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RASANYA DADAKU DIREMAS-REMAS………

STEP 1

- ISDN

(ISOSORBIT DINITRAT) jenis obat vasoi!ato"# obat $nt$%&en'eno"%an e&b$!$ a"a# $nt$% &enin'%at%an %eeseiaan

a"a an o%si'en %e jant$n'# biasan*a i '$na%an $nt$% sa%it i

aa *an' i sebab%an o!e an'ina+

- KRISTA,OIDBe"siat isotoni.# ee%ti a!a& &en'isi sej$&!a vo! .ai"an ata$

e&b a"a a!a& /a%t$ sin'%at an be"'$na aa asien *an'

&e&e"!$%an .ai"an se'e"a+E0 "in'e" !a%tat# Na2, 3#45 !!

Be"at jenis !ebi "in'an a"iaa %o!oi an e"$sin*a !ebi .eat

- DE6IBRI,ASIMen'a!i"%an a!i"an !ist"i% %e jant$n'# besa"n*a se%ita" 1733 jo$!e+

Pene&atann*a i ae0 an i batas %anan jant$n'+ 6$n'si $nt$%

&e"esta"t $n'si jant$n'+Pen'obatan *an' &en''$na%an a!i"an !ist"i% a!a& /a%t$ sin'%at+

Di!a%$%an en'an 86 an 8T tana nai# biasan*a ene"'i *an' i

be"i%an 933# 733# 7:3 jo$!e+ Ini%asi# $nt$% 86 # 8T tana nai# 8T

o!i&o"bi% *an' tia% stabi!+

- 2,OPIDO;RE,Men'a&bat a'"e'asi !ate!et $nt$% &en.e'a e&bent$%an a"i

t"o&b$s+Me"$a%an obat 'o! anti a'"e'asi t"o&bosit *an' be%e"ja se.a"a

se!e%ti# &en'a&bat i%atan ADP# &en'a&bat be%$an *an' aa i

e&b$!$ a"a+

- ASPI,ETUnt$% &en$"$n%an a'"e'asi t"o&bosit# <b"ino!iti% an anti%oa'$!an#

an &e"$a%an 'o! NSAID+

STEP 9

1+ Men'aa asien te"jai %e!$an n*e"i aa %i"i see"ti i "e&as-

"e&as *an' i ja!a"%an %e "aan' %i"i=9+ Men'aa te"aat %e!$an &$a! an &$ta =7+ Men'aa jant$n' i %esan%an %a"io&e'a!i an >R &enin'%at =?+ Men'aa saat i asan' EK; asi! i %esan%an ST e!evasi i !ea II

III an A86 =@+ Ma.a&-&a.a& n*e"i aa =



:+ Men'aa asien e"!$ i asan' in$se %"ista!oi =+ Kenaa o%te" &e&be"i%an o%si'en 9-?!&enit !e/at %an$! =C+ Ma.a&-&a.a& te"ai .ai"an =4+ Pe"beaan %"ista!oi an %o!oi =13+ Int"e"etasi e&e"i%saan !ab=

11+ Men'aa aa asien &enjai tia% "esonsi a+ .a"otis tia%te"aba# an 'a&ba"an vent"i%e! <b"i!asi an E2; so.%ab!e =

19+ Isi a"ii stana"t A>A 9313 $nt$ %as$s e&e"'en.* $nt$%

tina%an "es$sitasi =17+ DD =

STEP 7

1+ Men'aa asien te"jai %e!$an n*e"i aa %i"i see"ti i "e&as-

"e&as *an' i ja!a"%an %e "aan' %i"i=-

"asaan *' t% ena% aa sebe!a %i"i *' n*e"in*a i "asa%an ia&i" s!$"$ ba'+ Baan sebe!a %i"i e0+ ,ee"# "aan'# ba$# Ka"na e"sa&aan " e"&ato& e"sa"aann*a+ N*e"in*a nai% seanjan' sa"a senso"i% si&atis MS anta"a 2-7

s& T-@# " jant$n' n*e"i ia!i%an % !ee" 'n &!e/ati ba$

otot e%to"a!is t$"$n %e!en'an s$bste"na! aa atas+

Biasan*a !b se"in' % %i"i en*a%it jant$n' %o"one"+



Angina Pectoris (AP) iba'i &enjai 7

Angina Pectoris Stabil (APS)#

Angina Pectoris Unstable (APU)#

Variant Angina (Prinzmental’s Angina)+

AP aa!a "asa n*e"i *an' ti&b$! %a"ena is%e&ia &io%a"i$&

*an' &e&i!i%i %a"a%te"isti%

(1) !o%asi i aa# s$bste"na! ata$ sei%it i %i"in*a en'an

enja!a"an %e !ee"# "aan'# ba$ %i"i# !en'an an ja"i-ja"i ba'ian

$!na"# $n''$n' ata$ $na% %i"i

(9) %$a!itas n*e"i *an' t$&$! see"ti "asa te"tinibe"at iaa#

"asa esa%an *an' %$at a"i ia"a'&a# see"ti i"e&as an &a$

e.a# tia% see"ti it$s$%-t$s$%# %eaaan *an' be"at ise"tai

%e"in'at in'in an sesa% naas an be"!an's$n' 93 &enit an

be"at a"$s ie"ti&ban'%an APU an &as$% %e sin"o& %o"one"

a%$t (Rahman, 2007).

APS ti&b$! saat be"a%tivitas <si% %a"ena !a% ate"o&a *an'

be"aa i a+ .o"ona"ia a!a& %eaaan stabi! an n*e"i i!an' saatisti"aat# se"an'an tia% !ebi a"i 93 &enit# tia% ise"tai

%e!$an siste&i% (&$a! an %e"in'at in'in) (Rahman, 2007;

Karim, 2000).

APU te"jai aabi!a !a% ate"o&a aa a+ %o"ona"ia tia% stabi!#

%a"ena e"a"aan# "$t$" ata$ <ss$"a# sein''a te"bent$%

t"o&b$s i ae"a !a% *an' &en'a&bat a!i"an a"a %o"o"e"

an te"jai se"an'an an'ina+ Se"an'an an'ina atan'n*a tia%

tent$# saat isti"aat ata$ be"a%tivitas <si% an 'eja!an*a



te"'ant$n' a"i %eaaan t"o&b$s+ Bebe"aa %"ite"ia $nt$%

&enia'nosis APS aa!a

(1) An'ina "o'"esi %"eseno *ait$ te"jai enin'%atan a!a&

intensitas# "e%$ensi# an !a&a eisoe AP#

(9) An'ina at "estno.t$"na! *an' ba"$#

(7) An'ina as.a Ina"% Mio%a"+ 8a"iant An'ina (P"in&enta!Fs

An'ina) *an' isebab%an %a"ena sas&e a+ .o"ona"ia

/a!a$$n tana aan*a !esi ate"os%!e"oti% ata$ enin'%atan

beban jant$n'# bisa ti&b$! /a%t$ isti"aat#aa EK; ta&a%

e!evasi se'&en ST.(Karim, 2000)

Se.a"a <sio!o'i se! enote! a"a &e!eas endothelial derivedrelaxing factor (EDR6) *an' &en*ebab%an "e!a%sasi vas.$!a"# an

endothelial derived constriction factor (ED26) *an'

&en*ebab%an %ont"a%si vas.$!a"+ EDR6 iat$" o!e aseti!%o!in

&e!a!$i e"an'san'an "eseto" &$s%a"ini%# se"ta ADP# se"otonin#

t"o&bin# a"ena!in# vaso"esin# ista&in an no"a"ena!in j$'a

i%$t be"e"an se!ain &e&i!i%i ee% te"seni"i aa e&b$!$

a"a+ Paa %eaaan ato!o'is (&isa! !esi ate"os%!e"oti%)# &a%a

aseti!%o!in# ADP# an se"otonin j$st"$ &e"an'san' e!easan

ED26+ >io%sia a%ibat ate"os%!e"oti% j$'a &e"an'san' e!easanED26+ Dan seba'ian besa" ene"ita AP &ene"ita ate"os%!e"oti%

i a+ .o"ona"ia# &a%a "o$%si ADR6 be"%$"an'# seba!i%n*a

"o$%si AD26 &enin'%at sein''a te"jai enin'%atan ton$s a+

.o"ona"ia+ Ga!a$$n e&i%ian# jant$n' &e&i!i%i .o"ona"* "ese"ve

*an' besa" &a%a aa %eaaan biasa ene"ita *an'

&en'a!a&i ate"os%!e"oti% a+ %o"ona"ia &$n'%in tia% aa 'eja!a+

Na&$n saat be"a%tivitas# beban jant$n' &enin'%at ata$ %a"ena

enin'%atan sa"a si&atis# a!i"an a"a %o"one" tia% .$%$

$nt$% &en*$!ai o%si'en %e &io%a" sein''a te"jai io%sia

&io%a"+ >io%sia ini &a&$ &e"an'san' e!easan be"ba'ai

s$bstansi vasoa%ti see"ti %ate%o!a&in a"i $j$n'-$j$n' sa"a

si&atis jant$n' ita&ba en'an &enin'%atn*a "o$%si

ED26# &a%a te"jai!a vaso%ont"i%si a+ %o"ona"ia *an' !ebi !anj$t

te"jai is%e&i% jant$n'+ >io%sia an is%e&i% a%an &e"$ba

"oses '!i%o!isis a"i ae"obi% an anae"obi%# sein''a te"jai

en$"$nan sintesis ATP an eni&b$nan asa& !a%tat+ Se!ain it$#

en$"$nan o%siasi &etabo!i% &en'a%ibat%an te"!easn*a

ban*a% aenin n$%!eotia *an' &en'asi!%an aenosin+

Aenosin sebena"n*a &e&i!i%i ee% %a"io"ote%ti %a"enas$bstansi ini &en'a&bat e!easan eni& "oteo!iti%#



