Professional Documents
Culture Documents
CARDIOVASCULAR
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-DISTRIBUTION :
OKSIGEN, NUTRIEN,
WATER, ELEKTROLIT, HEART PUMPING : OXYGEN and
NUTRIEN to whole organ
VITAMIN, HORMON,
and tissues
MEDICINES etc,etc.
to our organ and tssues.
CARDIOVASCULAR VESSELS
‘ROAD’ / pipe for distribution
-CARRYING and
Oxygen and Nutrient
-TRANSPORTING : Carbon
dioxyde; metabolism
production, metabolism
residual BLOOD CARRYING MATERIAL &
- CONTRIBUTOR : immune sys “GARBAGES” from
- TERMOREGULATION the body to out side .
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As a PUMP: pumping the blood
HEART to whole body
Blood vessels : limited capacity
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SEORANG ANAK PEREMPUAN 7 TAHUN,DIBAWA ORANG TUANYA
UNTUK PERIKSA PADA SAUDARA KARENA ANAKNYA MENDERITA
DEMAM KURANG LEBIH SEMINGGU; MENGELUH SENDI-2 NYA
NYERI/SAKIT; KEJADIAN INI PERNAH DIALAMI BEBERAPA
WAKTU YANG LALU; KADANG-KADANG BICARA TAK JELAS;
TAK BISA BERGERAK/LEMAH
PADA PEMERIKSAAN SUHU 39°C; CHOREA, ERITEMA, ARTHRITIS.
1. PROBLEM ?
2. OBJEKTIF ?
3. PEMILIHAN TERAPI NON FARMAKOLOGIK
FARMAKOLOGIK
4. PERESEPAN ?
5. INFORMASI, INSTRUKSI dan PERINGATAN-2 ?
6. MONITORING – EVALUASI INTERVENSI ?
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HEART DISEASES
HYPERTENSION;
ANGINA PECTORIS
( CHEST-PAIN
ACUTE MYOCARDIAC INFARCTION);
CARDIAC ARRHYTMIAS.
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KELAINAN/PENYAKIT CARDIOVASCULAR
PADA :
NEONATUS ?
INFANTS ?
CHILDREN ?
ADOLESCENS ?
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HYPERTENSION
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Hypertension
SBP > 140 mmHg
DBP> 85 mmHg
Vital organs
Heart risk
Arrhythmia
cordis Sudden death Disability
Target:
BP: SBP < 130 – 140 mm Hg
DBP < 90 mm Hg
II. 1-2 Risk Factors MED RISK MED RISK V. HIGH RISK
III. 1-2 Risk Factors or TOD HIGH RISK HIGH V. HIGH RISK
or Diabetes
IV. Associated Clinical V. HIGH RISK V. HIGH V. HIGH RISK
Condition RISK
WHO – ISH, 1999 10
CARDIOVASCULAR RISK FACTORS;
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Complications of hypertension
Brain Strokes
TIA (transient ischemic attack)
Retinopathy
DIURETICS
β- BLOCKERS INITIAL
ACE-inhibitors PHARMACOTHERAPY
CALCIUM CHANNEL BLOCKERS
ARBs (angiotensine receptor blockers)
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Pharmacotherapy based on : Efficacy, Safety, + Costly (WHO-ISH, 1999)
Class of drug Compelling indication Possible Compelling C.I Possible C.I
indications
Diuretics •Heart Failure Diabetes Out
•ELDERLY
•Systalic hypertension
ß-Blockers • Angina Heart Failure •Asthma & CoPD •Phslipidemia
• After M.I Pregnancy •Heart Block •Athletes, physically active
• Tachyarrhythmia Diabetes (gr 2/3 AV) patients
•Peripheral vascular disease
Calcium •Angina Peripheral Heart block Congestive heart failure
antagonists •ELDERLY vascular disease
•Systolic hypertension
ACE inhibitors •Heart Failure •Pregnancy
•LU Dysfunction •Hyperkalaemia
•After myocardial infarct •Renalartery stenosis
(bilateral)
- Blocker Prostatic hypertrophy •Glucose Orthostatic hypotension
intolerance
•dyslipidemia
Angiotensin II Ace – inhibitor cough Heart failure •Pregnancy
Receptor •Hyperkalaemia
antagonist •Renalartery stenosis 16
(bilateral)
Choice of initial drugs
Diuretics
β - blockers
Calcium channel blocker
ACE inhibitor
AIIRA / ARB
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Pharmacotherapy hypertension ( in
Elderly ) Diuretic
Amlodipine 2,5- 10 mg
Dihydropyridines Felodipine 2,5- 20 mg
Isradipine 5 - 20 mg
Nicardipine 60 - 40 mg
Nifedipine 30 –120 mg
Nisaldipine 20 – 60 mg
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STEP CARE: RIGID VS LIBERAL
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Choice of the initial drugs
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LIFE STYLE MODIFICATION FOR HYPERTENSION PREVENTION and
MANAGEMENT
Limit alcohol intake to no more than 1 oz (30 mL) ethanol {e.g., 24 oz (720
mL) beer, 10 oz (300 mL) wine, or 2 oz (60 mL) 100-proof whiskey} per day
or 0.5 oz (15 mL) ethanol per day for women and lighter weight people.
Increase aerobic physical activity (30 to 45 minutes most days of the week).
Reduce sodium intake to no more than 100 mmol per day (2.4 g sodium or 6
g sodium chloride).
DECOMPENSATIO CORDIS
GAGAL JANTUNG
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CONGESTIVE HEART FAILURE
DECOMPENSATIO CORDIS
GAGAL JANTUNG
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CONGESTIVE HEART FAILURE
(CHF)
DECOMPENSATIO CORDIS
GAGAL JANTUNG
CONGESTIVE / CHRONIC
Increased exertion
Emotion
Salt in diet
Noncompliance
etc.
