KEGAWATDARURATAN kardiologi 2007

7/24/2019 KEGAWATDARURATAN kardiologi 2007

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29/02/16

1

KEGAWATDARURATANKEGAWATDARURATAN

di bidang Kardiologidi bidang Kardiologi

Sayid Ridho

FKIK UIN Syahid 280207



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Acut Coronary Syndrome

Sindrom !oroner a!ut

S"e!trum#

$ Un%ta&'e An(ina )ectori%/ UA)

$ Non S*+,I

$ S*+,I



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)ato.i%io'o(i

"'a! atero%!'eroti!acoroner

"enyem"itan "em&darah coroner

a'iran darah menurun

i%!emia mio!ard

nyeri dada/an(ina "ectori%

%ta&'e an(ina/e..ort an(ina



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4i'a ru"tur/di%ru"%i "'a! atero%!'eroti!

tim&u' reacti5a%i "'ate'eta((re(a%i d%&

trom&u%

Ne!ro%i% ,io!ard



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ua% 'e%i menentu!an %"e!trum ACS dan

&er!aitan den(an tata'a!%ana

$UA)# tan"a ne!ro%i% $NNS*+,I# ne!ro%i% rin(an

$S*+,I# ne!ro%i% &erat

"er'u e5a'ua%i dan monitorin( teru% meneru% +K:

dan +n;im!arena &i%a &eru&ah dia(no%i%nya UA) dan NNS*+,I dite(a!!an %ecara

retro%"e!ti.



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Kriteria dia(no%i% <= 1979

$ Nyeri dada !ha% in.ar!

$ Ke'ainan +K: dan e5o'u%inya yan( !ha% $ )enin(!atan +n;im da'am darah

CKCKm&*ro"onin

Sehin((a "er'u "emahaman tentan(

An(ina> +K: Norma'>

+n;im Norma'>


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UA)

An(ina den(an "enin(!atan#

.re!uen%i

inten%ita%/'ama nyeri

tim&u' "ada %aat i%tirahat/a!ti5ita% rin(an

tan"a &u!ti adanya ne!ro%i% mio!ard



?ia(no%i% 4andin(

di%e!%i aorta

"eri!arditi% a!ut "enya!it e%o.a(u%SC4A atau %i%t&i'ier

"enya!it "aru"'euraem&o'i"neumotora!

"%i!o(eni! )emeri!%aan "enun@an( 'ain

Ront(en dada treadmi'' eerci%e te%tan(io(ra.i



*ata'a!%ana

%emua "a%ien ACS haru% diraBat di ICCU

in.u% ?et/NaC' 09

a!ti5ita%#i%tirahat di tem"at tidurDcommode

mo&i'i%a%i %e%uai to'eran%i E 12@am

diet# "ua%a %/d nyeri hi'an(!md diet cair

%e'an@utnya diet @antun(



Nitro('i%erin 10$100u(/!(/mnt

Ana'(e%ia# mor.in 2$3 m( i5

"etidin 2$0 m(An%io'iti!# dia;e"am -2$ m(

aan%ia

A%"irin 160$-2 m(

=e"arinS*+,I# Ace inhi&itortrom&o'iti!/)*CA

D %tent



:a(a' antun(

ada'ah %indrom !'ini% a!i&at a&norma'ita%

@antun( yan( menye&a&!an "enurunan !e mam"uan daya "om"a @antun( muncu'

%&( re%"on hemodinami!rena' neura' dan

hormona' yan( !ara!teri%ti! ada (a(a' @antun( a!ut dan !roni!



)enye&a&

!e'ainan "eri!ard

mio!ard endo!ard

atau "em&u'uh darah @antun(

80$90 (an((uan .(% 5entri!e' !iri 2/- "enye&a& (a(a' @t( ada'ah (a(a' @t(

!oroner den(an di%.un(%i %i%to'i!


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)enye&a& 'ain# $!ardiomio"ati non i%!emi!

%"t# hi"erten%ihi"ertiroid

mio!arditi%a'!oho'i! $!ardiomio"ati idio"ati!

