Portofolio Aldi Chf

8/19/2019 Portofolio Aldi Chf

1/11

PORTOFOLIO

Kasus I

Topik : CHF

Tanggal (kasus) : 27 Nov 2015 Presenter : dr. Rinaldi Aditya Asrizal

Tanggal presentasi : - Pendamping : dr. Ratu Fajaria

Tempat presentasi : RSUD Dadi Tjorodi!o

Obyektif presentasi :

Keilmuan Keterampilan Penyegaran Tinauan Pustaka

!iagnostik "anaemen "asala# Istime$a

%eonatus &ay

i

'nak Remaa !e$asa Lansia &umil

!eskripsi :

Tuuan :&a#an ba#asan :

Tinauan

Pusaka

Riset Kasus 'udit

ara memba#as : !iskusi Presentasi

dan diskusi

mail Pos

!ata pasien : %ama : Tn. " # $$ t%n %o* registrasi :

%ama klinik : Telp : - Terdaftar seak : -

!ata utama untuk ba#an diskusi :

+* !iagnosis,ambaran Klinis : CHF N&HA ''

# S(sa na)as

.* Ri$ayat Pengobatan : Rutin *(ro*at di !oli jantun+ RSUD A*dul ,o(l(

/* Ri$ayat Kese#atan, Penyakit : S(sa na)as dan R# HT t(rontrol

0* Ri$ayat Keluarga, "asyarakat : -ran+ tua !asi(n ju+a ,(nd(rita %i!(rt(nsi

1* Ri$ayat Pekeraan :

2* Lain-lain :

!aftar Pustaka :

1. /ansjo(r A. d. a!ita S(l(ta (dot(ran aarta3 4(n(r*it /(dia Ausula!ius

FU' 2001.

2.Santoso A 6rinanto /unaar / Suryaan R Ri)8i S So(rianata S. Dia+nosis dan

tatalasana !ratis +a+al jantun+ aut. 2007

9.as!(r :raunald Faui Haus(r ;on+o a,(son. Harrisona+al antun+.F Unud#RSU4 San+la% D(n!asar

1* :raunald 6. H(art Failur( and Cor 4ul,onal. 'n3 as!(r D; :raunald 6 Fau%i AS (t.al

(ds. Harrison?s !rini!l(s o) int(rnal ,(diin( 1$ (d. 20093 19$777.

$. /ais(l Alan :ty!( natriur(ti !(!tid(3a ,ar(r it% to linial a!!liations ardia )ailur(

dia+nosis and !ro+nosis. T%( 97t% Annual N( &or Cardiovasular Sy,!osiu,3 /ajor To!is in

Cardiolo+yToday N( &or Hilton and To(rs N( &or D((,*(r 1012200=3 1@@201.

Cl(land > S(d*(r+ Follat% F (t al. T%( 6uro%(art )ailur( surv(y !ro+ra,,( a surv(y on t%(


2/11

8uality o) ar( a,on+ !ati(nts it% %(art )ailur( in 6uro!( 4art '3 !ati(nt %arat(ristis and

dia+nosis.6urH(art200932=322=$9.

7. Fonaro >C St(v(nson ;B Bald(n A (t al. ',!at o) a o,!r(%(nsiv( %(art )ailur(

,ana+(,(nt !ro+ra, on %os!ital r(ad,ission and )untional status o) !ati(nts it% advan(d %(art

)ailur(. A, oll Cardiol 17390372592.

@. C%odilaati R. +%ani( A. 4ola (tiolo+i +a+al jantun+ di RS/H 4al(,*an+. o!a!di /(nado

2009.

. Franis >S >assl(r 4 Sonn(n*li 6H 4at%o!%ysiolo+y and dia+nosis o) %(art )ailur(. 'n

T%( H(art Fust(r E Al(and(r RB. -?Rou( AR. 10t% (dition. Eolu,( 1. / >ra Hill. !.$55.

.R(,,( B.. B(d*(r+ . >uid(lin(s )or t%( dia+nosis and tr(at,(nt o) %roni %(art )ailur(3

Tas )or( )or t%( dia+nosis and tr(at,(nt o) %roni %(art )ailur(. 6uro!(an H(art ournal.