&en'a&bat inte"a%si ne$t"o<! an enote!# &en'a&bat

a'"e'asi !ate!et an &en'a&bat e!easan t"o&bo%san#

/a!a$$n be'it$# aenosin i%$t &en*ebab%an te"jain*a n*e"i

aa an'ina+ N*e"i aa AP isa!$"%an &e!a!$i ae"en sa"a

si&atis jant$n'+ Sa"a ini be"'ab$n' en'an sa"a so&ati..e"vi.o-to"a.a!is aa ja!$" as.enin' a"i a!a& &e$!!a

sina!is# sein''a %e!$an AP *an' %as aa!a ne"i aa ba'ian

%i"i ata$ s$bste"na! *an' &enja!a" %e ba$ %i"i te"$s %e

%e!in'%in' %i"i (Ka"i&# 9333)+

Paa AMI# i%ena! isti!a TRIAS AMI (N*e"i# Pe&e"i%saan

,abo"ato"i$&# an Pe"$baan EK;)+ N*e"i aa AMI te"jai

&enaa% an te"$s &ene"$s tia% &e"ea (/a!a$$n en'an

isti"aat ata$ e&be"ian nit"o'!ise"in)# "asan*a see"ti te"t$s$%-

t$s$% *an' &enja!a" %e ba$ an &en$j$ %e !en'an %i"i+ N*e"i

se"in' ise"tai sesa% naas# $.at# in'in# iao"esis be"at#

%ea!a te"sa &e!a*an' an &$a! &$nta+

Seba'ian besa" ene"ita AP j$'a &ene"ita ate"os%!e"oti% i

e&b$!$ a"a %o"one"+ Resi%o $ta&a te"jain*a ate"os%!e"oti%

&enin'%at en'an e"ta&baan $sia (aa /anita &enin'%at

sete!a &enoa$se)# $&$" !ebi a"i ?3 ta$n# "i/a*at %e!$a"'a#

ie"tensi# &e"o%o%# ie"%o!este"o!e&ia# an iabetes# en'a"$

a%to" "esi%o *an' %e.i! &e!i$ti obesitas# a%tivitas <si% *an'

%$"an'# stes# e<siensi est"o'en as.a&enoa$se (S.oen#9334)+

Pe&e"i%saan EK; an !abo"ato"i$& %i&ia a"a (%o!este"o!#

t"i'!ise"ia# >D,# ,D,# an asa& $"at)+ Paa EK;# t$j$ann*a

$nt$% &en'eta$i e"$baan ato!o'is aa $n'si jant$n'

(&isa! APU te"aat e"esi se'&en ST)+ Hi%a aa AMI te"aat

ase a/a! 'e!o&ban' T tin''i an si&et"is# e!evasi se'&en ST#

an be"!anj$t aan*a 'e!o&ban' S *an' &en$nj$%%an

ne%"osis+ ,abo"ato"i$& %i&ia a"a be"$b$n'an en'an a.to""esi%o# see"ti ate"os%!e"osis+ Kaa" ,D, *an' tin''i a!a& a"a

&enin'%at%an "esi%o ate"os%!e"osis *an' be"$b$n'an en'an

en*a%it jant$n'+ Ate"os%!e"osis be"%aitan en'an "oses

inJa&asi %"oni% aa inin' a"te"i te"aa bent$% te"tent$

jejas se! enote!+ Pen*ebab jejas se! enote! &e!i$ti

ie"!iie&ia# 'an''$an e&oina&i%# &e"o%o%# ie"tensi#

to%sin an a'en en*ebab ine%si+ Se!anj$tn*a# jejas enote!

&en*ebab%an enin'%atan e"&eabi!!itas enote!# aesi

!e$%osit se"ta t"o&bosit an a%tivasi %oa'$!asi+ Kejaian ini a%an

&eni&b$!%an e!easan an a%tivasi &eiato" %i&ia (growth



factor se"ta &eiato" inJa&asi) *an' %e&$ian ii%$ti o!e

"e%"$t&en an "o!ie"asi se! otot o!os a!a& t$ni%a inti&a

$nt$% &en'asi!%an ate"o&a+ (s.oen# 9334)+ Asa& $"at

&e"$a%an "o$% $"aian $"in ba'ian a"i &a%anan+ P$"in

aa!a sa!a sat$ sen*a/a basa o"'ani% *an' &en*$s$n asa&n$%!eat ata$ asa& inti a"i se! an te"&as$% a!a& %e!o&o%

asa& a&ino# $ns$" e&bent$% "otein+ P$"in seni"i isintesis

!e/at ja!$" De Novo (inte"&eiet a&<bo!i%)# oso"ibosi!asi $"in#

oso"i!asi n$%!eosia $"in+ Kaa" no"&a! asa& $"at a"a "ia

e/asa &'5 an /anita : &' 5+ Sa!a sat$ a%to" "esi%o

asa& $"at tin''i aa!a &a%anan %o!este"o! tin''i+ (K$&a"# 9334)

Ujung2 akson aferen primer berhubungan dengan neuron

spinal *an' mengantarkan sinyal nyeri ke sel2 pusat di

otak *an' mengatur persepsi nyeri+ A%son a"i &asin'9 selaferen primer be"$b$n'an en'an ban*a% ne$"on sina! an&asin'9 ne$"on sina! &ene"i&a &as$%an %onve"'en a"iban*a% se! ae"en "i&e"+ Se&$a ne$"on sina! *an' &ene"i&a&as$%an a"i vise"a an st"$%t$" &$s%$!os%e!eta!# j$'a&enaat &as$%an a"i %$!it+ Ka"ena %onve"'ensi ini# an %a"enane$"on sina! biasan*a an*a ia%tivasi o!e &as$%an a"i %$!it#&a%a a%tivitas *an' iban'%it%an i a!a& ne$"on sina! o!ein$ta"i o"'an9 a!a& se"in' isa!a a!a&at%an o!e ene"ita%eaa seb$a te&at *' %$"an' !ebi sa&a en'an ae"a %$!it*an' iine"vasi sa"a sina! *an' sa&a+

9+ Men'aa te"aat %e!$an &$a! an &$ta =

Mual dan Muntah



Mual aa!a pengenalan secara sadar terhadap eksitasi

pd daerah medulla *' se.a"a e"at be"$b$nn'an 'n ata$ &e"$a%an

ba'ian " $sat &$nta an &$a! t disebabkan oleh impulsiritasi yg dtng dr fraktus gastrointestinal, impuls yg

berasal dr otak bh yg berhubungan dgn motionsickness at impuls dr korte! serebri utk memulaimuntah+ M$nta &e"$a%an s$at$ .a"a &n t"a%t$s 'astointestina!&e&be"si%an i"in*a seni"i " isin*a %eti%a a&i" se&$a ba'ian atast"a%t$s 'ast"ointestina! te"i"itasi se.a"a !$as# san'at &en'e&ban'# at/ba%an san'at te"an'san'+ "mpuls motoriks yg menyebabkanmuntah ditransmisikan dr pusat muntah melalui syaraf cranialis#, #"", $, %&, dan %2 ke traktus gastrointestinal bagian atas danmelalui syarf spinalis kediafragma ke otot abdomen+

%) Antiperistaltik &e"$a%an ena$!$an te"aa &$nta+

Antie"ista!sis t i&$!ai sa&ai seja$ i!e$& it"a%t$s intestina!# an'e!o&ban' antie"ista!ti% be"'e"a% &$n$" nai% %e $s$s a!$s 'n%e.eatan 9-7 .& e"t%+ P"oses ini bena"9 t &eno"on' seba'ianbesa" isi $s$s %e&ba!i %e$oen$& an !a&b$n' !& /%t 7-@ &nt%e&$ian saat ba'ian atas t"a%t$s 'ast"ointestina!# te"$ta&a$oen$&# &enjai san'at &e"e'an'# e"e'an'an ini &enjai a%to"

en.et$s tina%an &$nta *' sebena"n*a+ Pd saat muntah#kontraksi intrinsik kuat terjadi baik pd duodenum maupun pdlambung, bersama relaksasi sebagian dr spinchter esofagusbagian bh, sehingga membuat muntahan mulai bergerak kedlm

esopagus+ D" sini %e"ja &$nta sesi<% *' &e!ibat%an otot9 abo&en&en'a&bi! a!i an &eno"on' &$ntaan %e!$a"+'aktu pusat muntah sudah cukup dirangsang dan dimulailahmuntah dg efek pertama insi"asi a!a& &en'an'%at os oie$s an !a"in' $nt$% &eno"on' s<n'te"

esoa'ea! te"b$%a &en$t$ '!otis &en'an'%at a!at$& &o!e $nt$% &en$t$ na"es oste"io" be"i%$tn*a ti&b$!!a %ont"a%si %$at ia"a'&a *' &en$j$

%eba/a be"sa&a en'an se&$a otot abo&en te%anan int"a'ast"i% tin''i a%i"n*a s<n'te" esoa'eea! "e!a%sasi &e&$n'%in%an en'e!$a"an isi !a&b$n' %e atas &e!a!$i

esoa'$s

MuntahM$nta &e"$a%an s$at$ .a"a i &ana traktus gastrointestinal

membersihkan dirinya sendiri dari sinyal ketika hampir semuabagian atas traktus gastrointestinal teriritasi secara luas, sangatmengembang, atau bahkan sangat terangsang+ istensi yang

berlebihan atau iritasi duodenum s$at$ "an'san'an %$s$s *an'%$at $nt$% &$nta+ "mpu"s ditransmisikan# see"ti *an' it$nj$%%an



aa ;a&ba" ::-9# baik oleh saraf aferen *agal maupun olehsaraf simpatis ke pusat muntah bilateral di medula# *an' terletak dekat traktus solitarius lebih kurang pada tingkat nukleusmotorik dorsalis *agus+ +eaksi motorik otomatis yang sesuaikemudian menimbulkan perilaku muntah+ I&$!s-i&$!s &oto"i%

*an' &en*ebab%an &$nta it"ans&isi%an a"i $sat &$nta &e!a!$isaraf kranialis #, #"", ", , dan "" ke traktus gastrointestinalbagian atas dan melalui saraf spinalis ke diafragma dan ototabdomen-

A./"P0+"S/A1S"S, P0.)A2U1UA. /0+2A)AP MU./A2+ Paataa a/a! a"i i"itasi 'ast"ointestina! ata$ istensi *an' be"!ebian#antiperistalsis &$!ai te"jai# se"in' bebe"aa &enit sebe!$& &$nta te"ja-i+ Antie"ista!sis aat i&$!ai sa&ai seja$ i!e$& i t"a%t$s intestina!#an 'e!o&ban' antie"ista!ti% be"'e"a% &$n$" nai% %e $s$s a!$sen'an %e.eatan $a sa&ai ti'a .&eti% "oses ini bena"-bena" aat&eno"on' seba'ian besa" isi $s$s %e&ba!i %e $oen$& an !a&b$n'a!a& /a%t$ ti'a sa&ai !i&a &enit+ Ke&$ian# aa saat ba'ian atast"a%t$s 'ast"ointestina!# te"$ta&a $oen$&# &enjai san'at &e"e'an'#e"e'an'an ini &enjai a%to" en.et$s *an' &eni&b$!%an tina%an&$na *an' sebena"n*a+ Paa saat &$nta# %ont"a%si int"insi% %$atte"jai bai% aa $oen$& &a$$n aa !a&b$n'# be"sa&a en'an"e!a%sasi seba'ian a"i s<n'te" esoa'$s ba'ian ba/a# sein''a&e&b$at &$ntaan &$!ai be"'e"a% %e a!a& esoa'$s+ Da"i sini# %e"ja&$nta sesi<% *an' &e!ibat%an otot-otot abo&en &en'a&bi! a!i an&eno"on' &$ntaan %e !$a"# see"ti *an' ije!as%an aa a"a'"a

be"i%$t ini+

30+4A )A+" MU./A2+ Se%a!i $sat &$nta te!a .$%$i"an'san' an ti&b$! e"i!a%$ &$nta# ee% *an' e"ta&a aa!a (1)be"naas a!a&# (9) nai%n*a t$!an' !ia an !a"in' $nt$% &ena"i% s<n'te"esoa'$s ba'ian atas s$a*a te"b$%a# (7) en$t$an '!otis# an (?)en'an'%atan a!at$& &o!e $nt$% &en$t$i na"es oste"io"+ Ke&$ianatan' %ont"a%si *an' %$at %e ba/a ia"a'&a be"sa&a en'an"an'san'an %ont"a%si se&$a otot inin' abo&en+ Keaaan ini &e&e"ase"$t i anta"a ia"a'&a an otot-otot abo&en# &e&bent$% s$at$te%anan int"a'ast"i% sa&ai %e batas *an' tin''i+ A%i"n*a# s<n'te"esoa'$s ba'ian ba/a be"e!a%sasi se.a"a !en'%a# &e&b$aten'e!$a"an isi !a&b$n' %e atas &e!a!$i esoa'$s+

