PENYAKIT JANTUNG KARDIOMIOPATI

8/9/2019 PENYAKIT JANTUNG KARDIOMIOPATI

1/23

PENYAKIT JANTUNG

KARDIOMIOPATI

Dr.TONIPRASETIA.SpPD


2/23

Definition

A primary disorder of the heart

mus!e that auses a"#orma!myoardia! performa#e a#d is #ot

the resu!t of disease or dysfu#tio# of

other ardia strutures $ myoardia!i#fartio#% systemi hyperte#sio#%

&a!&u!ar ste#osis or re'ur'itatio#(


3/23

WHO Classification

U#)#o*# ause+primary,

Di!ated -ypertrophi

Restriti&e

u#!assified

Specific heart muscle

disease (secondary)InfectiveMetabolicSystemic diseaseHeredofamilialSensitivityToxic


4/23

Functional Classification

Di!atated+o#'esti&e% D.M% ID.,

&e#triu!ar e#!ar'eme#t a#d syst dysfu#tio# -ypertrophi+I-//% -.M% -O.M,

i#appropriate myoardia! hypertrophy

i# the a"se#e of -TN or aorti ste#osis

Restriti&e+i#fi!trati&e, a"#orma! fi!!i#' a#d diasto!i fu#tio#


5/23

Idiopathic Dilated

Cardiomyopathy


6/23

ID. 0 Defi#itio#

a disease of u#)#o*# etio!o'y that

pri#ipa!!y affets the myoardium

12 di!atatio# a#d systo!i dysfu#tio#

#reased heart si3e a#d *ei'ht

2e#triu!ar di!atatio#% #orma! *a!! thi)#ess heart dysfu#tio# out of portio# to fi"rosis


7/23

I#ide#e a#d Pro'#osis

4056 ases per 566%666

76%666 #e* ases per year i# the U8/8A8 death from pro'ressi&e pump fai!ure

50year 79:

70year 490;6:

90year ;60


8/23

.!i#ia! Ma#ifestatio#s

-i'hest i#ide#e i# midd!e a'e symptoms may "e 'radua! i# o#set

aute prese#tatio#o

misdia'#osed as &ira! URI i# you#' adu!tso u#ommo# to fi#d speifi myoardia!

disease o# e#domyoardia! "iopsy


9/23

-istory a#d Physia!E=ami#atio#

/ymptoms of heart fai!ure

pu!mo#ary o#'estio# +!eft ->,

dysp#ea +rest% e=ertio#a!% #otur#a!,% orthp#ea systemi o#'estio# +ri'ht ->,

edema% #ausea% a"domi#a! pai#% #oturia

!o* ardia output

fati'ue a#d *ea)#ess hypote#sio#% tahyardia% tahyp#ea% J2D


10/23

Cardiac Imaging

.hest radio'ram

E!etroardio'ram

7;0hour am"u!atory E.G +-o!ter, !i'htheaded#ess% pa!pitatio#% sy#ope

T*o0dime#sio#a! ehoardio'ram

Radio#u!ide &e#triu!o'raphy .ardia atheteri3atio#

a'e ?;6% ishemi history% hi'h ris) profi!e%

a"#orma! E.G


11/23

Management of DCM

1imit ati&ity "ased o# fu#tio#a! status

sa!t restritio# of a 70' Na@+9' Na.!, diet f!uid restritio# for si'#ifia#t !o* Na@

i#itiate media! therapy

A.E i#hi"itors% diuretis di'o=i#% ar&edi!o!

hydra!a3i#e B #itrate om"i#atio#


12/23

{Hypertrophic

Cardiomyopathy


13/23

-ypertrophi .ardiomyopathy

>irst desri"ed "y the >re#h a#d Germa#s

arou#d 5C66 u#ommo# *ith ourre#e of 6867 to 687:

a hypertrophied a#d #o#0di!ated !eft &e#tri!e

i# the a"se#e of a#other disease

sma!! 12 a&ity% asymmetria! septa!hypertrophy +A/-,% systo!i a#terior motio# of

the mitra! &a!&e !eaf!et +/AM,


14/23

12/98

medslides.com14


15/23

Pathophysio!o'y

/ysto!e

dy#ami outf!o* trat 'radie#t Diasto!e

impaired diasto!i fi!!i#'% fi!!i#' pressure

Myoardia! ishemia

mus!e mass% fi!!i#' pressure% O7 dema#d

&asodi!ator reser&e% api!!ary de#sity

a"#orma! i#tramura! oro#ary arteries

systo!i ompressio# of arteries


16/23

.!i#ia! Ma#ifestatio#

Asymptomati% ehoardio'raphi fi#di#'

/ymptomati dysp#ea i# C6:

a#'i#a petoris i# 9:

fati'ue% pre0sy#ope% sy#ope

ris) of /.D i# hi!dre# a#d

ado!ese#ts

pa!pitatio#% PND% .->% di33i#ess !ess

freue#t


17/23

Management

"eta0adre#er'i "!o)ers

a!ium a#ta'o#ist

disopyramide

amiodaro#e% Feta"!o)er

myotomy0myetomy


18/23

Restriti&e .ardiomyopathy


19/23

RestrictiveCardiomyopathies

Hallmark: abnormal diastolic function rigid ventricular wall with impaired ventricularfilling

bear some functional resemblance toconstrictive pericarditis

importance lies in its differentiation fromoperable constrictive pericarditis


20/23

Classification

Idiopathi

Myoardia! 58 No#i#fi!trati&e

Idiopathi

/!eroderma

78 I#fi!trati&e Amy!oid

/aroid

Gauher disease

-ur!er disease

48 /tora'e Disease -emohromatosis

>a"ry disease

G!yo'e# stora'e E#domyoardia!

e#domyoardia! fi"rosis

-yperesi#ophi!i sy#d

.ari#oid

metastati ma!i'#a#ies

radiatio#% a#thray!i#e


21/23

Clinical Manifestations

Symptoms of right and left heart failureJugular Venous Pulse prominentxandydescents

Echo-Doppler abnormal mitral inflow pattern

prominent E wave (rapid diastolic filling) reduced deceleration time (LA pressure)


22/23

Treatment

No satisfatory media! therapy

Dru' therapy must "e used *ith autio# diuretis for e=treme!y hi'h fi!!i#' prssures

&asodi!ators may derease fi!!i#' pressure .a!ium ha##e! "!o)ers to impro&e

diasto!i omp!ia#e

di'ita!is a#d other i#otropi a'e#ts are #ot

i#diated


23/23

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