Diabetes Mellitus Dengan Komplikasi Heart Failure

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Transcript of Diabetes Mellitus Dengan Komplikasi Heart Failure

  • Diabetes Mellitus dengan Komplikasi Heart FailureFilbert Kurniawan, Lusia Natalia, Yosefa Anggi MPembimbing: dr. Eddy Setijoso, Sp PD-KGEH, dr. Hardjo Prawira, SpPD-KKV

  • Heart FailureSuatu 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 MellitusKriteria diagnosis diabetes mellitus: A1C 6,5% atau gula darah puasa 126 mg/dl (7,0 mmol/L) atauGula darah 2 jam post prandial (75 gram glukosa) 200 mg/dl (11,1 mmol/L) atauPasien dengan gejala klasik hiperglikemia / krisis hiperglikemik akut dengan gula darah sewaktu 200 mg/dl.

  • KomplikasiKronis:Akut:DKA dan HHS

  • glycaemic continuum

  • Diabetes Mellitus terhadap Gangguan Kardiovaskular

  • Tatalaksana Diabetes Mellitus dengan Gangguan KardiovaskularMelibatkan berbagai perbaikan fungsiLifestyleGlucose ControlBlood Pressure ControlDyslipidemia

  • DKA dan Heart FailureAcidosis peningkatan cathecolamine kompensasiAcidosis dengan pH < 7,2 depresi jantungNormal Oksidasi FFA sebagai sumber energi utama (70%) (dalam keadaan puasa): saling memberikan feedback dengan kadar glukosa dan insulinIskemik metabolisme anaerob dari glukosaDKA insulin - infark +++

  • Terapi pada pasien dengan DKA perlu memperhatikan berbagai aspek:Kondisi hidrasi (hindari overhidrasi)Keseimbangan elektrolitAsidosisFaktor 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;1524-4539Mann DL, Murali C. Heart failure and cor pulmonale. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J. Harrisons: priciples of internal medicine 18thed. United States : Mc Graw Hill. 2012. Pg 1901-15Kemp Clinton D, Conte John V. Review article : the pathophysiology of heart failure. Cardiovasculare Pathology 2012; 12: 365-71Haddad 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: 1717-31McMurray 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. Harrisons: 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.