4adi, kerja muntah berasal dari suatu kerja memeras otot5ototabdomen bersama dengan pembukaan s6ngter esofagus secaratiba5tiba sehingga isi lambung dapat dikeluarkan-



78.0 P0.90/US 30M8+0S0P/8+ )A+" M0 )U1A U./U3 M0MU1A" MU./A2 8102 8:A/5 8:A/A. A/AU 8102 MOTIO!I"K#!!. Se!ain a"i &$nta *an' i.et$s%an o!e "an'san'an i"itasi

t"a%t$s 'ast"ointestina! it$ seni"i# muntah

juga dapat disebabkan oleh impuls saraf yang timbul pada daerah otak di luarpusat muntah+ Ini te"$ta&a be"!a%$ aaae"a %e.i! *an' te"!eta% bi!ate"a! aa!antai vent"i%e! %ee&at e%at ae"aost"e&a an iseb$t zone pencets!emoreseptor. Pe"an'san'an e!e%t"i% aaae"a ini j$'a &en.et$s%an &$nta *an'!ebi entin'# e&a%aian obat-obat te"tent$#te"&as$% ao&o"<n# &o"<n# an bebe"aae"ivat i'ita!is# aat se.a"a !an's$n'&e"an'san' one en.et$s %e&o"eseto"an &e&$!ai &$nta+ Dest"$%si ae"a te"-seb$t &en'a&bat &$nta jenis ini tetaitia% &en'a&bat &$nta *an' iti&b$!%ano!e "an'san'an i"itasi aa t"a%t$s'ast"ointestina! it$ seni"i+

4uga, telah diketahui dengan baik baha gerakan perubahanarah tubuh yang cepat menyebabkan orang tertentu muntah+Me%anis&e e"isti/a ini aa!a seba'ai be"i%$t ;erakan merangsangreseptor dari labirin, dan impuls ditransrnisikan terutama melalui

intiinti *estibular ke dalam serebelum, kemudian ke <onepencetus kemoreseptor, dan akhirnya ke pusat muntah untuk menyebabkan muntah-

03S"/AS" 38+/"3A1 )A+" MU./A2+ Be"ba'ai "an'san'an si%is#te"&as$% 'a&ba"an *an' &en''an''$# ba$ *an' &e&$a%%an# ana%to" si%o!o'i !ain *an' ses$ai# j$'a aat &en*ebab%an &$nta+>$b$n'an sa"a *an' teat te"aa ee%-ee% inti tia% i%eta$i#/a!a$$n &$n'%in i&$!s &e!e/ati se.a"a !an's$n' $sat &$nta antia% &e!ibat%an one e"an'san'an %e&o"eseto"+$u%ton, &isio'ogi eoteran

7+ Men'aa jant$n' i %esan%an %a"io&e'a!i an >R &enin'%at =;a&ba"an "ont'en an batas-batas jant$n'L

3ardiomegali adalah seb$a %eaaan anato&is

(st"$%t$" o"'an) i &ana besa"n*a jant$n' !ebi besa" a"i

$%$"an jant$n' no"&a!# *a%ni !ebi besa" a"i @@5 besa" "on''a

aa+ aa Ka"io&e'a!i sa!a sat$ ata$ !ebi a"i ? "$an'an

jant$n' &e&besa"+ Na&$n $&$&n*a %a"io&e'a!i ia%ibat%an

o!e e&besa"an bi!i% jant$n' %i"i (vent"i%e! %a"ia sinist"a)Paa %a"io&e'a!i aat oto-ototn*a *an' &e&besa" ata$



"on''an*a *an' &e&besa"# &ana$n it$ se&$a aa!a aatasi

jant$n' $tn$% &en'aai e"$baan a!a& t$nt$tan %e"jan*a+

Pen*ebabn*a aa ban*a% se%a!i# a&i" se&$a %eaaan *an'

&e&a%sa jant$n' $nt$% be%e"ja !ebi %e"as aat &eni&b$!%an

e"$baan-e"$baan aa otot jant$n' sein''a jant$n' a%an&e&besa"+ ana!o'in*a aa!a &isa!n*a aa bina"a'a/an otot-

oton*a &e&besa" %a"ena se"in'n*a &e"e%a &e!a%$%an a%tivitas

beban tin''i+ jant$n' j$'a e&i%ian+

penyebab yang terbanyak---1+ Pen*a%it Hant$n' >ie"tensi

Paa %eaaan ini te"aat te%anan a"a *an' tin''i sein''a

jant$n' ia%sa %e"ja e%st"a %e"as &e&o&a &e!a/an '"aien

te%anan a"a e"ie" ana *an' tin''i+++

9+ Pen*a%it Hant$n' Ko"one"

Paa %eaaan ini seba'ain e&b$!$ a"a jant$n' (%o"one")

*an' &e&be"i%an aso%an o%si'en an n$t"isi %e jant$n'

te"'an''$ sein''a otot-otot jant$n' be"$saa be%e"ja !ebi

%e"as a"i biasan*a &en''anti%an seba'ian otot jant$n' *an'

!e&a ata$ &ati %a"ena %e%$"an'an aso%an a"a+

7+ Ka"io&ioati (Bisa %a"ena iabetes)

Ya%ni en*a%it *an' &en'a%ibat%an 'an''$an ata$ %e"$sa%an

!an's$n' aa otot-otot jant$n'+ >a! ini aat be"siat ba/aan

ata$ %a"ena en*a%it &etabo!is&e see"ti iabetes+ A%ibatn*aoto jant$n' a"$s %e"ja e%st"a $nt$% &enja'a aso%an a"a

teta !an.a"+

?+ Pen*a%it Kat$ Hant$n'

Di jant$n' aa ? %at$ *an' &en'at$" a"a *an' %e!$a" &as$%

jant$n'+ Aabi!a sa!a sat$ ata$ !ebi a"i %at$ ini &en'a!a&i

'an''$an see"ti &isa!n*a &en*e&it (stenosis) ata$ bo.o"

("e'$"'itasi) a%an &en'a%ibat%an 'an''$an aa .$"a jant$n'

(%e&a&$an jant$n' $nt$% &e&oa jant$n' en'an vo!$&e

te"tent$ se.a"a te"at$")+ A%ibatn*a jant$n' j$'a e"!$ %e"jae%st"a %e"as $nt$% &en$t$i %ebo.o"an ata$ %e%$"an'an a"a

*an' io&an*a+

@+ Pen*a%it Pa"$ K"onis

&en'aa en*a%it a"$ %"onis j$'a bisa &en*ebab%an

%a"io&e'a!i+++ Ka"ena aa en*a%it a"$ %"onis aat ti&b$!

%eaaan i &ana te"jai e"$baan see&i%ian "$a aa

st"$%t$" ja"in'an a"$ sein''a a"a &enjai !ebi s$!it $nt$%

&e!e/ati a"$-a"$ *an' %ita %ena! en'an na&a >IPERTENSI

PU,MONA,+ Ka"ena it$ bi!i% jant$n' %anan *an' &e&o&aa"a %e a"$-a"$ e"!$ %e"ja e%st"a %e"as# sein''a tia%



see"ti %eban*a%an %a"io&e'a!i b$%an bi!i% %i"i *an' &e&besa"

tai bi!i% %anan# tai ji%a s$a be"at ba%an bi!i% %i"i $n a%an

i%$t &e&besa"+http*++ar%aners.'ogspot.com+20-0+--+ariomega'i.htm'

?+ Men'aa saat i asan' EK; asi! i %esan%an ST e!evasi i !ea II

III an A86 =

KET

a- S/ ele*asi (se'&en ST be"aa iatas 'a"is isoe!e%t"i%)

a"tin*a otot jant$n' sean' &en'a!a&i ina"% *an'

a%$t(ba.ase"an'an jant$n')# aat i!iat i !ea II# III an A86

aa 'a&ba" 7+

b- S/ depresi (se'&en ST iba/a 'a"is isoe!e%t"i%) a"tin*a

sa&a en'an ST e!evasi an*a %ea!a&an ina"%n*a *an' be"bea+

Paa ST e!evasi otot *an' ina"% &e!i$ti otot jant$n' a!a& sa&ai

*an' te"!$a" (iseb$t T"ans&$"a!) sean'%an aa ST De"esi otot

*an' %ena ina"% an*a &e!i$ti otot jant$n' ba'ian a!a&

(s$beno.a"ia!)+ ST e"esi aat i!iat i !ea I an a8,+

Menentukan lokasi yang terkena gangguan-(,o%asi Ke!ainan)

http://aryaners.blogspot.com/2010/11/kardiomegali.html

http://aryaners.blogspot.com/2010/11/kardiomegali.html



Kete"an'an

1ead5lead yang berada diblok biru muda &e&"o*e%si%an

%onisi jant$n' a"ea Dean (Ante"io") *a%ni ,ea 81 s 8?#1ead yang berada diblok arna merah muda &e&"o*e%si%an

%onisi jant$n' a"ea %i"i (,ate"a!) *a%ni ,ea I# 8@ an 8:# anlead yang berada diblok arna kuning &e&"o*e%si%an %onisi

jant$n' a"ea ba/a (ine"io") *a%ni II# III an a86+Sedangkan lead a#+ jarang dihiraukan+

2onto Bi!a %ita &e!iat 'a&ba"an ST E!evasi i !ea I# a8,# 8@#

an 8: a"tin*a te"aat Ina"% A%$t i otot jant$n' sebe!a %i"i

(Ba.a Ina"% A%$t ,ate"a! %i"i)

