chorea

Treatment RF & RHD

1. Primary prevention :
1. Benzatine PNC G injection 1 X / i.m.
(BW > 27 kg 1,2 million unit)

(BW < 27 kg 600.000 unit)

2. Pencilline V : 250 mg/400.000 unit QID


/ oral : 10 days

Erythromycine : 40 mg /kg BW / day


TID-QID / oral : 10 days

Clindamycine, Nafcillin, Amoxycillin,

Cefalexin

Treatment RF & RHD

Duration secondary prevention


Categori
Duration
RF with carditis & permanent
valve abnormalities

minimal 10 years
until 40 yrs or
longlife

RF with carditis without perma


nent valve abnormalities

10 years or until
adult

RF without carditis

5 years or until
21 years

Treatment RF & RHD

Relief the symptoms


A. Carditis :
Anti inflammatory

- Carditis : Prednison : 2 mg/kg BW/day

tapp.
2-6 weeks
off

- Mild Carditis : Aspirin 90-100 mg/kg BW 4-6


4-8 weeks
week

B. Arthritis

- Aspirin : 100 mg/kg BW/ day : 2 weeks


2-3 weeks : doses decrease

Treatment RF & RHD

C. Heart Failure :

- Bedrest
- Digoxin
- Diuretics
- Vasodilator

- Fluid & salt restriction

D. Chorea :
- Physical stres & emotional must be controlled
- Anti inflammation drug : controversial
- Phenobarbital : 15-30 mg TID-QID
- Haloperidol : 0,5 mg ---> 2 mg TID
- Valproic acid / Chlorpromazine / Diazepam

Table. Guidelines for Bed Rest and Ambulation and Recommended


antiinflammatory agents

Arthritis

alone
Bed Rest
1-2 wk
Indoor ambulation 1-2 wk
Outdor activity
1-2 wk
(school)
Full activity
1-2 wk
Prednisone
Aspirin

0
0

Carditis
minimal
2-3 wk
2-3 wk
2-3 wk
2-3 wk
0
0

Carditis
moderate
4-6 wk
4-6 wk
4-6 wk

Carditis
severe
2-4 mo
2-3 mo
2-3 mo

4-6 wk

2-3 mo

2-4 wk
2-4 wk

2-6 wk
2-6 wk

Minimal Carditis Questionable cardiomegaly ; Moderate carditis definite but mild


cardiomegaly, Severe carditis, marked cardiomegaly or CHF

Surgical treatment and invasive intervention


Surgical treatment :
1. Valve Replacement :
- MR

- MS

- AR

2. Valvuloplasty
Invasive Intervention :
- Ballon Mitral Valvuloplasty (BMV) with
Inoue ballon : MS

DC
Decompensatio Cordis
Gagal Jantung

Conto: Mitral insuffisiensi


Setiap ventric.sist, ada darah naik
ke Atrium Kilama2
Stagnasi di Atrium Ki
V.Pulm. vasc.paru penumpukan cairan inf. Batuk kronik.
darah masuk ke Ao Jantung kerja keras (HR=Tachycardia)
Jantung membesar (Cardiomegali), Bila kerja,perlu O2 banyak napas
(Dyspnoe deffort, sampai orthopnoe ). Tanda2

DC kiri

PS darah berkurang masuk ke


A.Pulm.
Darah banyak ter
kumpul dalam V.Ki, A.Ki VCS
(TVC) VCI (Hepatomegali)
Edem pretibial, Edema dorsal
pedis, Ascites Jantung kerja
keras (Cardiomegali) dan Kalau
kerja sesak napas (Tachypnoe).
Freq.Jantung naik (Tachycardi)

Tanda DC Kanan

PENGOBATAN DC
1. DIGITALIS
2. DIURETIK
Dosis dan cara pemberian
harus diperlajari baik-baik

Terima

kasih