RIZKA R.R - C11108209 - CHF NYHA III ec MR+AS

7/24/2019 RIZKA R.R - C11108209 - CHF NYHA III ec MR+AS

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BAGIAN KARDIOLOGI

DAN KEDOKTERAN VASKULAR DESEMBER 2012

FAKULTAS KEDOKTERAN

UNIVERSITAS HASANUDDIN

GAGAL JANTUNG KONGESTIF NYHA III ec REGURGITASI

KATUP MITRAL + STENOSIS KATUP AORTA

Oleh :

RIZKA RAMADHANI RURAY

C111 08 209

S!e"#$%&" :

'"( )ENDRIK TANDEAN* S!()D+KKV* FINASIM(

DIBAWAKAN DALAM RANGKA MENYELESAIKAN TUGAS KEPANITERAAN

KLINIS DI BAGIAN KARDIOLOGI DAN KEDOKTERAN VASKULAR FAKULTAS

KEDOKTERAN UNIVERSITAS HASANUDDIN

MAKASSAR

2012

1



CONGESTIVE HEART FAILURE NYHA III

e.c MITRAL REGURGITATION + AORTA STENOSIS

KASUS

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DISKUSI

GAGAL JANTUNG KONGESTIF

I( DEFINISI

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,..6 >C,"$'$,; O! CO? ',l,- -e-e.h$ e7h,. -e,7&l$%-e 7h(

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7e.'.6,. '$ %%e- #e.,* -,, e,',,. $.$ '$%e7 6,6,l ,..6 &.6e%$ >K,7&

K,"$-* 2002?( G,6,l ,..6 &.6e%$ ,',l,h e$',-,-!,. ,..6 .

-e-&-!, ',",h ,.6 ,'e, . -e-e.h$ e7h,. ,"$.6,. ,,. &%$6e. ',.."$%$ >S-ele" B,"e* 2001?* ,"e. Se,' ',l,- S&'e-,.* 1991?* Re.,"'$*

1992?(

II( ETIOLOGI

Me,.$%-e ,.6 -e.',%,"$ e",'$., 6,6,l ,..6 &.6e%$ -el$!$

6,.66,. e-,-!,. &.e",$l$,% ,..6* ,.6 -e.e7,7,. ;",h ,..6 le7$h

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,-, e",'$ ,',l,h e"%,,. %e",7 && ,..6* #&l-e %e.;! 7e"",.6 ',.

;",h ,..6 .&"-,l -,%$h ',!, '$!e",h,.,.( V&l-e %e.;! ,',l,h -l,h

',",h ,.6 '$!&-!, !,', %e$,! &.e",%$ e"6,..6 !,', $6, ,&": ,$ !"el&,'*

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,&" $.$ e"6,.66* -,, ;",h ,..6 7e"",.6 >B"..e" ,.' S'',"h 2002?(

III( )ATOFISIOLOGI

)e.".,. &.",%$ #e.e"$el ,,. '$$$ !e.".,. ;",h ,..6 ,.6

%el,.., e",'$ !e.".,. e,.,. ',",h >TD?* ',. !e.".,. #&l-e ',",h ,"e"$

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>K,7& K,"%$-* 2002?(

IV( GAMBARAN KLINIS

G,-7,",. l$.$% 6,6,l ,..6 &.6e%$ 7e"6,..6 !,', l&,%$ 6,6,l ,..6

e"%e7( A',!. 6,-7,",. l$.$%., ,$:

Disfungsi ventrikel kiri atau gagal jantung kiri

T,.', ',. 6e,l, :

,( D$%!.e, : ,$7, !e.$-7,. ;,$",. ',l,- ,l#e&l$ ,.6 -e.66,.66

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-e.".., !e-7,.66,. %$%, h,%$l ,,7&l$,-e(

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7e".,!,%* ',. !e.6e,h,. 7,h<, ,..6 $', 7e".6%$

'e.6,. 7,$(

Disfungsi ventrikel kanan atau gagal jantung kanan

T,.', ',. 6e,l, :

,( E'e-, e%"e-$,% 7,<,h ,, e'e-, 'e!e.'e.

