Академический Документы
Профессиональный Документы
Культура Документы
Kardiomiopati
• Terapi simtomatik
– Diuretik
– ACE inhibitor
– Beta bloker
Kardiomiopati Hipertrofi
• Definisi
– Kelainan jantung yang ditandai oleh hipertrofi
miokardial tanpa diketahui etiologinya.
– Hipertrofi dengan atau tanpa obstruksi.
• Beberapa terminologi :
– Hypertrophic Obstructive Cardiomyopathy (HOCM)
– Hypertrophic Cardiomyopathy (HCM)
– Idiopatic Hypertrophic Subaortic Stenosis
– Asymmetrical Septal Hypertrophy
Kardiomiopati Dilatasi
• Asimtomatik
• Paling sering : sesak , sakit dada, pingsan
• Aritmia
• Sudden death
• Varian : hipertrofi apikal
Pendekatan diagnostik
• Anamnesis
• Pemeriksaan fisik
– Murmur sistolik ejeksi di area LSB
– Murmur sistolik di area mitral
• Radiologi
– Tidak ada tanda khas
• EKG
– Abnormalitas segmen ST dan gelombang T
– LVH
• Ekokardiografi
– LVH
– Disfungsi diastolik tapi fungsi sistolik normal
Penatalaksanaan dan terapi
• Medikal
– Menangani gejala obat inotropik negatif, obat pilihan : beta
bloker
– Hindari keadaan hipovolemi atau yang membuat hipekinetik
• Intervensi :
– Pacu jantung permanen
– Implant Defibrilator Kardioversi
– ablasi alkohol di septum ventrikel
• Pembedahan
– Subaortic miotomi , reseksi basal septum
– Koreksi katup mitral (kalau ada MR)
– Transplantasi jantung
Prediktor penderita HCM dengan
risiko tinggi
• Riwayat cardiac arrest
• Ventrikel takikardi
• Riwayat keluarga dengan sudden death
• Non sustained VT ditemukan dari pemeriksaan Holter
• Sinkope atau presinkope bukan neurogenik
• LVOT gradient > 50 mmHg
• Tebal dinding LV > 20 mm
• Dilatasi LA > 45 mm
• Respons hipotensi saat exercise
Definition
Restrictive cardiomyopahty
Characterized by restrictive filling and reduce
diastolic volume either or both ventricles with
normal or near normal systolic function and wall
thickness
Circulation 1996;93:841-842
N Engl J Med 2003;348:1639-46
Classification of restrictive
cardiomyopathies
Circulation 2000;101:2490-2496
Investigation
• ECG ( lewis, 1992 )
Shows atrial enlargement in virtual
patient.
LVH is seen in less than half
Impaired AV conduction is frequently
reported
• Chest radiography
CTR greater than 0.5 ( lewis,1992)
Pulmonary venous congestion is a
Echocardiography Patologi anatomi
Investigation
Investigation
• Cardiac catheterization
• required to evaluate the pulmonary vascular
resistance because it may be
markedly elevated even at
presentation.
The pulmonary vascular resistance
can be rise
markedly within month to several
years of the
initial diagnosis*
• left ventricular end-diastolic pressure is usually
*Tex Heart Inst J 1997;24:38-44;**Cardiology in review 2002;10(4):210-229
Prognosis
The probable outcome is poor, and
treatment is not usually very effective.
People with restrictive cardiomyopathy
may be candidates for heart transplant
Prognosis
• Median survival was 1.4 years,
six patient from eight died 0.2 to 7.0 years
after they were initially seen*
• Embolic events occurred in 33%**
• Markers for poor prognosis for sudden
death with presentation sign or symptom
ischemia***
Circulation 2002;105:2939-2942
Heart 2001;86:343-349
Clinical feature
• The chronic form
Usually present with ascites,
hepatomegaly,
dyspnea and failure to thrive. Symptoms
are
usually present for a months to years
before
correct diagnosis is made
• The sub acute form
HEART 2001;86:343-349
Follows an acute infectious illness by day
Management and Prognosis
• Pericardiectomy is the definitive treatment
for constrictive pericarditis in severe
constrictive with mortality 6 % to 19%
Circulation 2002;105:2939-2942
Constriction vs. Restriction