DR DAN DC.ppt [Read-Only] - Universitas Sumatera...
Transcript of DR DAN DC.ppt [Read-Only] - Universitas Sumatera...
KEL. JANTUNG DIDAPAT (ACQUIRED)KEL. JANTUNG DIDAPAT (ACQUIRED)KELAINAN JANTUNG KARENA INFEKSIKELAINAN JANTUNG KARENA INFEKSI
DI INDONESIA YANG TERBANYAK:DI INDONESIA YANG TERBANYAK:
1.DEMAM REUMATIK(1.DEMAM REUMATIK(DRDR), 2. DIFTERIA DAN ), 2. DIFTERIA DAN
3.ENDOKARDITIS LENTA3.ENDOKARDITIS LENTA
1.DEMAM REUMATIK: OK MENYEBABKAN 1.DEMAM REUMATIK: OK MENYEBABKAN
KEL. JANTUNG KEKEL. JANTUNG KE--2 PADA ANAK SETELAH 2 PADA ANAK SETELAH KEL. JANTUNG KEKEL. JANTUNG KE--2 PADA ANAK SETELAH 2 PADA ANAK SETELAH
KEL.JANTUNG KONGENITAL DI USA. KEL.JANTUNG KONGENITAL DI USA.
DI INDONESIA DR DI INDONESIA DR →→→→→→→→PENYEBAB UTAMA.PENYEBAB UTAMA.
DRDR PERLU DIDIAGNOSA CEPAT, DAN DIOBATI PERLU DIDIAGNOSA CEPAT, DAN DIOBATI
SEGERA SEGERA →→→→→→→→DPT MENCEGAH KEL. KATUP J.DPT MENCEGAH KEL. KATUP J.
[BIAYA BANYAK & ANGKA KEMATIAN TINGGI][BIAYA BANYAK & ANGKA KEMATIAN TINGGI]
INSIDENS INSIDENS ±± 3% PADA MASA EPIDEMIK DAN 3% PADA MASA EPIDEMIK DAN
INSIDENSNYA INSIDENSNYA ±± 0.3% PD MASA ENDEMIK 0.3% PD MASA ENDEMIK
ETIOLOGINYA:STREP. BETA HEMOL.GRUP A, ETIOLOGINYA:STREP. BETA HEMOL.GRUP A,
--DRDR SERING TERJADI BERSAMAAN URISERING TERJADI BERSAMAAN URI
--ASRAMA MILITER, KELOMPOK MASY. YG ASRAMA MILITER, KELOMPOK MASY. YG
TERISOLIR SERING EPIDEMI.TERISOLIR SERING EPIDEMI.
--INSIDENS INSIDENS DRDR PARALEL DGN INSIDENS URI PARALEL DGN INSIDENS URI
OK GABHS.OK GABHS.
Rheumatic feverRheumatic fever--pathogenesispathogenesis
Rheumatic feverRheumatic fever--pathogenesispathogenesis
Ada 4 Lapisan GAS. 1. Capsule (Hyaluronic acid) 2. Cel wall ( M - protein and M – Asosiated protein ) 3. Gtoup Carbohydrate (N-Acethyl Glucisamine Ribosome) 4. Protoplast membrane
1.
2.
3.
4.
Group A Streptococcus = GAS
4. Protoplast membrane (Protein, Lipid and Glucose)
Structur Antigen GAS sama dgn structur dari sel-sel: 1. Sendi (synovial membrane) 2. Sel-sel myocardium 3. Sel-sel Valvula / katup jantung 4. Sarcolema myocardium dan Sarcolema dari Subthalmic brain dan Nucleus caudatus
Dr.Babu UthmanDone by: Samya : RF and RHD 2007.
Rheumatic feverRheumatic fever--diagnosisdiagnosis
Subcutaneous nodules(nodules of rheumatoid arthritis are larger)
Rheumatic feverRheumatic fever--diagnosisdiagnosis
Erythematous patches
with central clearing
Erythema marginatum
Pathology :-Aschoff bodies antigen
presenting cells- Acute phase : inflammation process
in pericard, myocard & pericard- Chronic phase : injury of the valve- Chronic phase : injury of the valve- Difference of clinical and pathologi
cal manifestation in some countries- Host immunological response
take main role in clinical manifesta tion
Diagnosis :Diagnosis :
1944 : Dr.T.Duckett Jones : Jones Criteria 1944 : Dr.T.Duckett Jones : Jones Criteria
1955 : Modification of Jones Criteria1955 : Modification of Jones Criteria
1965 & 1984 : Revised of Jones Criteria1965 & 1984 : Revised of Jones Criteria1965 & 1984 : Revised of Jones Criteria1965 & 1984 : Revised of Jones Criteria
1992 : Update Jones Criteria1992 : Update Jones Criteria
Jones Criteria (focused)Jones Criteria (focused)
Problems : over diagnosis or under diagnosis Problems : over diagnosis or under diagnosis
1965 Jones Criteria (revised)
• Major manifestation• Carditis• Polyarthritis• Chorea• Subcutan nodule
• Minor manifestation• Fever• Arthralgia• Prolonged PR interval ECG
• Increase BSR
Diagnosis
• Subcutan nodule• Erythema marginatum • Increase BSR
• C reactive protein (+)• Leucocytosis• Previous history RF / RHD inactive
Evidence of previous
Strept. Infection
CULTURE / ASTO
1992 Jones Criteria (Updated)
Major manifestationCarditisPolyarthritis ChoreaSubcutan noduleErythema margina tum
Minor manifestationFeverArthralgiaIncrease BSRC reactive protein (+) LeucocytosisProlonged PR interval ECG
Diagnosis
Erythema margina tum LeucocytosisProlonged PR interval ECG
Evidence of previous Strept. Infection Culture / ASTO
Treatment RF & RHD (DR & Peny J.Re)• 1. Primary preventions :
• to eradicate Streptococcal infectcion :
• during acute RF attack
• 2. Secondary prevention :
• to prevent relaps of cute RF• to prevent relaps of cute RF
• 3. Relief the symptoms :
• - carditis / CHF
• - arthritis
• - Chorea
Treatment RF & RHD (DR & Peny. J.Rema)
•1. Primary prevention :
• 1. Benzatine PNC G injection 1 X / i.m.