3ASUS

Te"aatS/ 0le*asi di lead "", """ dan a#=# &a%nan*a %onisi

jant$n' sebe!a ba/a sean' &en'a!a&i inj$"i iseb$t "nfark

Akut "nferior+

S/ depresi di lead " dan a#1 a"tin*a te"aat %e&atian a%$t

otot jant$n' s$beno.a"ia! *an' !o%asin*a be"aa i sebe!a

ba/a jant$n'# iseb$t .on S/ 0le*asi Miocardial "nfarction

(.on S/0M")inferior+

http*++i.scri.com+oc+-0002-/+Interpretasi#K$

@+ Ma.a&-&a.a& n*e"i aa =

.>0+" AA

0="."S"

N*e"i aa ia!a e"asaan n*e"i ata$ tia% ena% *an'

&en''an''$ i ae"a aa an se"in'%a!i &e"$a%an

"asa n*e"i *an' i"o*e%si%an aa inin'

aa("eferred pain)

(!umer 1uu iagnosis 1aning $e3a'a %ang

4a5im; #$" R6 !e''er M..)

ciri khas nyeri dada

a+ 1etak



Se"in' asien &e"asa%an n*e"i aa i ae"a ste"n$& ata$ i

ba/a ste"n$& (s$bste"na!)# ata$ aa sebe!a %i"i an %aan'-

%aan' &enja!a" %e !en'an %i"i# aat &enja!a" %e $n''$n'#

"aan'# !ee"# ata$ %e !en'an %anan+ N*e"i aa j$'a aat ti&b$!i te&at !ain see"ti i ae"a ei'ast"i$&# !ee"# "aan'# 'i'i#

ba$+

b+ 3ualitas

Paa an'ina# n*e"i aa biasan*a see"ti te"te%an bena be"at#

ata$ see"ti i e"as ata$ te"asa anas# %aan'-%aan' an*a

&en'e!$ e"asaan tia% ena% i aa %a"ena asien tia% aat

&enje!as%an en'an bai%# !ebi-!ebi ji%a enii%an asien

%$"an'+

.+ ubungan dengan akti*itas

N*e"i aa aa an'ina e%to"is biasan*a ti&b$! aa saat

&e!a%$%an a%tivitas# &isa!n*a sean' be"ja!an .eat# te"'esa-

'esa# ata$ sean' be"ja!an &ena%i ata$ nai% tan''a+ Paa %as$s

*an' be"at a%tivitas "in'an see"ti &ani ata$ &en''oso% 'i'i#

&a%an te"!a!$ %en*an'# e&osi# s$a aat &eni&b$!%an n*e"i

aa+ N*e"i aa te"seb$t se'e"a i!an' bi!a asien &en'enti%an

a%tivitasn*a+ Se"an'an an'ina aat ti&b$! aa /a%t$ isti"aat

ata$ aa /a%t$ ti$" &a!a&+

+ 1amanya serangan

,a&an*a n*e"i aa biasan*a be"!an's$n' 1-@ &enit# %aan'-

%aan' e"asaan tia% ena% i aa &asi te"asa sete!a n*e"ii!an'+ Bi!a n*e"i aa be"!an's$n' !ebi a"i 93 &enit# &$n'%in

asien &enaat se"an'an ina"% &io%a" a%$t an b$%an an'ina

e%to"is biasa+ Paa an'ina e%to"is aat ti&b$! %e!$an !ain

see"ti sesa% naas# e"asaan !e!a# %aan'-%aan' n*e"i aa

ise"tai %e"in'at in'in+

1uu A3ar IP, i'i -, &K 8I.



0/"818;"

Pen*ebab n*e"i aa# anta"a !ain %a"ena otot jant$n' &en'a!a&i %e%$"an'an o%si'en %a"ena aan*aen*e&itan e&b$!$ a"a %o"one"+

Penyebab nyeri dada 3ardial

Ko"one" "asa sa%it a%ibat te"jain*a is%e&ia &io%a" %"n s$!ai

a!i"an a"a %o"one" *' s$at$ saat t% &en.$%$i %eb$t$an

$t% &etabo!is&e &io%a"

An'ina e.to"is

Ins$<siensi .o"one"

Ina"% &io%a"

Penyebab nyeri dada non kardial

n*e"i a%ibat %e!ainan a"$ an !e$"a see"ti e&bo!i a"$#!e$"itis# !e$"one$&onia# ie"tensi $!&ona! neo!as&a#an !ain9+

N*e"i &$s.$!os%e!eta! see"ti a"t"itis se"vi%a!# a"t"itis%ostove"teb"a!# %osto%on"itis# a%t$" i'a# !!+

N*e"i sa!$"an .e"na ba'ian atas see"ti "eJ$%s an sas&eesoa'$s# isa'ia %o"osi# t$%a% eti.# %o!i% %an$n'e&e$# !a&b$n' an %o!on# !!

N*e"i si%o'eni% see"ti "asa .e&as *an' be"!ebian# ne$"osis%a"ia!+

IP 8I

31AS"="3AS"

Rasa n*e"i &e"$a%an &e%anis&e e"taanan t$b$ ti&b$!

bi!a aa ja"in'an "$sa% inivi$ be"ea%si en'an .a"a

&e&ina%an sti&$!$s n*e"i+

Ada 2 tipe nyeri



%- nyeri cepat (nyeri tajam, nyeri tertusuk, nyeri

akut, nyeri elektrik)

ti&b$! !& /a%t$ %i"a9 3#1 eti%

sti&$!$s &e"an'san' "eseto" n*e"i &e%ani%# s$$

ja"as "asa n*e"i isa!$"%an &e!a!$i &e$!a sina!is A

an batan' ota% t"a%t$s neosinota!a&i%$s

2- nyeri lambat (nyeri terbakar, nyeri berdenyut5

denyut, nyeri kronik)

ti&b$! sete!a 1 eti%

sti&$!$s &e"an'san' "eseto" n*e"i &e%ani%# s$$#

%i&ia/i

ja"as "asa n*e"i isa!$"%an &e!a!$i &e$!a sina!is

.aban' 2 an batan' ota% t"a%t$s

a!eosinota!a&i%$s

&en$"$t t? "ei!e%sin*a Ka"ia!

• an'ina e%to"is stabi!

• an'ina e%to"is ta% stabi!

• STEMI (ST e!evation &io%a" ina"%)• Non STEMI

Non %a"ia! !e$"a! 'ast"ointe"tina! ne$"a! si%o'eni%

:+ Ma.a& &a.a& ina"% en'an tana an 'eja!a*a =



% "nfark miokarda Pato'enesis

A"te"os%!e"osis en*e&itan e&b$!$ a"a %o"one"is%e&ia &io%a" an'ina e.to"is ne%"osis ina"% &io%a"

b Pato<sio!o'iD$a jenis %o&!i%asi en*a%it IMA te"entin' ia!a %o&!i%asie&oina&i% an a"it&ia+ Segera setelah terjadi "MA#ae"a &io%a" a%an &e&"!iat%an enonjo!an sisto!i%(is%enesia) en'an a%ibat en$"$nan eje.tion "a.tion# isise%$n.$ (st"o%e vo!$&e) an enin'%atan vo!$&e a%i"sisto!i% an a%i" isto!i% vent"i%e! %i"i+ Te"jai enin'%atante%anan a%i" vent"i%e! %i"i nai% en'an a%ibat te%anan at"i$&

ja'a nai%+ Te%anan at"i$& iatas 9@&&>' *an' !a&a a%an&en*ebab%an t"ans$as (!e/atn*a se"$& ata$ .ai"an t$b$

!ain &e!a!$i e&b$!$ a"a seba'ai asi! a"i 'a*ai"oina&i%# &$n'%in a%ibat a"i e"aan'an) %e ja"in'aninte"stisi$& a"$ ('a'a! jant$n')+ Pe&b$"$%an e&oina&i%ini b$%an saja %a"ena ae"a ina"%# tetai j$'a ae"ais%e&i% ise%ita"n*a+ Mio%a" *an' &asi "e!ati bai% a%an&en'aa%an %o&ensasi# $nt$% &e&e"taan%an .$"a

jant$n'# tetai en'an a%ibat enin'%atan %eb$t$an o%si'en&io%a"+ Ko&ensasi tia% a%an &e&aai bi!a ae"asete&at j$'a &en'a!a&i is%e&ia ata$ ba%an s$a <b"oti%+

Pe"$baan e&oina&i% IMA ini tia% statis+ Bi!a IMA

&a%in tenan'# $n'si jant$n' a%an &e&bai% /a!a$$n tia%iobati+ >a! in isebab%an %a"ena ae"a *an' tain*a is%e&i%&en'a!a&i e"bai%an+ Seba!i%n*a e"b$"$%an e&oina&i%a%an te"jai bi!a is%e&ia be"%eanjan'an ata$ &e"!$as+ Dante"jain*a en*$!it &e%anis&e see"ti "$t$" set$&vent"i%e!# "e$"'itasi &it"a! a%$t an ane$"is&a vennt"i%e! j$'aa%an &e&e"b$"$% aa!+

A"it&ia &e"$a%an en*$!it IMA te"se"in' an te"jaite"$ta&a aa &enit-&enit ata$ ja&-ja& ee"ta&a sete!ase"an'an+>a! ini isebab%an o!e e"$baan-e"$baan &asa

"eJa%te"# a*a anta" "an'san' an %ee%aan te"aa"an'san'+ Dan siste& sa"a a$tono&+ Pasien IMA ine"io"$&$&n*a &en'a!a&i enin'%atan ton$s a"asi&atis en'ana%ibat %e.ene"$n'an b"aia"it&ia&enin'%at# sean'enin'%atan ton$s si&atis en'an a%ibat %e.ene"$n'anIMA ine"io" a%an &e&e"tin''i %e.ene"$n'an <b!asivent"i%e! an e!$asan ina"%+

(B$%$ Aja" Pen*a%it Da!a&# Hi!i 1# Eisi 7)

. Dia'nosis



Ke!$an *an' %as ia!a n*e"i aa "et"oste"na!# see"tii"e&as-"e&as# ite%an# it$s$%# anas# ata$ itini ba"an'be"at+ N*e"i aat &enja!a" %e !en'an ($&$&n*a %i"i)# ba$#!ee"# "aan'# ba%an %e $n''$n' an ei'ast"$&+ N*e"ibe"!an's$n' !ebi !a&a a"i an'ina e.to"is biasa an tia%

