Diabetes Mellitus dengan

Komplikasi Heart Failure

Filbert Kurniawan, Lusia Natalia, Yosefa Anggi MPembimbing: dr. Eddy Setijoso, Sp PD-KGEH, dr.

Hardjo Prawira, SpPD-KKV

Heart Failure• Suatu sindroma klinis yang kompleks,

diakibatkan adanya kelainan pada struktur dan fungsi dari pengisian ventrikel atau ejeksi darah

Etiologi

Patofisiologi

Diagnosis

Tatalaksana

Acute Heart Failure

Diabetes Mellitus

• Kriteria diagnosis diabetes mellitus:• A1C ≥ 6,5% atau gula darah puasa ≥126

mg/dl (7,0 mmol/L) atau• Gula darah 2 jam post prandial (75 gram

glukosa) ≥ 200 mg/dl (11,1 mmol/L) atau• Pasien dengan gejala klasik hiperglikemia /

krisis hiperglikemik akut dengan gula darah sewaktu ≥ 200 mg/dl.

Komplikasi

Kronis:

Akut:DKA dan HHS

“glycaemic continuum”

Diabetes Mellitus terhadap Gangguan Kardiovaskular

Tatalaksana Diabetes Mellitus dengan Gangguan Kardiovaskular• Melibatkan berbagai perbaikan fungsi

• Lifestyle• Glucose Control• Blood Pressure Control• Dyslipidemia

DKA dan Heart Failure

• Acidosis peningkatan cathecolamine kompensasi

• Acidosis dengan pH < 7,2 depresi jantung• Normal Oksidasi FFA sebagai sumber

energi utama (70%) (dalam keadaan puasa): saling memberikan feedback dengan kadar glukosa dan insulin

• Iskemik metabolisme anaerob dari glukosa• DKA insulin - infark +++

• Terapi pada pasien dengan DKA perlu memperhatikan berbagai aspek:• Kondisi hidrasi (hindari overhidrasi)• Keseimbangan elektrolit• Asidosis• Faktor Pemicu

Thank you !!!

• Yancy CW, Marriel J, Biykem B, et al. 2013 ACCF/AHA Guidelines for the management of heart failure: A Report of the American College of Cardiology Foundation/ America Heart Association Task Force on Practice Guidelines. Circulation. 2013;1524-4539

• Mann DL, Murali C. Heart failure and cor pulmonale. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J. Harrison’s: priciples of internal medicine 18thed. United States : Mc Graw Hill. 2012. Pg 1901-15

• Kemp Clinton D, Conte John V. Review article : the pathophysiology of heart failure. Cardiovasculare Pathology 2012; 12: 365-71• Haddad Francois, Doyle Ramona, Murphy Daniel J, dan Hunt Sharon A. Right ventricular function in cardiovascular disease part II : pathophysiology,

clinical importance, and management of right ventricular failure. Circulation 2008; 117: 1717-31• McMurray JJ, Adamopoulos S, Anker SD, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for

the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Eur Heart J. 2012;33:1787-847.• American Diabetes Association ADA. Standards of Medical Care in Diabetes – 2013. Diabetes Care 2013 ; 36(1): s11-66.• Powers AC. Diabetes Mellitus. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J. Harrison’s: priciples of internal medicine 18thed. United

States : Mc Graw Hill. 2012. Pg 2968-3003.• Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN. Hyperglycemic Crises in Adult Patients With Diabetes. Diabetes Care 2009 ; 32 (7): 1335-43.• European Society of Cardiology. ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD.

European Heart Journal 2013.• Yamagishi S. Cardiovascular disease in recent onset diabetes mellitus. Journal of Cardiology 2011; 57 : 257-62.• Miki T, Yuda S, Kouzu H, Miura T. Diabetic cardiomyopathy: pathophysiology and clinical features. Heart fail rev 2013; 18: 149-66.• Boudina S, Abel ED. Diabetic cardiomyopathy causes and effects. Rev Endocr Metab Disord 2010;11(1): 31-9.• Gandhi MJ, Suvarna TT. Cardiovascular complications in diabetic ketoacidosis. Int J Diab Dev Countries 1995; 15: 132-33.• Tuunanen H, Knuuti J. Metabolic Remodelling in Human Heart Failure. Cardiovascular research 2011; 90: 251-7.• Walter F, Ballinger II, Heinz V. Anaerobic metabolism of heart. Circ Res 1962; 11: 681-5.• Opie LH. Metabolism of Free fatty acids, glucose and cathecolamines in Acute Myocardial Infarction. The American Journal of Cardiology 1975; 36: 938-53.