2001.Eolu,(22.nu,*(r17!.152755. S(d*(r+. . C%air!(rson. >uid(lin(s )or t%( dia+nosis and

tr(at,(nt o) %roni %(art )ailur(3 )ull

t(t Gu!dat( 2005. T%( 6uro!(an soi(ty o) ardiolo+y 2005.

3asil Pembelaaran :

+* Dia+nosis >a+al antun+ roni

.* 4ato+(n(sis +a+al antun+ roni

/* 4(natalasanaan >a+al antun+ roni

0* 6duasi t(ntan+ !(ny(*a* )ator r(sio dan !(natalasanaan yan+ t(!at

4ubyektif

4asi(n dala, !(n+o*atan %ari ( 9 datan+ d(n+an (lu%an uta,a s(sa na)as s(ja

uran+ l(*i% 1 ,in++u S/RS s(sa ti,*ul saat !asi(n *(rati)itas rin+an Gsaat itu

!asi(n s(dan+ *(rsi% *(rsi% ru,a% dan ,(,*ai (tia !asi(n dudu istira%at.

!asi(n ,(,ilii riayat %i!(rt(nsi dan rutin onsu,si o*at %i!(rt(nsi.

!asi(n rutin *(ro*at ( !oli jantun+ RSUD A*dul /ulu.

!asi(n ,(n+au jia t(anan dara% nor,al nya *(risar 190#@0 s#d 1@0#100.

!asi(n ,(n+(lu% ai nya ju+a !(rna% *(n+a dan *(ruran+ jia ,inu, o*at dari

dot(r.

R# Dis!no( D())ort GI -t%o!tno( G 4aroy,al noturnal dis!no( G

R# Roo GI saat ,uda s(aran+ suda% *(r%(nti :atu G

R4D3 Hi!(rt(nsi GI 4(nyait 4aru G D/ G

Obyektif

4ada !(,(risaan )isi dida!at


3/11

Pemeriksaan Fisik

• (adaan u,u, 3 ta,!a sait rin+an

• (sadaran 3 C/

• T(anan Dara% 3 190#@0 ,,H+

• Nadi 3 7$#,(nit r(+ul(r

• Fr(u(nsi Na)as 3 22 # ,(nit

• Su%u 3 9$70 C

4tatus eneralis

(!ala 3 Nor,o%(!al E4 tida ,(nin+at

/ata 3 onjun+tiva tida an(,is sl(ra tida it(ri

ulit 3 Tur+or ulit *ai

T%oras

o 4aru

'ns!(si 3 >(raan na)as si,(tris iri dan anan

4al!asi 3 Fr(,itus iri sa,a d(n+an anan

4(rusi 3 Sonor di (dua la!an+an !aru

Ausultasi 3 E(siul(r r%oni # %((zin+ #

o antun+

'ns!(si 3 'tus jantun+ tida t(rli%at

4al!asi 3 'tus jantun+ tida t(ra*a

4(rusi 3 :atas jantun+ anan lin(a !arast(rnal d( 'CS 5

&atas antung kiri linea mid 5la6i5ula sinistra I4 1 bergeser

ke a7ila + 5m

Kesan: Kardiomegali

Ausultasi 3 /ur,ur G >allo! G

A*do,(n

'ns!(si 3 datar


4/11

4al!asi 3 Datar H(!ar dan li(n tida t(ra*a Ny(ri t(an di titi

/:urn(y dan (!i+astriu, G d()ans ,usul(r G

Tida t(ra*a ,assa

4(rusi 3 Ti,!ani

Ausultasi 3 :isin+ usus GI nor,al

6str(,itas 3 CRT nor,al. -(d(, (tr(,itas su!(rior #

-(d(, (tr(,itas in)(rior #

Pemeriksaan Penunang:

H* 3 1= +r#dl

;(uosit 3 +8*919,mm/

Tro,*osit 3 1$7.000#,,9

H(,atorit 3 =1J

>DS 3 190 ,+#dl

Ur(u, 3 97 ,+#dl

Cr(atinin 3 0 ,+#dl

6> : Tampak T In6erted pada Lead . s,d 2

Kesan: 3ipertrofi 6entrikel; dd iskemia miokardium

Ro T%ora 3 Kardiomegali

>a,*aran :ronitis

'ssessment (Penalaran klinis)