?i%.un(%i %i%to'i!#

(an((uan !ontra!ti'ita% otot 5entri!e' yan(

menye&a&!an "enurunan curah @t( %e!uncu" Stro!e Go'ume



?i%.un(%i dia%to'i! ham&atan "en(i%ian .i''in( 5entri!e'

%ehin((a 5o'ume @antun( menurun a!i&atnya ter@adi "enurunan curah @antun( %emenit cardiac out"ut:a(a' @antun( a!ut &i%a ter@adi da'am - &t! edema "aru a!ut %yo! !ardio(eni! ea%er&a%i a!ut "ada (a(a' @antun( !roni!



!'a%i.i!a%i (a(a' @antun( a!ut

!'a%i.i!a%i Ki''i"H

Ke'a% I# tida! ter'ihat tanda/(e@a'a di%.un(%i 5entri!e' !iri

Ke'a% II# (a''o" S-/!on(e%ti "u'moner

rin(an %am"ai moderat Ke'a% III# edema "aru a!ut &erat

Ke'a% IG# %indrom Syo!



1+dema )aru A!ut

Se%a! na"a% yan( di%e&a&!an tran%uda%i

cairan dari !a"i'er "aru !e ruan( inter%titia'

"aru Inter%titia' "u'monary oedema

dan %e'an@utnya !e da'am ruan( a'5eo'u%

A'5eo'ar "u'monary oedema a!i&at "enin(!atan te!5"u'mona'i%



Kriteria dia(no%i% +dema "aru a!ut

%e%a! na"a% &ertam&ah he&at da'am B!t

%in(!at @am/hari di%ertai (e'i%ah

&atu! den(an %"utum &er&u%a !emerahan )F# %iano%i% %entra'%e%a! na"a% d(n &unyi

na"a% me'a'ui mu!u% &er&uih&u&'y

re%"iratory %ound%

ron!i &a%ah tida! nyarin( di &a%a' "aru !md memenuhi ham"ir %e'uruh 'a" "aru y(

!d(2 di%ertai &ron!o%"a%mea%ma !ardia'e

ta!i!ardi den(an (a''o" S-



+K: &i%a %inu% ta!i!ardi d( hi"ertro.i atrium!iri atau AF t(t "enye&a& (a(a' @t(

a&# "2 rendah "C2 mu'a2 rendah !md hi"er!a"nia

en;im !ardio%"e%i.i! menin(!at &i'a ,I

Ront(en# o"a%i.i!a%i hi'u% dan &a(ian &a%a' !md !e arah ata%!d( tim&u' e.u%i

+cho# ter(antun( "enye&a& (a(a' @t(



*ata'a!%ana ni'ai A4C o!%i(en 3$6'/mnt in.u% i5 emer(en%i

intu&a%i &i'a a%ido%i% dan hi"oten%i monitor *?+K: dan o!%imetri o&ati aritmia d( o&at?C %hoc! "acu @t( o&ati etio'o(i *? turun# do"amin $20u(/mnt nor e"ine.rin 0$-0u(/mnt D IA4) &i'a *?80 mm=( *? norma' atau nai!# .uro%emid 0$1 m(/!(/mnt i5 nitro('i%erin 03$m(/ mnt Satu 10$100u(/!(/mnt mor.in 1m( i5 2 !a'i nito"ru%id 01$u(/!(/mnt @i!a %ta&i' mu'ai di(o!%indiureti! atau AC+ inhi&itor ora'



2Syo! Kardio(eni!

ada'ah !e(a(a'an %ir!u'a%i a!ut !arena

!etida!mam"uan daya "om"a @antun( "enye&a&

in.ar! @antun( a!ut 'ua%

tam"onade

!ardiomio"ati aritmia &'o!

!e'ainan !atu"



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?ia(no%i%

&i'a te!anan %i%to'i! 90 mm=(

o'i(uri 20$-0 cc/@am

tida! ada "enye&a& 'ain hi"oten%i %e"erti#

"erdarahandiare rea!%i 5a(a' aritmia

o&at2an dehidra%i



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"a%ien &ia%anya tam"a! (e'i%ah "ucat

e!%tremita% din(in di%ertai

%iano%i% "eri.er

!u'it 'em&a& dan din(in

*ata'a!%ana

%ama den(an +dema "aru a!ut



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-+a%er&a%i a!ut "ada (a(a' @antun( !roni! di"icu o'eh .a!tor "re%i"ita%i &ai! non!ardia! mau"un !ardia!