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STRATEGY CHF
NON-PHARMACOTHERAPY
PHARMACOTHERAPY
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TREATMENT OF CHRONIC H F :
4. Give diuretic
5. Give ACE inhibitor or ARB
6. Give digitalis
(if systolic dysfunction with 3rd heart sound or atrial fibrillation present)
7. Give β-blocker
(to patients with stable class II-IV HF)
8. Give vasodilators
9. Cardiac resynchronization if wide QRS interval is present in normal sinus
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rhythm.
PHARMACOTHERAPY
DIURETICS
ALDOSTERONE RECEPTOR ANTAGONIST
ACE – inhibitors
ANGIOTENSIN RECEPTOR BLOCKERS
BETA – blockers
CARDIAC GLYCOSIDES / CARDIOTONIC
VASODILATORS
BETA AGONISTS, dopamine
BIPYRIDINES
NATRIURETIC PEPTIDE
(Katzung,BG et al., 2007)
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MECHANISM and SITE OF ACTION
DRUGS USE IN CONGESTIVE HEART FAILURE
2. DIURETICs Group;
reducing afterload by reducing blood volume ( increase of urine excretion )
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HAL-HAL YANG PERLU DIPERHATIKAN PADA
PENDERITA GAGAL JANTUNG:
3. Untuk DIGOKSIN, salah satu sifat obat ini di akumulasi ditubuh, cara
pemakaian harus memperhatikan besar obat yang diekresikan dalam
24 jam. Waktu paruh panjang ( 40 - >160 jam ).
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ANGINA PECTORIS
CHEST PAIN
NYERI DADA
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DRUGS USED IN THE TREATMENT
OF ANGINA PECTORIS.
ATHEROSCLEROTIC ANGINA
Type of ANGINA = CLASSIC ANGINA
= ANGINA OF EFFORT
VASOSPASTIC ANGINA
= REST ANGINA
= VARIANT ANGINA
UNSTABLE ANGINA = PRINZMETAL’S ANGINA
= CRESCENDO ANGINA
= ACUTE CORONARY SYNDROME
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ANGINA PECTORIS
impairment oxygenation of the heart muscle
+
EJECTION
TIME
+ + + + +
HEART
PERIPHERAL HEART FORCE
BLOOD VOLUME VENOUS TONE
RESISTANCE RATE
Vasospasm may
reduce supply
rev ents
o sis p pply Effort
Sten ased su increases
e
in c r demand
Symptoms: Diagnosis
Crushing sensation Possible resting ECG changes
in chest or neighbouring areas during exercise stress test :
Associated with effort - ST segment elevated or depressed
- arrhythmias
Relieved by rest or - decreased BP
nitroglycerin - ischaemic myocardium revealed by
thallium-201 or MIBI imaging
Angiography shows
coronary artery disease 34
VARIANT ANGINA = vasospastic angina = Prinzmetal’s angina
sm r e duces
Vasospa ply
sup
Symptoms Diagnosis
-- angina pain at rest -- ST segment elevation during
-- angina not effort-related pain
-- often occurs on early morning -- angina induced by ergonovine
-- exacerbated by smoking -- angoigraphy may not reveal
coronary artery diseases
-- exercise stress test of little value
Long duration
Intermediate
Short duration
(Trevor,AJ; Katzung,BG; Masters,SB; 2005)
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OBAT-OBAT YANG DIGUNAKAN
PADA SERANGAN ANGINA (ANGINA PECTORIS)
SERANGAN AKUT :
NON-FARMAKOTERAPI : segera diistirahatkan begitu serangan
nyeri muncul, baringkan pada tempat yang aliran udara baik.
FARMAKOTERAPI :
- GLYSERIL TRINITRAT spray 400 mcg/metered dose, sublingual,
diulang tiap 5 menit sampai nyeri hilang/berkurang atau
- GLYSERIL TRINITRATE tablet 300 – 600 mcg s.l. diulang tiap
3-5 menit sampai mencapai dosis max 1.800 mcg atau
- ISOSORBIDE DINITRATE tablet 5 mg, diberikan s.l.. Diulang
tiap 5 menit. Maksimum 3 tablet.
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CALCIUM CHANNEL-BLOCKING MEDICINES
DIHYDROPYRIDINE : NON-DIHYDROPYRIDINE :
amlodipine bepridil
felodipine diltiazem
nicardipine verapamil
nifedipine
nimodipine
nisoldipine, etc.
VASODILATATION
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β-ADRENOCEPTOR-BLOCKING AGENTS
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β – BLOKER AGENTS :
- Atenolol
- Carvedilol
- Labetalol
- Metopolol
- Nadolol
- Pindolol
- Propranolol
- Timolol, etc.
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Adverse Drug Reaction
Impaired/
failure organ Multiple polypharmacy compliance
disease state
Altered organ
response
Adverse Drug
Altered drug
concentration Reactions
Homeostatic
regulation
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OXYGEN CONSUMPTION
ANGINA ATTACK
LONGTERM / UNCONTROLED
MYOCARD INFARCTION
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CARDIAC ARRHYTHMIAS
ARITMIA CORDIS
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ARITMIA CORDIS : malfunction of the electrical impuls
conduction in the heart.
ARITMIA CORDIS :
1. DECREASING THE HEART RATE SINUS BRADYCARDIA
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ARITMIA CORDIS CLASSIFICATION
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PHARMACOTHERAPY ARITMIA CORDIS
Ia : action prolong the action potential duration (APD) and dissociate from
the channel with intermediate kinetics;
Ib : action shorten the APD in some tissue of the heart and dissociate from
the channel with rapid kinetics;
Ic : action have minimal effect on the APD and dissociate from the channel
with slow kinetics;
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