Sistem Kardiovaskular

7/16/2019 Sistem Kardiovaskular

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PATOLOGI

KARDIOVASKULERdr. Cut Warnaini



ANATOMI



SISTEM KONDUKSI IMPULS

JANTUNG

SA node

AV nodeBundle of His

Serabut Purkinje





VASKULARISASI

Arteri coronaria Vena coronaria



a. coronaria kiri (sirkumfleksa dan

desending anterior)



a. coronaria kanan dan a. desending

posterior)



HEART SOUNDS

• S1 :

– closure of mitral and tricuspid valves

– Early sistole

–Single sound

– Apex

• S2 :

– Closure of aortic and pulmonic valves

– Diastole

– Physiologic splitting

– Pulmonic area



Cont.

• Extra systolic HS

– Ejection click

– Mid/late extra systolic HS

• Extra diastolic HS

– Opening snap

– S3

– S4



Cont.



SINDROM KORONER AKUT

• >90% dari ruptur plak aterosklerosis

• Partial occlution (unstable angina, NSTEMI)

•

Complete obstruction (STEMI)• Angina : “ pressure”, “discomfort ”, “tightness”,

“heaviness”, “constriction”

•

Nyeri retrosternal, menjalar; diffuse; jarangbertahan lebih dari 5-10’; tidak hilang dengan

istirahat



Cont.



Cont.



Cont.

• ST elevation



Cont.

• Faktor risiko: dislipidemia, merokok,

hipertensi, DM, menopause

• Diagnosis :

– Anamnesis

– Pemeriksaan fisik

– Pemeriksaan penunjang : EKG, marka jantung

(Troponin, CK-MB)



GAGAL JANTUNG

The inability of the heart to pump blood

forward at a sufficient rate to meet themetabolic demands of the body ( forward failure), or the inability to do so only if the cardiac filling pressures are

abnormally high (backward failure)



Disfungsisistolik

Disfungsidiastolik

GagalJantung

Kiri

Jantung

Paru

Gagal jantung

Kanan



Manifestasi Klinis

• Gagal jantung kiri : Dyspnea, ortopnea, PND,

fatigue, Cahexia, dusky, diaphoretic, akral

dingin, takipnea, pernapasan Cheyne-Stokes,

takikardia, Pulmonary rales, ronchi , wheezing,

efusi pleura

• Gagal jantung kanan : Edema perifer, RUQ

discomfort (hepatomegali), JVP meningkat,efusi pleura



Diagnosis

• Anamnesis

• Pemeriksaan fisik

•

Pemeriksaan penunjang : rontgen thoraks,echocardiography , kateterisasi jantung



HIPERTENSI

• Kondisi dimana tekanan sistolik ≥ 140 mmHg

dan atau tekanan diastolik ≥ 90 mmHg

• Hipertensi :

1. H. Esensial/primer (95%)

2. H. Sekunder



Classification of Blood Pressure in

Adults

Category Systolic Pressure

(mmHg)

Diastolic Pressure

(mmHg)

Optimal <120 And <80

Normal <130 And <85

High-normal 130-139 Or 85-89

Hypertension

Stage 1 140-159 Or 90-99

Stage 2 160-179 Or 100-109

Stage 3 ≥180 Or ≥110



Clinical clues

1. Usia : < 20 atau > 50 tahun HS

2. Severity : HE (stg.1&2), HS (stg.3)

3. Onset : HE (gradual), HS ( present abruptly from previously a normotensive patient )

4. Riwayat keluarga : HE (riw.keluarga), HS

(sporadis)



Organ Target

1. Jantung

2. Cerebrovascular

3. Aorta dan pembuluh darah perifer4. Ginjal

5. Retina



Krisis Hipertensi

• Suatu keadaan emergensi ditandai denganpeningkatan tekanan darah yang berat

• TTIK Hypertensive encephalopathy

(headache, blurred vision, confusion,somnolence, coma)

• Retina Funduskopi : perdarahan, aksudasi,

papilledema• Angina

• Edema paru



CONGENITAL HEART

DISEASE

Acyanotic

Cyanotic



Acyanotic

1. Atrial Septal Defect (ASD)



2. Ventricular Septal Defect (VSD)



3. Patent Ductus Arteriosus (PDA)



4. Congenital Aortic Stenosis

5. Pulmonic Stenosis

6. Coarctation of the Aorta



Cyanotic

1. Tetralogi Fallot



2. Transposisi Arteri Besar



DEMAM REMATIK/PENY.

JANTUNG REMATIK• Inflamasi

• Jantung, kulit, jar.ikat

• Post Streptoccus sp. Infection

• Merupakan suatu proses imonulogi, BUKAN

infeksi langsung Streptococcus sp. pada katup

jantung

• Gejala : demam, menggigil, arthralgia, fatigue



Jones’ Criteria Major criteria

Carditis

Polyarthritis

Syndenham’s chorea

Erythema marginatum

Subcutaneus nodule



Cont.

Minor criteria

Migratory arthralgias

Fever

Increase acute phase reactants (ESR,leukocytosis)

Prolonged PR interval on ECG

Evidence of streptococcal infectionAntistreptolysin O antibodies

Positive throat culture for Streptococci group A



Diagnosis

2 kriteria mayor, atau 1 kriteria mayor

ditambah 2 kriteria minor



Daftar Pustaka

Lilly, Leonard S. Pathophysiology of Heart

Disease.4th Ed.Philadelphia:Lippincott William

& Wilkins,2007.

Documents

Sistem Kardiovaskular