Non !ardia!# tida! men(i!uti rencana tera"i a'!oho'dru( a&u%e in%u.i%ien%i (in@a'in.e!%iem&o'i "aru !ehami'anhi"erten%ianemia d''

Kardia!# AFSG* dan aritmia 5entri!e' &radiaritmia "er&uru!an !e'ainan !atu" ,CI d''



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(a(a' @antun( !roni! di!'a%i.i!a%i!an

!'a%i.i!a%i NJ=A

!e'a% I# tim&u' %e%a!/'e'ah %aat a!t5 Fi%i! &erat !e'a% II#(e@a'a %aat a!t5.i%i! &ia%a atau moderat

!e'a% III# (e@a'a %aat a!t5.i%i! rin(an

!e'a% IG# (e@a'a %aat i%tirahat

tata'a!%ana ata%i !e'ainan "rimernya

'ain2 %ama den(an edema "aru a!ut



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:an((uan Irama antun(

(an((uan "em&entu!an ran(%an(

(an((uan hantaran ran(%an(

di%ritmia

aritmia

di&a(i 2 @eni% ta!i!ardi &i'a .re!uen%i E100/mnt

4radi!ardi &i'a 60/mnt



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4'o! A$G

%i%tem hantaran @t( y( meneru%!an im"u'%

%ete'ah !e'uar dari atrium a(ar menca"ai

5entri!e' %h( tim&u' %i%to' @t( di%e&ut %i%tem hantaran atrio 5entri!u'er AG con

duction %y%tem Se'ama im"u'% me'a'ui

%i%tem hantaran ini d"t ter@adi &er&a(ai

dera@at ham&atan# Norma'H im"u'% tida! 'e&ih dari 020$021 %c

%&( inter5a' )R

4'o! AG dera@at I hin((a 4'o! AG !om"'it



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4'o! AG dera@at I

(e' ) dii!uti RS d(n inter5a' )RE021 dt!

RS &ia%anya %em"itNteta"i &i%a @( 'e&arR/ 444

etio'o(i# )K in.'ama%i mio!arditi%demam

remati!into!di(ita'i%

(@'# t(t (an((uan hemodinami! dan cau%a

tera"i# o&%er5a%i



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4! AG dera@at II ti"e I# <ec!en&ach inter5a' )R %ema!in meman@an( dii!uti (e' ) y( tida! di%ertai RS

!md dii!uti '( d( )R Norma' danma!in meman@an(

etio'o(i# in.ar! in.erior EE mio!arditi%demam remati! (e@a'a# di;;y%in!o"%e%a! %am"ai (a(a' @t( nyeri dada tera"i# o&%er5a%i &i'a %ta&i' =R ter'a'u 'am&at d( SA 0 m( IGi%o"rotereno' a'u"ent/e.edrin ora' &i'a dera@at AG &'o!nya menin(!at )a!ai "acu @t(



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ti"e 2# inter5a' )R !on%tan%e!a'i$!a'i )

tida! dii!uti RS

&i'a RS amat 'am&an !rn "er&an din(an )R ter'a'u tin((i di%e&ut

hi(h de(ree AG &'o!

etio'o(i# ti"e 1 tera"i ti"e 1!rn (an((uan hemodina

mi! 'e&ihEE"ema!aian "acu @t(E



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4'o! AG dera@at -/ com"'ete AG &'oc!