"esonsi te"aa nit"o'!ise"in+ Kaan'-%aan' te"$ta&aaa asien iabetes an o"an' t$a# tia% ite&$%an n*e"isa&a se%a!i+ N*e"i aat ise"tai e"saan &$a!# &$nta#sesa%# $sin'# %e"in'at in'in# be"eba"-eba" ata$ sin%oe+Pasien se"in' na&a% %eta%$tan+ Ga!a$$n IMA aat&en$"$n%an &aniestasi e"ta&a en*a%it jant$n' %o"one"#na&$n bi!a ana&nesis i!a%$%an se.a"a te!iti a! ini se"in'sebena"n*a s$a ia$!$i %e!$an-%e!$an an'ina#e"asaan i aa ata$ ei'ast"$&+

Ke!ainan aa e&e"i%saan jas&ani tia% aa %a"a%te"isti%

an aat no"&a!+ Daat ite&$i b$n*i jant$n' %e$a *an'e.a a"ao%sa!# i"a&a 'a!!o# aan*a %"eitasi basa!&e"$a%an tana ben$n'an a"$-a"$+ Ta%i%a"ia# %$!it *an'$.at# in'in an iotensi ite&$%an aa %as$s *an' !ebibe"at# %aan'-%aan' ite&$%an $!sasi is%ineti% *an'ta&a% ata$ te"aba i inin' aa aa IMA inte"io"+

Pe&e"i%saan <si%Ke!ainan aa e&e"i%saan jas&ani tia% aa %a"a%te"isti%

an aat no"&a!+ Daat ite&$i b$n*i jant$n' %e$a *an'e.a a"ao%sa!# i"a&a 'a!!o# aan*a %"eitasi basa!&e"$a%an tana ben$n'an a"$-a"$+ Ta%i%a"ia# %$!it *an'$.at# in'in an iotensi ite&$%an aa %as$s *an' !ebibe"at# %aan'-%aan' ite&$%an $!sasi is%ineti% *an'ta&a% ata$ te"aba i inin' aa aa IMA inte"io"+

e Pe&e"i%saan en$njan'EK;

Pe"$baan EK; .$%$ sesi<%# tetai tia% e%a $nt$%ia'nosis

IMA aa ase *an' &asi ini+ Be"asa"%an %e!ainanEK; IMA iba'i atas 9 *ait$

IMA en'an 'e!o&ban'

1 M$!a-&$!a te"jai e!evasi se'&en ST an' %onve%saa anta"an *an' &en.e"&in%an ae"a IMA+Kaan' ba"$ te"jai bebe"aa ja& sete!a

se"an'an+ De"esi se'&en ST *an' "esi"o%a!te"jai Qaa anta"an *an' be"!a/anan+



9 Dii%$ti te"bent$%n*a 'e!o&ban' ato!o'is *an'&en$nj$%%an IMA t"ans&$"a! (te"jai 9? ja&e"ta&a IMA)+

7 sete!a e!evasi se'&en ST be"%$"an'# 'e!o&ban' T te"ba!i% (inve"si)+ Ke$an*a aat &enjai

no"&a! sete!a bebe"aa a"i ata$ &in''$+Ante"io" 87-8?

Ate"oseta! 81-89

Ante"o!ate"a! I# a8,# 8@-8:

Ante"io" !$as I# a8,# 81-8:

Ante"o!ate"a! tin''i I# a8,

Poste"io" 81-89

8ent"i%e! %anan II#III# a86#87R#8?R

IMA non 'e!o&ban'

Tia% aa ato!o'is# an*a ij$&ai e"esise'&en ST an inve"si si&et"i% 'e!o&ban' T

9+ ,abo"ato"i$&

Penin'%atan %aa" eni& ata$ isoeni& &e"$a%anini%ato" sesi<% IMA# *ait$ %"eatinin osos%inase

(2PK2K)# S;OT# ,a%tat ei"o'enase (,D>)# a!ai"o%si b$ti"at ei"o'enase (->BD>)#t"oonin T# anisoeni& 2PK MP ata$ 2KMB+

7+ Raio!o'i

Be"'$na bi!a ite&$%an aan*a ben$na'n a"$ ('a'a! jat$n') ata$ %a"io&e'a!i+

?+ E%o%a"io'"a<

Den'an e%o%a"io'"a< 9 i&ensi aat ite&$%an

ae"a !$as IMA $n'si o&a jant$n' se"ta %o&!i%asi

(B$%$ Aja" Pen*a%it Da!a&# Hi!i 1# Eisi 7)

Dia'nosis banin'i An'ina e.to"is tia% stabi!ins$<siensi %o"one" a%$tii Dise%si ao"taiii Ke!ainan sa!$"an .e"na ba'ian atas (e"nia ia"a'&ati.a#

esoa'itis "eJ$%s)

iv Ke!ainan !o%a! inin' ao"tav Ko&"esi sa"a



vi Ke!ainan int"a abo&ina!

' P"o'nosis1 Mo"ta!itas te"tin''i ? ja& e"ta&a se"an'an IMA

9 Da!a& 9? ja& be"i%$tn*a &asi "a/an7 Sete!a 9? ja& %o&!i%asi san'at &en$"$naTin'%at I Ki!!i

Tana s*o% an ben$n'an a"$+P"o'nosis bai%# &o"ta!itas @5

bTin'%at II Ki!!i Ben$n'an a"$ "in'an

P"o'nosis !ebi je!e%

. Tin'%at III Ki!!i

Ee&a Pa"$

De%o&ensasi %i"i

P"o'nosis !ebi je!e% !a'i

Tin'%at I8 Ki!!i S*o%# &o"ta!itas sa&ai C3 5

( IPD Dia'nosis an Te"ai+ P"o+ D"+ A >a!i&-M$bin# SPD# MS.#KPTI)

Bea AKUT an KRONIS =>ie"t"o< vent"i%e! an .a"io&e'a!i %o&!i%asi !anj$t a"i ==

+ T$j$an i be"i%an %"ista!oi= Me%anis&e P"oses *an' &e&$n'%in%an

.ai"an i!an'=

C+ Men'aa asien e"!$ i asan' in$se %"ista!oi =

?9A"+A. 3+"S/A18"@(Inro Mu'%ono,#% 6ari3anto,#% Rahar3o)

3ristaloid adalah suatu kelompok cairan,tanpa

penambahan solute ionic atau non5 ioik,seperti .a9l kedalam air+ Keban*a%an#na&$n tia% se&$an*a#iso-os&o!a"

an tia% see"ti %o!oi# %"ista!oi &$"a#&$a &e&b$atn*aan tia% &en*ebab%an "ea%si i&$no!o'is+3ristaloid tidak



mengandung partikel onkotik dank arena itu tidakterbatas dalam ruang intra*askuler- ,a"$tan %"ista!oidigunakan untuk meningkatkan *olumeekstrasel,interstitial dan plasma dengantanpapeningkatan *olume intrasel+

1arutan 3ristaloid "sotonik ,a"$tan i%ata%an isotoni. aabi!a os&o!a!itas !as&a no"&a!se.a"a %!inis (9C3-733 &Os&,)+ ,a"$tan *' se"in' %ita seb$tseba'ai !a"$tan isotoni. see"ti Na2! 3#45 ata$ R, tia%!ateat#na&$n *' bena" aa!a &ene%ati isotoni.#%a"ena -Na.! 3#45 (73C &Os&,) sei%it ie"toni% -R, (97&Os&,) sei%it iotoni%+8o!$&e iv be"%$"an' aa be"ba'ai %eaaan 'a/ata"$"at+Pe"bai%an se'e"a vo!$&e iv san'at entin' $nt$%&en'e&ba!i%an e"$si ja"in'an an %ebe"asi!an "es$sitasi+

Pe&be"ian Na2! 3#45 j$&!a besa" aat &eni&b$!%ani!$tiona! a.iosis#tetai b$%an &asa!a %!inis *' entin'%a"ena %e!ebian %!o"ia aat i%e!$a"%an &e!a!$i 'inja!+Pe&be"ian R, tia% &e&e"b$"$% a.ae&ia !a%tat a%ibats*o%#tetai en'an&e&e"bai%i vo!$&e si"%$!asi a%an te"jai en$"$nan"o$%si asa& !a%tat an !a%tat a%an i&etabo!is&e i ea"+

"ndikasi lar-kristaloid isotonic -asien s*o% iovo!e&i% ('ast"oente"itis)# Aabi!a s$&be"ena"aan s$a &$!ai te"atasi#e&be"ian .ai"an %o!oia%an !ebi e<sien

a!a& &enin'%at%an vo!$&e iv+

1arutan 3ristaloid ipertonik 2ai"an t$b$ se&$a %o&a"te&en &en'an$n' 'a"a&en'an %onsent"asi *an' be"bea+2ai"an e%st"ase!$!e" (E26)*an' be"aa i iv ata$$n iinte"stitia! (is) &en'an$n' Nat"i$& 1?3-1@3 &E,#sean'%an a!a& int"ase!$!e" an*a 13 &E,+ Unt$%&e&e"taan%ann %aa" Na anta"a int"a an e%st"ase!$!e"aa &e%anis&e o&a Na *' be"t$'as &en'e!$a"%an %e&ba!iNa *an' be"asi! &as$% %e int"ase!$!e"+ Kei!an'an vo! ai" an

Na isotoni. te"jai aa %ei!an'an .ai"an iv see"ti -ena"aan-ia"e-&$ntabe"S$btit$si %ei!an'an $a jenis tai a"$s i!a%$%an en'an!a"+e!e%t"oni% isotoni.#*ait$ en'an .ai"an Na(1?3-1@3 &E,)+Penggantian untuk pendarahan dapat dilakukandengan beberapa cara,yaitu 1+,a"$tan e!e%t"o!it isotoni. 9-?0 a"i j$&!a a"a *an'i!an'+9+,a"$tan %o!oi isotoni. j$&!a a"a *an' i!an'7+,a"$tan ie"toni% en'an j$&!a j$&!a a"a *an'i!an'+



Kaa" Na !as&a a%an &en*ebab%an ena"i%an ai" a"i IS6&as$% %e a!a& I86+ Ma%in tin''i %aa" Na in$se#&a%inban*a% ai" IS6 *an' aat ita"i% %e a!a& I86+,a"$tan *an' se%a"an' &$!ai ban*a% i'$na%an aa!a Na2!-#@5 an @5+

Ke&a&$an ai" tia% Na&a% be"&a%na aa %aa" @5 antia% aat 135+,a"$tan 'a"a& ie"toni% Na2! 1#@-#@5 (@33-9?33&Os&,)ia%ai $nt$% -s*o% iovo!e&i%-"es$sitasi asien !$%a ba%a"-t"a$&a %ea!a a!a& $a*a &en'$"an'i be"ta&ban*aee&a-!$%a ba%a"-ee&a ota%0fek larutan garam hipertonik -&enin'%at%an .$"a jant$n' (e"bai%an "e!oa)&e&e"bai%i a!i"an a"a %e o"'an9 vita!+-en'a"$i %esei&ban'an .ai"an &en$"$n%an TIK

