Gagal Jantung

dr Putra Hendra SpPD

UNIBA
Distribution of Blood in the Body
Organs

as therapy for
chronic heart
failure

Figure 15-13: Distribution of blood in the body at rest

The Heart:

2 sisi pompa jantung

 Kanan
 Mudah menyesuaikan
 Bertekanan rendah
 Volume bervariasi
 Kiri
 Kaku
 Kuat
 Bertekanan tinggi
 Volume tetap
 Jenis
 Systolic (masalah pompa) ketidakmampuan jantung
berkontraksi mendorong darah kedepan

 Diastolic (masalah pengisian)  ketidakmampuan

jantung kiri relax secara normal  darah balik kembali ke
paru.

 Left-sided—inability of the left ventricle to pump enough

blood, causing fluid back up into the lungs

 Right-sided—inefficient pumping of the right side of the

heart, causing fluid buildup in the abdomen, legs, and
feet
 Acute vs. Chronic
 Acute—an emergency situation in which a patient was
completely asymptomatic before the onset of heart
failure; seen in acute heart injury such as MI

 Chronic—long-term syndrome in which a patient

exhibits symptoms over a long period of time, usually as
a result of a preexisting cardiac condition
PATOFISIOLOGI
KLINIS
L heart failure

Butterfly
appearence
 LEFT-SIDED HEART FAILURE
 DYSPNEA  CHEYNE-STOKES
 DRY COUGH RESPIRATIONS
 FATIQUE
 CRACKLES
 WEAKNESS
 WHEEZES
 CYANOSIS
 ORTHOPNEA
 NOCTURIA
 HEMOPTYSIS
 TACHYCARDIA
 “Paroxysmal”
NOCTURNAL  Pulmonary Edema
DYSPNEA
R Heart failure
 RIGHT-SIDED HEART FAILURE
 JUGULAR VEIN  SPLENOMEGALY
DISTENSION  HEPATOMEGALY
 DEPENDENT  GI DISCOMFORT
PERIPHERAL EDEMA  NOCTURIA
 ASCITES  TACHYCARDIA
 WEIGHT GAIN
 FATIGUE
 WEAKNESS
ETIOLOGI
 Many etiologies of CHF
 Congenital heart disease
 Coronary artery disease
 Valvular heart disease
 Cardiomyopathy
 Arrythmia cordis
 Hypertension
 Peripartum cardiomyopathy
 Lung disease
 Thyroid
 Anemia
 Toxins
 Many others
 Diagnosis jantung
 Diagnosis anatomi :
- Kardiomegali
- Kelainan katup (MI,MS)
 Diagnosis fungsionial:
- Dekompensasi kordis
 Diagnosis etiologi
- Penyakit jantung rematik
(PJR)
- Penyakit jantung koroner
(PJK)
 ETIOLOGI

 Penyakit jantung kongenital

 Penyakit jantung rematik
 Penyakit jantung Iskemik
 Penyakit jantung tiroid
 Penyakit jantung anemik
 Penyakit jantung pulmonal
v
 Rheumatic Fever
 Strep throat from the streptococcal
infection begins a disease process
where the heart valves are damaged.
This condition is called rheumatic fever
and it affects the connective tissues of
the body.
klasifikasi
 Heart Failure
Lifestyles, Fitness
and Rehabilitation
 New York Heart Association (NYHA)
Functional Classification
Class % of Symptoms
patients
I 35% No symptoms or limitations in ordinary physical
activity
II 35% Mild symptoms and slight limitation during
ordinary activity
III 25% Marked limitation in activity even during minimal
activity. Comfortable only at rest
IV 5% Severe limitation. Experiences symptoms even at
rest
diagnose
 Diagnostic Investigations
 Blood tests - CBC, liver biochemistry, urea
and electrolytes, cardiac enzymes , BNP or N-
terminal portion of proBNF (NPproBNP),
thyroid function.
 Chest X-ray - cardiac size and evidence of
pulmonary congestion
 Electrocardiogram - evidence of ischaemia,
arrhythmia, RAH, LAH, RVH, LVH
 Echocardiography. To establish the
presence of systolic and/or diastolic
impairment of the left or right ventricle. They
may also reveal the aetiology
 Hypertrophy