4asi(n $$ ta%un datan+ d(n+an (lu%an sesak nafas saat beraktifitas ,(,*ai jia

istira%at !asi(n ,(n+(lu% kaki nya uga perna# bengkak dan *(ruran+ jia ,inu,

o*at dari dot(r. !asi(n ,(,ilii ri$ayat #ipertensi dan rutin onsu,si o*at

%i!(rt(nsi. Pasien rutin berobat ke poli antung R4


5/11

6+ 3T in6erted pada lead . s,d 2

!efinisi

>a+al jantun+ ronis adala% sindro, linis yan+ o,!l(s ai*at (lainan )un+si atau

strutural jantun+ yan+ ,(n++an++u (,a,!uan jantun+ untu *(r)un+si s(*a+ai !o,!a

Patogenesis

4o,!a yan+ tida ad(uat dari jantun+ ,(ru!aan dasar t(rjadinya +a+al jantun+. S(*a+ai

r(asi dari %al t(rs(*ut aalnya dindin+ jantun+ ,(r(ntan+ untu ,(na%an l(*i% *anya

dara% ar(na %al ini ,aa otot jantun+ ,(n(*al untu ,(,o,!a l(*i% uat. S(,(ntara itu

+injal ,(ny(*a*an tu*u% ,(na%an airan dan sodiu,. 'ni ,(na,*a% ju,la% dara% yan+

*(r(dar ,(lalui jantun+ dan !(,*ulu% dara%. Hal ini ,(ny(*a*an (naian yan+ !ro+r(si)

!ada t(anan !(n+isian sist(,i ratarata di,ana t(anan atriu, anan ,(nin+at sa,!ai

a%irnya jantun+ ,(n+ala,i !(r(+an+an yan+ *(rl(*i%an atau ,(njadi san+at (d(,as(%in++a tida ,a,!u ,(,o,!a dara% yan+ s(dan+ s(ali!un.

Tu*u% (,udian ,(no*a untu *(ro,!(nsasi d(n+an ,(l(!asan %or,on yan+ ,(,*uat

jantun+ *((rja l(*i% (ras. D(n+an *(rlalunya atu ,(anis,( !(n++anti ini +a+al dan

+(jala+(jala +a+al jantun+ ,ulai ti,*ul.

S(!(rti +(lan+ ar(t yan+ dir(ntan+ *(rl(*i%an ,aa (,a,!uan jantun+ untu ,(r(ntan+

dan ,(n+(rut (,*ali aan *(ruran+. -tot jantun+ ,(njadi t(r(ntan+ s(ara *(rl(*i%an dan

tida da!at ,(,o,!a dara% s(ara ()isi(n.

9 ,(anis,( o,!(nsasi N(uroHor,onal yaitu3

1. /(nin+atnya ativitas adr(n(r+i si,!atis

2. /(nin+atnya *(*an aal ai*at ativasi sist(, r(ninan+iot(nsinaldost(ron

9. Hi!(rtro)i v(ntri(l.

"anifestasi Klinis

>a,*aran linis +a+al jantun+ s(ara u,u, 3

L Dis!n(a atau !(rasaan sulit *(rna)as adala% ,ani)(stasi yan+ !alin+ u,u, dari +a+al

jantun+. Dis!n(a dis(*a*an ol(% !(nin+atan (rja !(rna)asan ai*at on+(sti vasular

!aru!aru yan+ ,(n+uran+i (l(nturan !aru!aru. /(nin+atnya ta%anan aliran udara ju+a

,(ni,*ulan dis!n(a. Dis!n(a saat *(rativitas ,(nunjuan +(jala aal dari +a+al jantun+

iri.


6/11

L -rto!n(a atau s(sa !osisi *(r*arin+ t(ruta,a dis(*a*an ol(% r(distri*usi aliran dara%

dari *a+ian*a+ian tu*u% yan+ di *aa% ( ara% sirulasi s(ntral. R(a*sor!si dari airan

int(rstitial dari (str(,itas *aa% ju+a aan ,(ny(*a*an on+(sti vasular !aru!aru l(*i%

lanjut.