• (BW > 27 kg 1,2 million unit)
• (BW < 27 kg 600.000 unit)• (BW < 27 kg 600.000 unit)
• 2. Pencilline V : 250 mg/400.000 unit QID
• / oral : 10 days
• Erythromycine : 40 mg /kg BW / day
• TID-QID / oral : 10 days
• Clindamycine, Nafcillin, Amoxycillin,
• Cefalexin
•Duration secondary prevention
•Categori Duration
• RF with carditis & permanent minimal 10 years
• valve abnormalities until 40 yrs or longlife
Treatment RF & RHD
longlife
• RF with carditis without perma 10 years or until
• nent valve abnormalities adult
• RF without carditis 5 years or until 21 years
Relief the symptoms
•A. Carditis :
• Anti inflammatory
• - Carditis : Prednison : 2 mg/kg BW/day tapp.
– 2-6 weeks off
Treatment RF & RHD
– 2-6 weeks off
– - Mild Carditis : Aspirin 90-100 mg/kg BW 4-6
– 4-8 weeks week
•B. Arthritis• - Aspirin : 100 mg/kg BW/ day : 2 weeks
• 2-3 weeks : doses decrease
•C. Heart Failure :
• - Bedrest - Digoxin
• - Diuretics - Vasodilator
• - Fluid & salt restriction
•D. Chorea :
•- Physical stres & emotional must be controlled
Treatment RF & RHD
•- Physical stres & emotional must be controlled
•- Anti inflammation drug : controversial
•- Phenobarbital : 15-30 mg TID-QID
•- Haloperidol : 0,5 mg ---> 2 mg TID
•- Valproic acid / Chlorpromazine / Diazepam
Table. Guidelines for Bed Rest and Ambulation and Recommended
antiinflammatory agents
• Arthritis Carditis Carditis Carditis
• alone minimal moderate severe
•Bed Rest 1-2 wk 2-3 wk 4-6 wk 2-4 mo
•Indoor ambulation 1-2 wk 2-3 wk 4-6 wk 2-3 mo
•Outdor activity 1-2 wk 2-3 wk 4-6 wk 2-3 mo
•(school)
•Full activity 1-2 wk 2-3 wk 4-6 wk 2-3 mo
•Prednisone 0 0 2-4 wk 2-6 wk
•Aspirin 0 0 2-4 wk 2-6 wk
Minimal Carditis Questionable cardiomegaly ; Moderate carditis definite but mild cardiomegaly,
Severe carditis, marked cardiomegaly or CHF
Surgical treatment and invasive intervention
•Surgical treatment :
•1. Valve Replacement :
• - MR
• - MS
• - AR• - AR
•2. Valvuloplasty
•Invasive Intervention :
•- Ballon Mitral Valvuloplasty (BMV) with
• Inoue ballon : MS
DCDC
Decompensatio CordisDecompensatio CordisDecompensatio CordisDecompensatio Cordis
Gagal JantungGagal Jantung
Conto: Mitral insuffisiensi
Setiap ventric.sist, ada darah naik
ke Atrium Ki→→→→lama2
Stagnasi di Atrium Ki
→→→→V.Pulm. →→→→vasc.paru →→→→pe-
numpukan cairan →→→→inf. →→→→Batuk kronik.
↓↓↓↓ darah masuk ke Ao →→→→Jantung kerja keras (HR↑↑↑↑=Tachycardia)
Jantung membesar (Cardiomegali), Bila kerja,perlu O2 banyak napas ↑↑↑↑
(Dyspnoe d’effort, sampai orthopnoe ). Tanda2 DC kiri
PS darah berkurang masuk ke
A.Pulm. Darah banyak ter
kumpul dalam V.Ka →→→→A.Ki →→→→ VCS
(TVC↑↑↑↑) →→→→ VCI (Hepatomegali) →→→→
Edem pretibial, Edema dorsal
pedis, Ascites →→→→ Jantung kerja
keras (Cardiomegali) dan Kalau keras (Cardiomegali) dan Kalau
kerja sesak napas (Tachypnoe).
Freq.Jantung naik (Tachycardi)
Tanda DC Kanan
PENGOBATAN DCPENGOBATAN DC
1. DIGITALIS1. DIGITALIS
2. DIURETIK2. DIURETIK
Dosis dan cara pemberianDosis dan cara pemberian
harus diperlajari baikharus diperlajari baik--baikbaik
�Terima kasih