-ie"nat"e&i-ie"%!o"e&ia-''' e!e%t"o!it (tana a"it&ia)-&en'$"an'i .ai"an a"$ e0t"avas%$!e"-sin"o& %o&a"te&en abo&en se%$ne" (.o asien s*o%a%ibat !$%a ba%a" *' i"es$sitasi)+"ndikasi larutan garam hipertonik

-"es$sitasi vo!$&e .ai"an aa asien %"itis-te"ai .ee"a %ea!a,a"$tan >ie"toni% &e&be"i%an %e$nt$n'an a!a&e&bent$%an ee&a ja"in'an# %esei&ban'an .ai"an#ansin"o&a %o&a"te&en int"a."ania!#tetai sa!in ie"toni%aat &e&bant$ a!a& %as$s i&ana enin'%atan TIK tia%aat iatasi en'an &anito!+

4+ Kenaa o%te" &e&be"i%an o%si'en 9-?!&enit !e/at %an$! =

Pemberian 82Penyediaan oksigen

8ksigen sangat diperlukan oleh sel miokard untukmempertahankan fungsinya, yang didapat dari sirkulasikoroner yang untuk miokard terpakai sebanyak B&5C&sein''a /aja"!a aabi!a a!i"an %o"one" e"!$ itin'%at%an+ A!i"ana"a %o"one" te"$ta&a te"jai se/a%t$ asto!e aa saat ototvent"i%e! a!a& %eaaan isti"aat+ Ban*a%n*a a!i"an %o"one"ien'a"$i o!e bebe"aa a! see"ti te%anan iasto!i% ao"ta#

!a&an*a setia iasto!e an $%$"an e&b$!$ a"et"i te"$ta&aa"te"io!e+ Hai en'$"an'an a!i"an %o"one" $&$&n*a isebab%an



o!e %e!ainan e&b$!$ %o"one"# "enan*a te%anan iasto!i% ao"taan &enin'%atn*a en*$t jant$n'+

Pemakaian 8ksigen

Aa bebe"aa a! *an' ien'a"$in*a *ait$

1+ enyut jantung

Aabi!a en*$t jant$n' be"ta&ba .eat &a%a %ee"!$an o%si'ene"&enit a%an

&enin'%at+

9+ 3ontraktilitas

Den'an be%e"ja &a%a ban*a% i%e!$a"%an %ate%o!a&in (A"ena!in

an No"A"ena!in)# sein''a a%an &ena&ba tena'a %ont"a%si jant$n'+

7+ /ekanan sistolik *entrikel 3iri+ Ma%in tin''i te%anan ini#&a%in ban*a%

e&a%aian o%si'en+

?+ Ukuran jantung

Hant$n' *an' besa" &e&e"!$%an o%si'en *an' ban*a%+

(Inro Mu'%ono,#% 6ari3anto,#% Rahar3o)

13+ Ma.a&-&a.a& te"ai .ai"an =

1+ 2ai"an K"ista!oi

V BM "ena ( C333 Da!ton ) en'an ata$ tana '!$%osa

V Te%anan on%oti% "ena# sein''a .eat te"ist"ib$si %e se!$"$ "$an'

e%st"ase!$!e"

V Men'an$n' e!e%t"o!it Rin'e" !a.tate# Rin'e"Fs so!$tion# Na2! 3#4 5

V Tia% &en'an$n' e!e%t"o!it De%st"osa @ 5

9+ 2ai"an Ko!oi

V BM tin''i ( C333 Da!ton )

V Te%anan on%oti% tin''i# sein''a seba'ian besa" a%an teta tin''a! i

"$an' int"avas%$!e"

V Te"&as$% 'o!on'an ini A!b$&in# P!as&a "otein "a.tion P!as&anat#



P"o$% a"a se! a"a &e"a#

Ko!oi sinteti% De%st"an# >*"o0*et*! sta".

7+ 2ai"an K$s$s

V Die"'$na%an $nt$% ini%asi %$s$s ata$ %o"e%si &isa! Na2! 7 5#Soi$&-bi%a"bonat# Mannito!# Nat"i$& !a%tat ie"toni%

Aa $!a .ai"an %o&binasi# &isa! Rin'e" an De%st"osa @ 5

Na2! 3#?@ 5 an De%st"osa @ 5+

;o!on'an K"ista!oi

1+ Rin'e"Fs ,a.tate

2ai"an a!in' < sio!o'is ji%a ie"!$%an vo!$&e besa"+

Ban*a% i'$na%an seba'ai te"ai .ai"an en''anti ("es$sitasi ata$

"e!a.e&ent te"a*)# &isa!n*a aa s*o% iovo!e&i%# ia"e# t"a$&a

an !$%a ba%a"+

,a%tat a!a& R, a%an i&etabo!is&e o!e ati &enjai bi%a"bonat $nt$%

&e&e"bai%i %eaaan# &isa! asiosis &etabo!i%+

Ka!i$& a!a& R, tia% .$%$ $nt$% %eb$t$an sea"i-a"i# aa!a'i $nt$%

%as$s e<sit %a!i$&+

Tia% &en'an$n' '!$%osa# sein''a seba'ai .ai"an "$&atan(&aintenan.e) a"$s ita&ba '!$%osa $nt$% &en.e'a %etosis+

Pe&be"ian &a%si&a! 9333 &! e" a"i+

9+ Na2! 3#4 5 ( No"&a! sa!ine )

Dia%ai seba'ai .ai"an "es$sitasi ("e!a.e&ent te"a* )# te"$ta&a aa

%as$s

V %aa" NaW "ena

V ji%a R, tia% .o.o% (a!%a!osis# "etensi KW )

V .ai"an te"i!i $nt$% t"a$&a %ea!a

V $nt$% &en'en.e"%an e"itosit sebe!$& t"ans$si

Me&$n*ai %e%$"an'an

V tia% &en'an$n' >2O7

V tia% &en'an$n' KW



V %aa" NaW an 2! "e!ati tin''i# sein''a aat te"jai asiosis

ie"%!o"e&ia# asiosis i!$siona!# an ie"nat"e&ia

Pe&be"ian &a%si&a! 1@33 &! e" a"i

7+ De%st"osa @ 5Die"'$na%an seba'ai .ai"an "$&atan (&aintenan.e) aa asien en'an

e&batasan as$an nat"i$& ata$ seba'ai .ai"an en''anti aa $"e

/ate" e<sit+

Pen''$naan e"ioe"ati

V be"!an's$n'n*a &etabo!is&e

V &en*eia%an %eb$t$an ai"

V &en.e'a io'!i%e&i

V &e&e"taan%an "otein *an' aa ib$t$%an &ini&a! 133 '

%a"boi"at $nt$% &en.e'a ie.an*a %an$n'an "otein t$b$

V &en$"$n%an %aa" asa& !e&a% bebas an %eton

V &en.e'a %etosis# ib$t$%an &ini&a! 933 ' %a"boi"at

2ai"an in$s &en'an$n' e%st"osa# %$s$sn*a De%st"osa @ 5 tia% bo!e

ibe"i%an aa asien t"a$&a %ea!a (ne$"ot"a$&a) %a"ena e%st"osa an

ai" a%an be"ina se.a"a bebas %e a!a& se! ota%+ Di a!a& se! ota%

(int"ase!$!e")# e%st"osa a%an i&etabo!isi" *an' a%an &en*ebab%an

ee&a ota%+

2e"&in D$nia Keo%te"an Eisi Mei H$ni 9313 XTe"ai .ai"an a"aZ

"+ E"* ,e%sana# S+An

1+ 2ai"an K"ista!oi

2ai"an ini &e&$n*ai %o&osisi &i"i .ai"an e%st"ase!$!e" (2ES 2E6)+

Ke$nt$n'an a"i .ai"an ini anta"a !ain a"'a &$"a# te"seia en'an

&$a i setia

$sat %eseatan# tia% e"!$ i!a%$%an ."oss &at.# tia% &eni&b$!%an

a!e"'i ata$ s*o%

ana<!a%ti%# en*i&anan see"ana an aat isi&an !a&a+

2ai"an %"ista!oi bi!a ibe"i%an a!a& j$&!a .$%$ (7-? %a!i .ai"an %o!oi)

te"n*ata

sa&a ee%tin*a see"ti e&be"ian .ai"an %o!oi $nt$% &en'atasi e<sit

vo!$&e

int"avas%$!e"+



Ga%t$ a"$ .ai"an %"ista!oi i "$an' int"avas%$!e" se%ita" 93-73 &enit+

>e$'&an et a! (149) &en'e&$%a%an ba/a /a!a$$n a!a& j$&!a

sei%it

!a"$tan %"ista!oi a%an &as$% "$an' inte"stitie! sein''a ti&b$! ee&ae"ie" an a"$

se"ta be"a%ibat te"'an''$n*a o%si'enasi ja"in'an an ee&a ja"in'an

!$%a# aabi!a

seseo"an' &enaat in$s 1 !ite" Na2! 3#45+

Pene!itian Mi!!s %% (14:) i &ean

e"an' 8ietna& t$"$t &e&e"%$at ene!itan *an' i!a%$%an o!e

>e$'&an# *ait$

e&be"ian sej$&!a .ai"an %"ista!oi aat &en'a%ibat%an ti&b$!n*a

ee&a a"$ be"at+

Se!ain it$# e&be"ian .ai"an %"ista!oi be"!ebian j$'a aat

&en*ebab%an ee&a ota%

an &enin'%atn*a te%anan int"a %"ania!+

Ka"ena e"beaan siat anta"a %o!oi an %"ista!oi i&ana %"ista!oi a%an

!ebi

ban*a% &en*eba" %e "$an' inte"stitie! ibanin'%an en'an %o!oi &a%a

%"ista!oi

sebai%n*a ii!i $nt$% "es$sitasi e<sit .ai"an i "$an' inte"stitie!+

,a"$tan Rin'e" ,a%tat &e"$a%an .ai"an %"ista!oi *an' a!in' ban*a%

i'$na%an



$nt$% "es$sitasi .ai"an /a!a$ a'a% iotonis en'an s$s$nan *an' a&i"

&en*e"$ai

.ai"an int"avas%$!e"+ ,a%tat *an' te"%an$n' a!a& .ai"an te"seb$t a%an

&en'a!a&i

&etabo!is&e i ati &enjai bi%a"bonat+ 2ai"an %"ista!oi !ainn*a *an'

se"in' i'$na%an

aa!a Na2! 3#45# tetai bi!a ibe"i%an be"!ebi aat &en'a%ibat%an

asiosis

ie"%!o"e&i% (e!$tiona! *e".!o"e&i. a.iosis) an &en$"$nn*a %aa"

bi%a"bonat

!as&a a%ibat enin'%atan %!o"ia+

9+ 2ai"an Ko!oi

Diseb$t j$'a seba'ai .ai"an en''anti !as&a ata$ biasa iseb$t X!as&a

s$bstit$teZ ata$ X!as&a e0ane"Z+ Di a!a& .ai"an %o!oi te"aat

atbaan *an'