L 4arosis,al Noturnal Dis!n(u G4ND atau ,(ndada t(r*an+un ar(na dis!n(a di!iu

ol(% !(r(,*an+an (d(,a !aru!aru int(rstitial. 4ND ,(ru!aan ,ani)(stasi yan+ l(*i%

s!(si)i dari +a+al jantun+ iri dari!ada dis!n(a atau orto!n(a.

L As,a ardial adala% ,(n+i ai*at *ronos!as,( dan t(rjadi !ada atu ,ala, atau ar(na

ativitas )isi.

L :atu non !roduti) ju+a da!at t(rjadi s(und(r dari on+(sti !aru!aru t(ruta,a !ada

!osisi *(r*arin+. T(rjadinya roni ai*at transudasi airan !aru!aru adala% iri %as dari

+a+al jantun+ roni !ada aalnya t(rd(n+ar di *a+ian *aa% !aru!aru s(suai !(n+aru%

+aya +ravitasi.

!iagnosis

rit(ria dia+nosis +a+al jantun+ ,(nurut Fra,in+%a, H(art Study 3

Kriteria mayor 3

a. 4arosis,al noturnal dis!n(u

*. Roni !aru di *asal

. 6d(,a aut !aru # G/(ny(*a*an orto!no(

d. ardio,(+ali

(. >allo! S9

+. R()lus %(!ato ju+ular

%. 4(nin+atan t(anan v(na ju+ularis

Kriteria minor 3

a. 6d(,a (str(,itas

*. :atu ,ala, %ari

. H(!ato,(+ali

d. Dis!n(ad?())ort


7/11

(. 6)usi !l(ura

). Taiardi G120#,(nit

+. a!asitas vital *(ruran+ 1#9 dari nor,al

Dia+nosis +a+al jantun+ dit(+aan d(n+an3 2 /ayor

1 /ayor dan 2 /inor

!eraat gagal antung berdasarkan %?3':

N&HA ' 3 4(nyait jantun+ na,un tida ada +(jala atau (t(r*atasan ati)itas s(%ari %ari

N&HA '' 3 4(nyait jantun+ dan ada (t(r*atasan ati)itas rin+an s(%ari %ari *iasa

G*(rjalan nai tan++a N&HA ''' 3 4(nyait jantun+ dan ada (t(r*atasaan ati)itas yan+ san+at rin+an ,isal

G*(rjalan 1020/

N&HA 'E 3 4(nyait jantun+ dan (t(r*atasan yan+ san+at *(rat saat ondisi istira%at

PemeriksaanPenunang

Dala, ,(,*antu !(n(+aan dia+nosis +a+al jantun+ da!at dilauan !(,(risaan *(riut

ini3

1. 6>

6> %anya ,(r()l(sian !(ru*a%an (l(tri Gatrial dan v(ntriular arit,ia s(*a+ai

)ator s(und(r dala, ,(n+a,ati !(ru*a%an anato,i. Hasil !(,(risaan 6> tida

s!(si)i ,(nunjuan adanya +a+al jantun+. 6> *(rsi)at ,(,*antu ,(nunjuan


8/11

in)ar is(,i %i!(rtro)i dll da!at dit(,uan lo volta+( T inv(rsi MS d(!r(si ST

dan lain

T inv(rt(d atau +(lo,*an+ T t(r*ali ,(n++a,*aran r(!olarisasi v(ntri(l.

>(lo,*an+ T san+at r(ntan t(r%ada! *(r*a+ai ,aa, !(n+aru% *ai yan+ *(rasal dari

jantun+ ,au!un luar jantun+ s(%in++a ,(,!unyai +a,*aran yan+ *(rvariasi.