(e' ) tida! &erhu&un(an d(n RS den(an

.re!) 'e&ih %erin( di&andin(!an RS

etio'o(i# )K a!ut/!roni%

(e@a'a# (an((uan hemodinami!

tera"i# "acu @antun(



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$?i%ritmia ta!i!ardi

%inu% ta!i!ardi

a!i&at ran(%an(an &er'e&ih %ara. %im"ati% terhada" nodu%

SAirama %inu%ma%ih ada (e' ) yan( norma'

RSE100/mnt'an(%in(

etio'o(i# umumnya e!%tra!ardia' %"tH

demam "%i!o(eni! anemiahi"ertiroidi%me tera"i# ata%i "enya!it da%ar



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*a!i!ardi Atria' e!to"i di atrium im"u'% !md di%a'ur!an !e nodu%

AG dan 5entri!e' ,e!ani%menya ada'ah re$entry

dan d"t @u(a "enin(!atan automati%ita% @ara! R$R re(u'ar (e' ) ma%ih ter'ihat!adan( ta! @e'a% .re! :e' ) 130$280/mnt

etio'o(i# ,CI))Ka'!oho'hi"o!a'emihi"o!%ia!a.ein dan amino.i'in tera"i# ata%i "enya!it da%ar di(ita'i%/5era"ami'/"enye!at &eta t(t !'ini%



29/02/16--

F'uter Atria' 'eta! !e' di atrium ter@adi me!re$entry menin(!atnya automati%ita%atau adanya

a!ti5ita% "emicu tri((ered acti5ity etio'o(i# )Kinto!di(ita'i%hi"erten%i (e' ) %e"erti mata (er(a@i %aB teeth (e' ) 220$-0/mnt R$R ma%ih teratur

RS 'an(%in( tera"i# o&ati "enya!it da%ar di(ita'i%/5era"ami'/"enye!at &eta %e'an@utnya (o' !inidinamiodaron&i'a meneta" !ardio5er%i %in!



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Fi&ri'a%i atria'

ter@adi mu'ti Ba5e'et d(n re$entry di atrium

minimum Ba5e'et Se&a(ian ran(%an(

diteru%!an !e 5entri!e'

etio'o(i# !e'!atu")Ktiroto!%i!o%i%hi"er

ten%i!eracunan di(ita'i%idio"ati!



29/02/16-

*era"i# di(ita'i%&i'a meneta" !ardio5er%i terencana &i'are%i%ten di'a!u!an a&'a%i

nodu% AG den(an "ema%an(an "ace ma!er

Gentri!e' ta!i!ardi "ern(%an(an ter'eta! di 5entri!e' RS 10$200/mnt RS me'e&ar

hu& ) dan RS tida! teta" tera"i# 'ido!ain/amiodaron &i'a (a(a' atau hemodinami! &uru! !ardio5er%i &eru'an(H +)S 'a'u a&'a%i



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Fi&ri'a%i 5entri!e'

"enye&a& cardiac arre%t

RS &eru&ah %ama %e!a'i

am"'itudo R %udah %an(at !eci'

tera"i# ?C %hoc! %e(era

re%u%ita%i



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IntroductionIntroduction

?e.ine the %u&@ect matter

State Bhat the audience Bi'' 'earn in thi%

%e%%ionFind out any re'e5ant &ac!(round and

intere%t o. the audience



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Agenda Agenda

i%t the to"ic% to &e co5ered

i%t the time% a''otted to each



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OverviewOverview

:i5e the &i( "icture o. the %u&@ect

+"'ain hoB a'' the indi5idua' to"ic% .it

to(ether

*et

*e

t

*et

*et*et

*et

*e

t

*et*et



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VocabularyVocabulary

:'o%%ary o. term%

?e.ine the term% a% u%ed in thi% %u&@ect



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Topic OneTopic One

+"'ain detai'%

:i5e an eam"'e

+erci%e to rein.orce 'earnin(



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Topic TwoTopic Two

+"'ain detai'%

:i5e an eam"'e

+erci%e to rein.orce 'earnin(



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u!!aryu!!ary

State Bhat ha% &een 'earned

?e.ine Bay% to a""'y trainin(

ReLue%t .eed&ac! o. trainin( %e%%ion



W"ere to Get #ore In$or!ationW"ere to Get #ore In$or!ation

ther trainin( %e%%ion%

i%t &oo!% artic'e% e'ectronic %ource%

Con%u'tin( %er5ice% other %ource%

KEGAWATDARURATAN kardiologi 2007

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