&e&$n*ai be"at &o!e%$! tin''i en'an a%tivitas os&oti% *an'

&en*ebab%an .ai"an ini

.ene"$n' be"taan a'a% !a&a (/a%t$ a"$ 7-: ja&) a!a& "$an'

int"avas%$!e"+ O!e

%a"ena it$ %o!oi se"in' i'$na%an $nt$% "es$sitasi .ai"an se.a"a .eat

te"$ta&a aa

s*o% iovo!e&i%e"&o"a'i% ata$ aa ene"ita en'an

ioa!b$&ine&ia be"at an

%ei!an'an "otein *an' ban*a% (&isa! !$%a ba%a")+



11+ Men'aa aa asien &enjai tia% "esonsi a+ .a"otis tia%te"aba# an 'a&ba"an

19+ Isi a"ii stana"t A>A 9313 $nt$ %as$s e&e"'en.* $nt$%

tina%an "es$sitasi =17+ DD =

S".+8M 38+8.0+ A3U/

De<nisi Sin"o&a Ko"one" A%$t (SKA)

Me"$a%an se%t"$& &aniestasi a%$t an be"at *an' &e"$a%an %eaaan

%e'a/ata"$"atan a"i %o"one" a%ibat %etia%sei&ban'an anta"a %eb$t$ano%si'en &io%a"i$& an a!i"an a"a (K$&a"# 933)+

9+1+9+ 6a%to" "esi%o Sin"o&a %o"one" a%$t

6a%to" "isi%o iba'i &enjai &enjai $a %e!o&o% besa" *ait$ a%to" "isi%o

%onvensiona! an a%to" "isi%o *an' ba"$ i%eta$i be"$b$n'an en'an

"oses ate"ot"o&bosis (B"a$n/a!# 933)+

6a%to" "isi%o *an' s$a %ita %ena! anta"a !ain &e"o%o%# ie"tensi#

ie"!iie&ia# iabetes &e!it$s# a%ti<tas <si%# an obesitas+ Te"&as$% i

a!a&n*a b$%ti %ete"!ibatan te%anan &enta!# e"esi+ Sean'%an bebe"aa



a%to" *an' ba"$ anta"a !ain 2RP# >o&o.*stein an ,io"otein(a) (Santoso#

933@)+

Di anta"a a%to" "isi%o %onvensiona!# aa e&at a%to" "isi%o bio!o'is *an' ta%

aat i$ba# *ait$ $sia# jenis %e!a&in# "as# an "i/a*at %e!$a"'a+

6a%to"-a%to" "isi%o !ain &asi aat i$ba# sein''a be"otensi aat

&e&e"!a&bat "oses ate"o'eni%+ 6a%to"-a%to" te"seb$t aa!a enin'%atan

%aa" !ii se"$&# ie"tensi# &e"o%o%# 'an''$an to!e"ansi '!$%osa an iet

tin''i !e&a% jen$# %o!este"o!# an %a!o"i +

9+1+7 Pen*a%it Yan' Te"&as$% Da!a& SKA

Yan' te"&as$% %ea!a& Sin"o&a %o"one" a%$t aa!a an'ina ta% stabi!#

&io%a" ina"% a%$t en'an e!evasi se'&en ST (STEMI)# an &io%a" ina"%

a%$t tana e!evasi se'&en ST (NSTEMI) (Bassan# 933)+

9+9 An'ina Pe%to"is Ta% Stabi!

9+9+1 De<nisi An'ina Pe%to"is Ta% Stabi!

An'ina e%to"is aa!a n*e"i aa inte"&itten *an' isebab%an o!e is%e&ia

&io%a"i$& *an' "eve"sibe! an se&enta"a+

Di%eta$i te"ba'i atas ti'a va"ian $ta&a an'ina e%to"is

an'ina e%to"is tii%a! (stabi!)#

an'ina e%to"is "in&eta! (va"ian)# an

an'ina e%to"is ta% stabi!+

An'ina e%to"is ta% stabi! itanai en'an n*e"i an'ina *an' "e%$ensi n*a

&enin'%at+

Se"an'an .ene"$n' i i.$ o!e o!a"a'a *an' "in'an# an se"an'an

&enjai !ebi intens an be"!an's$n' !ebi !a&a a"i an'ina e%to"is stabi!+

An'ina ta% stabi! &e"$a%an tana a/a! is%e&ia &io%a"i$& *an' !ebi

se"i$s an &$n'%in i"eve"sibe! sein''a %aan'-%aan' iseb$t an'ina "a

ina"%+

Paa seba'ian besa" asien# an'ina ini i i.$ o!e e"$baan a%$t aa !a%

i se"tai t"o&bosis a"sia!# e&bo!isasi ista! t"o&b$s an ata$ vasosas&e+

Pe"$baan &o"o!o'i% aa jant$n' aa!a a"te"os%!e"osis %o"one" an !esi

te"%aitn*a (K$&a"# 933)+

9+9+9 Eie&io!o'i An'ina Pe%to"is Ta% Stabi!

Di A&e"i%a se"i%at setia ta$n# 1 j$ta asien i "a/at i "$&a sa%it %a"ena

an'ina e% to"is ta% stabi! i&ana : sa&ai C e"sen %e&$ian &enaat

se"an'an ina"% jant$n' *an' tia% ata! ata$ &enin''a! a!a& sat$ ta$n

sete!a ia'nosis i te'a% %an (T"isnoai# 933:)+



Pato'enesis Pen*a%it

1+ R$t$" !a%

R$t$" !a% a"te"os%!e"oti% ian''a en*ebab te"entin' an'ina e%to"is ta%

stabi!# sein''a tiba-tiba te"jai o%!$si s$btota! ata$ tota! a"i e&b$!$%o"one" *an' sebe!$n*a &e&$n*ai en*e&itan *an' &inina!+

D$a e"ti'a a"i e&b$!$ *an'

&en'a!a&i "$t$" sebe!$&n*a

&e&$n*ai en*e&itan @35 ata$

%$"an'# an aa 45 asien

en'an an'ina ta% stabi!

&e&$n*ai en*e&itan %$"an'

a"i 35+ P!a% a"te"os%!e"oti% te"i"i

a"i inti *an' &en'an$n' ban*a%

!e&a% an e!in$n' ja"in'an<b"oti. (<b"oti. .a)+P!a% tia%

stabi! te"i"i a"i inti *an' ban*a%

&en'an$n' !e&a% an aan*a in<!t"asi se! &a%"oa'+ Biasan*a "$t$"

te"jai aa tei !a% *an' be"e%atan en'an inti&a *an' no"&a! ata$ aa

ba$ a"i ti&b$nan !e&a%+ Kaan'-%aan' %e"eta%an ti&b$! aa inin'

!a% *an' a!in' !e&a %a"ena aan*a eni& "otease *an' i asi!%an

&a%"oa' an se.a"a eni&ati% &e!e&a%an inin' !a% (<b"o$s .a)+

Te"jain*a "$t$" &en*ebab%an a%tivasi# aesi an a'"e'asi !ate!et an

&en*ebab%an a%tivasi te"bent$%n*a t"o&b$s+ Bi!a t"o&b$s &en$t$e&b$!$ a"a 1335 a%an te"jai ina"% en'an e!evasi se'&en ST#

sean'%an bi!a t"o&b$s tia% &en*$&bat 1335 an an*a &eni&b$!%an

stenosis *an' be"at a%an te"jai an'ina ta% stabi! (T"isnoai# 933:)+

9+ T"o&bosis an a'"e'asi t"o&bosit

A'"e'asi !ate!et an e&bent$%an t"o&b$s &e"$a%an sa!a sat$ asa"

te"jain*a an'ina ta% stabi!+ Te"jain*a t"o&bosis sete!a !a% te"'an''$ i

sebab%an %a"ena inte"a%si *an' te"jai anta"a !e&a%# se! otot o!os an se!

b$sa (oa& .e!!) *an' aa a!a& !a% be"$b$n'an en'an e%s"esi a%to" ja"in'an a!a& !a% ta% stabi!+ Sete!a be"$b$n'an en'an a"a# a%to"



ja"in'an be"inte"a%si en'an a%to" 8IIa $nt$% &e&$!ai %as%ae "ea%si

eni&ati% *an' &en'asi!%an e&bent$%an t"o&bin an <b"in (T"isnoai#

933:)+

7+ 8asosas&e

Te"jain*a vaso%onst"i%si j$'a &e&$n*ai e"an entin' aa an'ina ta%

stabi!+ Di e"%i"a%an aa is$n'si enote! an baan vasoa%ti *an'

i"o$%si o!e !ate!et be"e"an a!a& e"$baan a!a& ton$s e&b$!$

a"a an &en*ebab%an sas&e+ Sas&e *an' te"!o%a!isi" see"ti aa

an'ina "in&eta! j$'a &en*ebab%an an'ina ta% stabi!+ Aan*a sas&e

se"in' %a!i te"jai aa !a% *an' ta% stabi! an &e&$n*ai e"an a!a&

e&bent$%an t"o&b$s (T"isnoai# 933:)+

?+ E"osi aa !a% tana "$t$"

Te"jain*a en*e&itan j$'a aat i sebab%an %a"ena te"jain*a "o!ie"asian &i'"asi a"i otot o!os seba'ai "ea%si te"aa %e"$sa%an enote!

aan*a e"$baan bent$% a"i !esi %a"ena be"ta&ban*a se! otot o!os aat

&eni&b$!%an en*e&itan e&b$!$ en'an .eat an %e!$an is%e&ia

(T"isnoai# 933:)+

9+9+? Dia'nosis Dan Pe&e"i%saan Pen$njan'

Ke!$an asien $&$&n*a be"$a an'ina $nt$% e"ta&a %a!i ata$ %e!$an

an'ina *an' be"ta&ba a"i biasa+ N*e"i aa aa an'ina biasa tai !ebi

be"at an !ebi !a&a# &$n'%in ti&b$! aa /a%t$ isti"aat# ata$ ti&b$!