 Right atrial enlargement (RAE/RAH)

 Left atrial enlargement (LAE/LAH)
 Right ventricular hypertrophy (RVH)
 Left ventricular hypertrophy (LVH)

For more presentations

www.medicalppt.blogspot.com
 RAH
Right atrial enlargement
 To diagnose RAE you can use the following criteria:
 II P > 2.5 mm, or
 V1 or V2 P > 1.5 mm > 1 ½ boxes (in height)

Remember 1 small
> 2 ½ boxes (in height)
box in height = 1 mm

A cause of RAE is RVH from pulmonary hypertension.

For more presentations
www.medicalppt.blogspot.com
 LAH

Left atrial enlargement

 To diagnose LAE you can use the following criteria:
 II > 0.04 s (1 box) between notched peaks, or
 V1 Neg. deflection > 1 box wide x 1 box deep

Normal LAE
A common cause of LAE is LVH from hypertension.
For more presentations
www.medicalppt.blogspot.com
 RVH

Right ventricular hypertrophy

 Compare the R waves in V1, V2 from a normal ECG and one from
a person with RVH.
 Notice the R wave is normally small in V1, V2 because the right
ventricle does not have a lot of muscle mass.
 But in the hypertrophied right ventricle the R wave is tall in V1,
V2.

Normal RVH
For more presentations
www.medicalppt.blogspot.com
 LVH
Left ventricular hypertrophy
 To diagnose LVH you can use the following criteria*:
 R in V5 (or V6) + S in V1 (or V2) > 35 mm, or
 avL R > 13 mm

S = 13 mm
* There are several
other criteria for the
diagnosis of LVH.

R = 25 mm
A common cause of LVH
is hypertension.

For more presentations

www.medicalppt.blogspot.com
Diagnosis of CHF (Framingham) requires the simultaneous
presence :
 at least 2 major criteria
1 major + 2 minor criteria.
Major criteria:
•Paroxysmal nocturnal dyspnea
•Neck vein distention
•Rales
•Radiographic cardiomegaly (increasing heart size on chest radiography)
•Acute pulmonary edema
•S3 gallop
•Increased central venous pressure (>16 cm H2O at right atrium)
•Hepatojugular reflux
•Weight loss >4.5 kg in 5 days in response to treatment
Minor criteria:
•Bilateral ankle edema
•Nocturnal cough
•Dyspnea on ordinary exertion
•Hepatomegaly
•Pleural effusion
•Decrease in vital capacity by one third from maximum recorded
•Tachycardia (heart rate>120 beats/min.)
pengelolaan
 Three Basic Treatment
Strategies
 Pharmacologic management

 Devices and surgical management

 Lifestyle management
 Pengelolaan gagal jantung
 Bed Rest (Acute Stage) ,Later On
Decreased Physical Activity
 Oxygen Therapy
 Low Salt Diet
 Diuretics
 ACE Inhibitors
 Beta blockers (Under Certain Conditions )
 Digitalis
 Anticoagulation
 Implantable ICD
 Cardiac Transplantation
 Sifat – sifat otot Jantung
1. Inherent rhythmycity ( chronotropic )
kesanggupan jantung dengan cara otomatis dan secara
periodik merangsang dirinya sendiri.

2. Conductivity ( dromotropic )
kesanggupan jantung untuk menghantar rangsang, baik dari
jaringan kusus penghantar rangsang maupun dari ototnya.

3. Exitability ( bathmotropic )
kemampuan jantung untuk dapat dirangsang.

4. Contractility ( inotropic )
kemampuan jantung untuk berkontraksi.
 Sifat obat jantung
Inotropik: Kronotropik:

(+) : Adrenergik (+) : Adrenergik

Digitalis
(-) : beta bloker (-) : Digitalis
Beta bloker
 Stage D
Patients with Refractory End-Stage HF
LVAD
The promise of stell cell research.