'nv(rsi +(lo,*an+ T ,(ru!aan t(,uan yan+ tida s!(si)i. :anya %al yan+ da!at

,(ny(*a*an +(lo,*an+ T t(r*ali s(!(rti blokade 5abang berkas ,au!un

#ipertrofi 6entrikel yang disertai kelainan repolarisasi. In6ersi gelombang T

dengan sendirinya #anya merupakan petunuk tentang iskemia dan tida

diasno+ti untu in)ar ,ioardiu,. Na,un sala% satu iri dia+nosti !ada inv(rsi

+(lo,*an+ T adala% (si,(trisannya. 4ada is(,ia ,ioardiu, inv(rsi +(lo,*an+ T

aan *(rsi)at si,(tris s(dan+an !ada s(*a+ian *(sar (adaan lain *(rsi)at asi,(tris.

2. Foto t%ora

Foto t%ora da!at ,(,*antu dala, ,(ndia+nosis +a+al jantun+. ardio,(+ali

*iasanya ditunjuan d(n+an adanya !(nin+atan ardiot%orai ratio # CTR Gl(*i%

*(sar dari 05 !ada ta,!ilan !ost(rior ant(rior.

9. 4(,(risaan la*oratoriu,

4ada !(,(risaan la*oratoriu, dida!atan adar aliu, da!at nor,al atau ,(nurun

s(und(r t(r%ada! t(ra!i diur(ti. Hi!(ral(,ia da!at t(rjadi !ada ta%a! lanjut dari

+a+al jantun+ ar(na +an++uan +injal

adar aliu, dan natriu, ,(ru!aan !r(ditor ,ortalitas.

Penatalaksanaan

• Non )ar,aolo+i 3

a Anjuran U,u,

6duasi 3 T(ran+an %u*un+an antara )ator r(sio (lu%an +(jala dan

!(n+o*atan.

S(suaian (,a,!uan )isi d(n+an (+iatan s(%ari%ari.

* Tindaan U,u,


9/11

Di(t G%indaran o*(sitas r(nda% +ara, 2 + !ada +a+al jantun+ rin+an dan 1 +

!ada +a+al jantun+ *(rat ju,la% airan 1 lit(r !ada +a+al jantun+ *(rat dan

15 lit(r !ada +a+al jantun+ rin+an.

H(ntian roo tira% *arin+ !ada +a+al jantun+ aut *(rat dan (sas(r*asi

aut.

• Far,aolo+i

Diur(ti 3 untu ,(na!ai t(anan v(na ju+ularis nor,al dan ,(n+%ilan+an (d(,a

!(r,ulaan da!at di+unaan loo! diur(ti G)uros(,id atau tiazid. :ila r(s!on tida

uu! *ai dosis da!at dinaian *(rian diur(ti intrav(na atau o,*inasi loo!

diur(ti d(n+an tiazid. Diur(ti %(,at aliu, s!ironolaton d(n+an dosis 2550

,+#%ari da!at ,(n+uran+i ,ortalitas !ada !asi(n d(n+an +a+al jantun+ s(dan+ sa,!ai

*(rat Glas )un+sional 'E yan+ dis(*a*an +a+al jantun+ sistoli.

4(n+%a,*at AC6 *(r,an)aat untu ,(n(an ativasi n(uro%or,onal dan !ada +a+al

jantun+ yan+ dis(*a*an dis)un+si sistoli v(ntri(l iri. 4(,*(rian di,ulai d(n+an

dosis r(nda% dititrasi s(la,a *(*(ra!a ,in++u sa,!ai dosis yan+ ()(ti).

4(ny(at *(ta *(r,an)aat sa,a s(!(rti !(n+%a,*at AC6. 4(,*(rian ,ulai d(n+andosis (il (,udian dititrasi s(la,a *(*(ra!a ,in++u d(n+an ontrol (tat sindro,

+a+al jantun+. :iasanya di*(rian *ila (adaan suda% sta*il. 4ada +a+al jantun+ las

)un+sional '' dan '''. 4(ny(at *(ta yan+ di+unaan arv(dilol *iso!rolol atau

,(to!rolol. :iasa di+unaan *(rsa,asa,a d(n+an !(n+%a,*at AC6 dan diur(ti.

An+iot(nsin '' anta+onis r(s(!tor da!at di+unaan *ila ada ontraindiasi !(n++unaan

!(n+%a,*at AC6.

o,*inasi %idralazin d(n+an 'SDN ,(,*(ri %asil yan+ *ai !ada !asi(n yan+

intol(ran d(n+an !(n+%a,*at AC6 da!at di!(rti,*an+an.