7( He!,&-e6,l$ ',. .e"$ e,. !,', ,'",. ,.,. 7,,% ,7'&-e.

;( A.&"e%$, ',. -,l e",'$ ,$7, !e-7e%,",. #e., ',. %,% #e.,

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!e-7,.66,. !"&' %,-!,h ,,7&l$%-e ,.6 $', ,'e,

',"$ ,"$.6,.(

V( DIAGNOSIS

G,6,l ,..6 &.6e%$ ',!, '$'$,6.&%$% 'e.6,. -e.66.,,. ;"$e"$,

'$,6.&%$ F",-$.6h,-( De.6,. '$e-,.., 2 "$e"$, -,&" ,, 1 "$e"$,-,&"

'$,-7,h 2 "$e"$, -$.&" -,, '$,6.&%$% 6,6,l ,..6 &.6e%$ ',!, '$e6,,.(

11



VI( )ENATALAKSANAAN

T,. ',%," !e.,,l,%,.,,. !,%$e. ',. 6,6,l ,..6 ,',l,h :

,( D.6 $%$",h, . -e.6",.6$ 7e7,. e", ,..6

7( Me.$.6,,. e,,. ',. e$%$e.%$ &.",%$ ,..6 'e.6,. 7,h,.+7,h,. ,"-,&l&6$%

;( Me.6h$l,.6,. !e.$-7.,. ;,$",. 7h 7e"le7$h,. 'e.6,. e",!$ '$"e$;* '$e ',.

$%$",h,(

Terapi Farmakologis

Gl&%$', ,..6* '$"e$; ',. #,%&'$l,&" -e"!,,. ',%," e",!$ ,"-,&l&6$% 6,6,l

,..6

D$6$,l$% -e.$.6,,. e,,. &.",%$ ,..6 ',. -e-!e"l,-7, "ee.%$ ,..6(

Terapi Diuretik

D$7e"$,. . -e-,; e"e%$ .,"$- ',. ,$" -el,l$ 6$.,l* &7, $.$ $', '$!e"l,.

7$l, !,%$e. 7e"%e'$, -e"e%!&.( )e-7,,%,. ,$#$,% '$6$,l$% ',. '$$ "e.',h .,"$-* ,'<,l

!e-7e"$,. &7, '$e.,. &leh 7e", 7,',.* "&%e-$' >L,%$? e",-, %,.6, !e.$.6

',l,- e",!$ 6,6,l ,..6 ,"e., ',!, -e.'$l,,%$ "e.l,* %eh$.66, -e.$.6,,. ,!,%$,%

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Te",!$ '$"e$; ,.6, !,.,.6 ',!, -e.e7,7,. h$!&.,"e-$, ,.6 -e.6,$7,,.

le-,h* le$h* -,l,$%e* ",- && ',. 'e. .,'$ ,.6 e;$l ',. ;e!,(

12



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'$,.',$ 'e.6,. 'e. .,'$ le-,h* %,", ,..6 -e.,h* h$!e"e.%$* && e.'&"*

!e.".,. "ele% e.'&. ',. ele-,h,. --(

Terapi Vasodilator

O7,+&7,,. #,%&,$ -e"!,,. !e.6&7,,. ,-, !,', !e.,,l,%,.,,. 6,6,l ,..6(

N,"$- .$",!"&%$', %e;,", $.",#e., -el,l$ $.%e ,.6 '$!,., e!, '&%$%., h,"%

'$7,,%$ ,6," e,.,. %%&le ,"e"$&le e,! ',l,- 7,,% ,.6 '$$.6$.,.(

N$"&6l$%e"$.

