Hypertension

&
Congestif Heart Failure
 Hypertension
• Hypertension doubles the risk of
cardiovascular diseases, including coronary
heart disease (CHD), congestive heart failure
(CHF), ischemic and hemorrhagic stroke, renal
failure, and peripheral arterial disease.
RISK FACTORS
TARGET ORGAN DAMAGE
Patofsiologi
CLASSIFICATION OF BLOOD PRESSURE
ORAL ANTIHYPERTENSIVE DRUGS
 Goals of Therapy

• Since most persons with hypertension, especially those

50 with SBP and DBP to targets that are 140/90 mm Hg
is associated with a decrease in CVD complications.
• 87 In patients with hypertension and diabetes or
renaldisease, the BP goal is 130/80 mm Hg.
 CHF
 Keadaan patofisiologi dimana jantung tidak
mampu memenuhi kebutuhan jaringan dengan
kecepatan yang sesuai dengan kebutuhan
metabolisme jaringan atau hanya dapat dengan
meningkatkan tekanan pengisian(Braunwald)
 Sindroma klinik akibat gangguan struktur atau
fungsional jantung yang berakibat terganggunya
kemampuan ventrikel untuk mengisi dan
memompa darah(ACC/AHA)

 Braunwald E. Heart Failure.In:Braunwald E, Fauci AS, Kasper DL(editor),Harrison’s Principle of Internal Medicine.
15th edition. McGrawHill:NewYork
 ACC/AHA 2005 Guideline update for the diagnosis and management of chronic heart failure in the adult. Circulation
2005;112:1825-52
 THE FRAMINGHAM HEART
STUDY CRITERIA
Major criteria Minor criteria
1. Paroxysmal nocturnal dyspnea Ankle edema
2. Neck vein distention Night cough
3. Ralles Hepatomegaly
4. Cardiomegaly Pleural effusion
5. Acute pulmonary oedema Vital capacity reduced by one-third from predicted
6. S3 gallop Tachycardia(≥ 120)
7. Increased venous pressure(>16
cm)
8. Circulation time≥ 25 s
9. Hepatojugular reflux positive

Major or minor criteria

Weight loss of more than 4,5 kg over 5 days in response to treatment

Definite CHF
Two major criteria or one major criteria and two minor criteria
 Etiologi
• Abnormalitas miokard (infark miokard), kontraksi
yang tidak terkoordinasi (left bundle branch block),
berkurangnya kontraktilitas (kardiomiopati)
• Overload (hipertensi)
• Abnormalitas katup
• Abnormalitas ritme jantung (takikardi)
• Abnormalitas perikard atau efusi perikard
(tamponade)
• Kelainan kongenital jantung
 STAGING GAGAL JANTUNG
American College of Cardiology/American Heart Association

Stage A No structural heart disease and no symptoms but risk

factors:CAD, hypertension, diabetes, cardiotoxin, familial
cardiomiopathy

Stage B Abnormal LV systolic function, MI, valvular heart disease

but no HF symptoms

Stage C Structural heart disease and HF symptoms

Refractory HF symptoms to maximal medical

Stage D management
 KLASIFIKASI GAGAL JANTUNG
New York Heart Association

Class I No limitation:ordinary physical exercise does not cause

undue fatique, dyspnoe,or palpitation

Slight limitation of physical activity: comfortable at rest

Class II but ordinary activity results in fatique, palpitation, or dypne

Marked limitation of physical activity: comfortable at

Class III rest but less than ordinary activity results in symptom

Unable to carry out any physical activity without

Class IV discomfort: symptoms of heart failure are present even at rest
with increased discomfort with any physical activity
 PATOFISIOLOGI
• Gangguan kontraktilitas ventrikel kiri  mengganggu
pengosongan ventrikel  volume residu ventrikel
meningkat  EDV (End Diastolic Volume)meningkat,
 peningkatan LVEDP (Left Ventricle End Diastolic
Pressure)  meningkatkan LAP( Left Atrium Pressure ),
sehingga  tekanan   kapiler  dan   vena  paru-paru  juga
  akan meningkat
• Jika tekanan hidrostatik di kapiler paru-paru > tekanan
onkotik vaskular transudasi cairan ke interstitial dan
bila cairan tersebut merembes ke dalam alveoli 
edema paru-paru
 DIAGNOSIS GAGAL JANTUNG
 Identifikasi pasien gagal jantungtanda dan gejala
klinis
 Tentukan kapasitas fungsionalklasifikasi NYHA
 EKG
 Tentukan kelainan struktural dan fungsional
ekokardiografi
 Identifikasi kausa dan faktor pencetus
- iskemia miokard
- HHD
- Kelainan katup jantung
 Pengobatan
• Tujuan :
• 1. Pencegahan:
• - mencegah disfungsi ventrikel & gagal jantung
• - mencegah progresivitas disfungsi venrikel
• menjadi gagal jantung
• 2. Morbiditas: mempertahankan / memperbaiki
• kualitas hidup
• 3. Mortalitas: memperpanjang usia harapan hidup
•
Terima kasih