Di+osin di*(rian untu !asi(n si,!to,ati d(n+an +a+al jantun+ dis)un+si sistoli

v(ntri(l iri dan t(ruta,a yan+ d(n+an fibrilasi atrial di+unaan *(rsa,asa,a

diur(ti !(n+%a,*at AC6 !(ny(at *(ta.

Antioa+ulan dan anti!lat(l(t. 'spirin diindikasikan untuk pen5ega#an emboli

serebral !ada !(nd(rita d(n+an )i*rilasi atrial d(n+an )un+si v(ntri(l yan+ *uru.


10/11

Antioa+ulan !(rlu di*(rian !ada )i*rilasi atrial ronis ,au!un d(n+an riayat

(,*oli t%ro,*osis dan transi(nt is%(,is atta t%ro,*us intraardia dan

an(uris,a v(ntri(l.

Antiarit,ia tida dir(o,(ndasian untu !asi(n yan+ asi,!to,ati atau arit,ia

v(ntri(l yan+ tida ,(n(ta!.

Anta+onis alsiu, di%indari. an+an ,(n++unaan alsiu, anta+onis untu

,(n+o*ati an+ina atau %i!(rt(nsi !ada +a+al jantun+.

Prognosis

• Batu ti,*ulnya +a+al jantun+

• Ti,*ul s(ran+an aut atau ,(na%un

• D(rajat *(ratnya +a+al jantun+

• 4(ny(*a* !ri,(r

•

(lainan atau *(sarnya jantun+ yan+ ,(n(ta!

• (adaan !aru

• C(!atnya !(rtolon+an !(rta,a

• R(s!ons dan la,anya !(,*(rian di+italisasi

•

S(rin+nya +a+al jantun+ a,*u%

Plan

!iagnosis :

CHF ( HHD Fun+sional lass ''


11/11

;(uositosis

Pengobatan :

'EFD R; 10 t!, G,iro G!(,*atasan !(,*(rian airan !ada !asi(n jantun+ san+at dianjuran a+ar

,(n(+a% ,(,*(rat nya r(t(nsi airan

'nj. C()triaon( # 12 ja, Gs(*a+ai anti*iotia ad(uat l(uositosis

'nj. Ranitidin# 12 ja, ,(n+uran+i +(jala y+ *(r%u*un+an d(n+an (l(*i%an asa, la,*un+

'nj. Furos(,id # 100 Gdiur(ti indiasi o(d(, !ada +a+al jantun+ anti%i(rt(nsi

Ca!to!ril 25 ,+ # 2 1 Ganti %i!(rt(nsi

As!il(t @0 ,+# 1 1 G!(n(+a%an (,*oli s(r(*ral#stro(

'SDN S; # ia s(sa Gjia linis !asi(n ,(,*(rat (ara% is(,i jantun+

Di(t3 R(nda% +ara,

:atasi airan dan ati)itas Gs(suaian (,a,!uan )isi d(n+an (+iatan s(%ari%ari

Pendidikan :

6duasi !asi(n t(ntan+ !(ntin+ nya !atu% o*at %i!(rt(nsi ,odi)iasi li)(styl( s(rta di(t. %indaran

o*(sitas sto! roo lati%an jas,ani 95 # ,in++u s(la,a 2090 ,(nit atau s(!(da statis

5 ali # ,in++u s(la,a 20 ,nt d(n+an *(*an 70J@0J d(nyut jantun+ ,asi,al !ada +a+al jantun+

rin+an dan s(dan+ istira%at *arin+ dan *atasi airan !ada +a+al jantun+ aut *(rat dan (sas(r*asi

aut.

Konsultasi : Dij(lasan s(ara rasional t(ntan+ tatalasana yan+ di*(rian dan !antan+an

Ruukan : Rujuan (!ada dot(r s!(sialis jantun+ dan !(nyait dala,

Kontrol : ontrol ulan+ s(tia! *ulan *ila o*at %a*is.

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Portofolio Aldi Chf