MITRAL REGURGITASI

I( DEFINISI

M$",l "e6"6$,%$ ,',l,h %, e,',,. '$-,., e"',!, ,l$",. ',",h 7,l$

#e."$el $"$ e ',l,- ,"$- $"$ !,', %,, %$%&l* ,$7, $', ',!, -e.!.,

13



,! -$",l %e;,", %e-!".,( ),', MI* ,l$",. ',",h %,, %$%&l e"7,6$ ',*

%e7,6$,. e ,&", ',. %$%,., e ,"$- $"$ e-7,l$( H,l e"%e7 ',!, e",'$

,$7, $', -e.! %e-!".,., ,! -$",l(

II( ETIOLOGI

Be"7,6,$ &.'$%$ !,&l&6$% ',!, -e.e7,7,. e",'$., "e6"6$,%$

-$",l '$,.,",., K,"'$&-$&!,$ h$!e""&!$* 6,6,l #e."$el $"$* !"&l,!% ,!

-$",l* 'e-,- "e-,$* 'e6e.e",%$* ',. el,$.,. &.6e.$,l(

III( DIAGNOSIS

)e-e"$%,,. $%$% !,', "e6"6$,%$ -$",l "&.$ 7$,%,., '$',!,,.

!e.$.6,,. 'e. ,..6 ,$7, ,"$,l $7"$ll,%$ ,, 6,6,l ,..6* !e"7e',,.e,.,. ',",h %$%&l ',. '$,%&l -e.e-!$* !l%,%$ .,'$ le-,h 'e.6,. ,-!l$'&

"e.',h ,$7, !e.".,. %"&e #&l-e( A!e% ,..6 7e"6e%e" e l,e",l

>!e-7e%,",. #e."$el $"$?* thrill !,', ,!e%( A%l,%$ '$',!,,. -"-" ,.6

e"6,7.6 'e.6,. 7.$ ,..6 !e",-, ',. 7e"l,. !,', ,%e %$%&l$ e",-,

e"'e.6," !,', ,!e% ,..6(

G,-7,",. EKG !,', "e6"6$,%$ -$",l $', ,', ,.6 %!e%$$* .,-.

$7"$l,%$ ,"$,l %e"$.6 '$e-,. !,', "e6"6$,%$ -$",l ,"e., el,$.,. &"6,.$(

F&& &",% ',!, -e-!e"l$h,,. ,.',+,.', !e-7e%,",. ,"$- $"$ ',.

#e."$el $"$( ),', "e6"6$,%$ -$",l "&.$ ',!, e"l$h, 6,-7,",. h$!e"e.%$

!l-&.,l ,, e'e-, !,"( E;h&;,"'$&6",$ -e"!,,. ,l, '$,6.&%$ ,-,

. "e6"6$,%$ -$",l( De.6,. e;h&;,"'$&6",$ ',!, '$e,h$ -&"&l&6$ le%$

,! -$",l* 'e",, ,, 7e",., "e6"6$,%$ -$",l* .6%$ #e."$el $"$ ',.

,"$- $"$(

IV( )ENATALAKSANAANTe",!$ "e6"6$,%$ -$",l , ,',l,h %e;e!,., -e.".,. #&l-e

"e6"6$,%$* ,.6 %ee"%., ,,. -e.6",.6$ h$!e"e.%$ !l-&.,l ',. e,.,.

,"$,l ',. -e.$.6,,. %"& #&l-e( O7, #,%&'$l,&" ,"e"$,l >%&'$-

.$"&!"%$'e? -e"!,,. e",!$ ,-, . "e6"6$,%$ -$",l ,( ),',

"e6"6$,%$ -$",l "&.$* ',!, '$7e"$,. '$"e$, . &."&l 6,6,l ,..6

',. %e%,* 7e, 7l&e" . -e.6",.6$ elh,. 7e"'e7," ',. .e"$ ',',* ACE

$.h$7$&" . -e-!e"7,$$ %"#$#,l ',. 6e,l,* ,.$&,6l,. &",l . !,%$e.

"e6"6$,%$ -$",l 'e.6,. ,"$,l $7"$l,%$* ',. !"&$l,%$% 'e-,- "e-,$

14



>!e.$%$l$.?( Te",!$ &!e",%$ %e!e"$ "e&.%"%$ ,! -$",l >,..l&!l,%*

-e-!e"!e.'e &"',? ,, !e.66,.$,. ,! -$",l > Mitral Valve Replacement ?

V( KOM)LIKASI

Be"7,6,$ &-!l$,%$ ',!, e",'$ ,$7, ,',., "e6"6$,%$ -$",l ,',!.

&-!l$,%$ ,.6 e"%e"$.6 ,$:

• G,6,l ,..6 &.6e%$

• T"&-7&e-7&l$

AORTA STENOSIS

I( DEFINISI

A&", %e.&%$% ,',l,h %, &.'$%$ '$-,., e",'$ !e.e-!$,. !,', ,! ,&",(

)e.e-!$,. $.$ -e.6h,-7, ,! ,&", . -e-7, %e!e.h., ,.6

-e.6,$7,,. e",'$., &7%"%$ !,', ,l$",. ',",h ',"$ ,..6 e ,&", ,.6

.,.$., ,,. '$e"%,. e %el"h 7h(

II( ETIOLOGI

Be"7,6,$ &.'$%$ !,&l&6$% ',!, -e.e7,7,. e",'$., %e.&%$% ,&", ,.,",l,$. 'e-,- "e-,$* &.6e.$,l* ',. 'e6e.e",%$(

III( DIAGNOSIS

)e-e"$%,,. $%$% !,', %e.&%$% ,&", '$',!,,. %e%,* ',. 6e,l,+6e,l, %e!e"$

,.6$., !e&"$% 6, %e"$.6 '$',!,,. ',. .,.$., ,,. 7e"-,.$e%,%$ e 6,6,l

,..6( A%l,%$ '$',!,,. -"-" ,.6 e"6,7.6 'e.6,. 7.$ ,..6

!e",-, ',. 7e"l,. !,', ,%e %$%&l$( G,-7,",. EKG !,', %e.&%$% ,&", $',

,', ,.6 %!e%$$( F&& &",% ',!, -e-!e"l$h,,. ,.',+,.', !e-7e%,",.

,"$- $"$ ',. #e."$el $"$( E;h&;,"'$&6",$ -e"!,,. ,l, '$,6.&%$ ,-,

. %e.&%$% ,&",( De.6,. e;h&;,"'$&6",$ ',!, '$e,h$ -&"&l&6$ le%$ ,!

,&",* 'e",, ,, 7e",., %e.&%$% ,&",* .6%$ #e."$el $"$ ',. ,"$- $"$(

IV( )ENATALAKSANAAN

S,+%,., e",!$ 'e$.$$ . %e.&%$% ,&", ,',l,h !e.66,.$,. ,! ,&",

>Valve Replacement ?( )e"e-7,.6,. 6e,l, !,', %e.&%$% ,&", ,',l,h $.'$,%$

,.6 el,% . !e.66,.$,. ,! ,&",( ),%$e. ,.6 $', '$l,,.

!e.66,.$,. ,!* ',!, '$l,,. #,l#l&!,l% ,.6 ',!, -e.6",.6$ 6e,l,

%e.&%$% ,&",( Te",!$ -e'$,-e.&%, %e!e"$ '$"e$ ',!, -e.6",.6$ 6e,l,

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%e.&%$% ,&", %e-e.,",* e,!$ $', -e-7e"$,. ee ',l,- ,.6, <, ,.6

!.,.6(

V( KOM)LIKASI

Be"7,6,$ &-!l$,%$ ',!, e",'$ ,$7, ,',., "e6"6$,%$ -$",l ,',!.

&-!l$,%$ ,.6 e"%e"$.6 ,$:

• G,6,l ,..6 &.6e%$

• T"&-7&e-7&l$

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RIZKA R.R - C11108209 - CHF NYHA III ec MR+AS

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