%a"ena a%tivitas *an' &ini&a!+ N*e"i aa aat ise"tai %e!$an sesa% naas#&$a! sa&ai &$nta# %aan'-%aan' ise"tai %e"in'at in'in+ Paa

e&e"i%saan <si% se"in' %a!i tia% aa *an' %as+

Pe&e"i%saan en$njan'

V E!e%t"o%a"io'"a< (EK;)

V Pe&e"i%san !abo"ato"i$&

Pe&e"i%saan t"oonin T ata$ I an e&e"i%saan 2K-MB te!a i te"i&a

seba'ai e"tana a!in' entin'+

9+9+@ Penata!a%sanaan An'ina Pe%to"is Ta% Stabi!

Tina%an $&$&

Pasien e"!$ e"a/atan i "$&a sa%it sebai%n*a i $nit intensi %o"one"#

asien e"!$ i isti"aat%an (be "est)# i be"i enenan' an o%si'en

e&be"ian &o"<n ata$ etiin e"!$ aa asien *an' &asi &e"asa%an

n*e"i aa /a!a$$n s$a &enaat nit"o'!ise"in (T"isnoai# 933:)+

Te"ai &ei%a&entosa

V Obat anti is%e&ia



V Nit"at# en*e%at beta# anta'onis %a!si$&+

V Obat anti a'"e'asi t"o&bosit

V Asi"in# ti%!oiin# %!oio'"e!# inibito" '!i%o"otein IIb IIIa

V Obat anti t"o&bin

V Un"a.tionnate >ea"in # !o/ &o!e.$!a" /ei't ea"in

V Di"e.t t"o&bin inibito"s

9+7 Ina"% Mio%a" Den'an E!evasi ST (STEMI)

Ina"% &io%a"i$& &en$nj$%an te"bent$%n*a s$at$ ae"a ne%"osis

&io%a"i$& a%ibat is%e&ia tota!+ MI a%$t *an' i%ena! seba'ai Xse"an'an

jant$n'Z# &e"$a%an en*ebab t$n''a! te"se"in' %e&atian iin$st"i an

&e"$a%an sa!a sat$ ia'nosis "a/at ina te"se"in' i ne'a"a &aj$ (K$&a"#933)+

9+7+1 Eie&io!o'i STEMI

Ina"% &io%a" a%$t &e"$a%an sa!a sat$ ia'nosis "a/at ina te"se"in' i

ne'a"a &aj$+ ,aj$ &o"ta!itas a/a! (73 a"i) aa IMA aa!a 735 en'an

!ebi a"i sea"$ %e&atian te"jai sebe!$& asien &en.aai "$&a sa%it+

An'%a %ejaian NSTEMI !ebi se"in' i banin'%an en'an STEMI (Bassan#

933)+

9+7+9 Pato<sio!o'i STEMI

STEMI $&$&n*a te"jai ji%a a!i"an a"a %o"one" &en$"$n se.a"a &enaa%

sete!a o%!$si t"o&b$s aa !a% a"te"os%!e"osi% *an' s$a aa

sebe!$&n*a+ Stenosis a"te"i %o"one" be"at *an' be"%e&ban' se.a"a !a&bat

biasan*a tia% &e&i.$ STEMI %a"ena be"%e&ban'n*a ban*a% %o!ate"a!

seanjan' /a%t$+ STEMI te"jai ji%a t"o&b$s a"te"i %o"one" te"jai se.a"a

.eat aa !o%asi inj$"* vas%$!a"# i&ana inj$"* ini i .et$s%an o!e a%to"-

a%to" see"ti &e"o%o%#ie"tensi an a%$&$!asi !ii+

Paa seba'ian besa" %as$s# ina"% te"jai ji%a !a% a"te"os%!e"osis &en'a!a&i

<s$"# "$t$" ata$ $!se"asi an ji%a %onisi !o%a! ata$ siste&i% &e&i.$t"o&bo'enesis# sein''a te"jai t"o&b$s &$"a! aa !o%asi "$t$" *an'

&en'a%ibat%an o%!$si a"te"i %o"one"+ Pene!itian isto!o'is &en$nj$%%an !a%

%o"one" .ene"$n' &en'a!a&i "$t$" ji%a &e&$n*ai <b"o$s .a *an' tiis

an inti %a*a !ii (!ii "i. .o"e)+ Paa STEMI 'a&ba"an ato!o'is %!asi%

te"i"i a"i <b"in "i. "e t"o&b$s# *an' ie".a*a &enjai asa" sein''a

STEMI &e&be"i%an "eson te"aa te"ai t"o&bo!iti%+

Se!anj$tn*a aa !o%asi "$t$" !a%# be"ba'ai a'onis (%o!a'en# ADP# e<ne"in#

se"otonin) &e&i.$ a%tivasi t"o&bosit# *an' se!anj$tn*a a%an &e&"o$%si

an &e!eas%an t"o&bo0an A9 (vaso%ont"i%to" !o%a! *an' oten)+ Se!aina%tivasi t"o&bosit &e&i.$ e"$baan %ono"&asi "eseto" '!i%o"otein IIbIIIa+



Sete!a &en'a!a&i %onve"si $n'sin*a# "eseto" &e&$n*ai a<nitas tin''i

te"aa se%$en asa& a&ino aa "otein aesi *an' !a"$t (inte'"in) see"ti

a%to" von Gi!!eb"an (vG6) an <b"ino'en# i&ana %e$an*a aa!a &o!e%$!

&$!tiva!en *an' aat &en'i%at 9 !ate!et *an' be"bea se.a"a si&$!tan#

&en'asi!%an i%atan si!an' !ate!ets an a'"e'asi+

Kas%ae %oa'$!asi i a%tivasi o!e ajanan tiss$e a.to" aa se! enote!

*an' "$sa%+ 6a%to" 8II an [ i a%tivasi# &en'a%ibat%an %onve"si "ot"o&bin

&enjai t"o&bin# *an' %e&$ian &en'%onve"si <b"ino'en &enjai <b"in+

A"te"i %o"one" *an' te"!ibat %e&$ian a%an &en'a!a&i o%!$si o!e t"o&b$s

*an' te"i"i a'"e'at t"o&bosit an <b"in+ Paa %onisi *an' ja"an'# STEMI

aat j$'a isebab%an o!e e&bo!i %o"one"# abno"&a!itas %on'enita!# sas&e

%o"one" an be"ba'ai en*a%it inJa&asi siste&i% (A!/i# 933:)+

9+7+7 Dia'nosis Dan Pe&e"i%saan

Paa ana&nesis e"!$ itan*a%an en'an !en'%a ba'ai&ana %"ite"ia n*e"iaa *an' i a!a&i asien# siat n*e"i aa aa asien STEMI &e"$a%an

n*e"i aa tii%a! (an'ina)+ 6a%to" "esi%o see"ti ie"tensi#iabetes &e!it$s#

is!iie&ia# &e"o%o%# se"ta "i/a*at en*a%it jant$n' %o"one" i %e!$a"'a

(A!/i# 933:)+

Paa a&i" seten'a %as$s# te"aat a%to" en.et$s sebe!$& te"jai STEMI#

see"ti a%tivitas <si% be"at# st"ess# e&osi# ata$ en*a%it &eis !ain *an'

&en*e"tai+ Ga!a$$n STEMI bisa te"jai seanjan' a"i ata$ &a!a&# tetai

va"iasi si"%aian i !ao"%an aat te"jai aa a'i a"i a!a& bebe"aa ja&

sete!a ban'$n ti$"+

Paa e&e"i%saan <si% i aati asien 'e!isa an tia% bisa isti"aat+

Se"in'%a!i e%t"e&itas $.at i se"tai %e"in'at in'in+ Ko&binasi n*e"i aa

s$bste"na! 73 &enit an ban*a% %e"in'at i .$"i'ai %$at aan*a STEMI+

Tana <sis !ain aa is$n'si vent"i%$!a" aa!a S? an S7 'a!!o# en$"$nan

intensitas jant$n' e"ta&a an s!it a"ao%si%a! b$n*i jant$n' %e$a+ Daat

ite&$%an &$"&$" &isisto!i% ata$ !ate sisto!i% ai%a! *an' be"siat

se&enta"a (A!/i# 933:)+

Se!ain it$ ia'nosis STEMI ite'a%an &e!a!$i 'a&ba"an EK; aan*a e!evasi

ST %$"an' !ebi 9&&# &ini&a! aa $a saaan "e%o"ia! *an'be"a&in'an ata$ %$"an' !ebi 1&& aa 9 saaan e%t"e&itas+

Pe&e"i%saan eni& jant$n'# te"$ta&a t"oonin T *an' &enin'%at#

&e&e"%$at ia'nosis (A!/i# 933:)+

9+7+? Penata!a%sanaan STEMI

Tata!a%sana i "$&a sa%it

I22U A%tivitas# Pasien a"$s isti"aat a!a& 19 ja& e"ta&a+ Diet# %a"ena

"esi%o &$nta an asi"asi se'e"a sete!a ina"% &io%a"# asien a"$s $asa

ata$ an*a &in$& .ai" en'an &$!$t a!a& ?-19 ja& e"ta&a+ Diet



&en.a%$ !e&a% 735 %a!o"i tota! an %an$n'an %o!este"o! 733&'a"i+

Men$ a"$s ie"%a*a se"at# %a!i$&# &a'nesi$&# an "ena nat"i$&+

Bo/e!s# isti"aat i te&at ti$"+ Pen''$naan na"%oti% se"in' &en*ebab%an

ee% %onstiasi sein''a i anj$"%an en''$naan en.aa" "in'an se.a"a

"$tin+

Seasi# asien &e&e"!$%an seasi se!a&a e"a/atan# $nt$%

&e&e"taan%an e"ioe ina%tivasi en'an enenan' (A!/i# 933:)+

Te"ai a"&a%o!o'is

V 6ib"ino!iti%

V Antit"o&boti%

V Inibito" A2E

V Beta-B!o.%e"

9+? Ina"% Mio%a" A%$t Tana E!evasi ST (NSTEMI)

9+?+1 Eie&io!o'i NSTEMI

;eja!a *an' a!in' se"in' i %e!$%an aa!a n*e"i aa# *an' &enjai sa!a

sat$ 'eja!a *an' a!in' se"in' i aat%an aa asien *an' atan' %e I;D #

i e"%i"a%an @#7 j$ta %$nj$n'an ta$n+ Ki"a-%i"a 17 a"in*a i sebab%an

o!e $nstab!e an'ina NSTEMI# an &e"$a%an en*ebab te"se"in'

%$nj$n'an %e "$&a sa%it aa en*a%it jant$n'+ An'%a %$nj$n'an $nt$%asien $nstab!e an'ina NSTEMI se&a%in &enin'%at se&enta"a an'%a STEMI

&en$"$n (Sjaa"$in# 933:)+

9+?+9 Pato<sio!o'i

NSTEMI aat i sebab%an o!e en$"$nan s$!ai o%si'en an ata$

enin'%atan %eb$t$an o%si'en &io%a" *an' ie"be"at o!e obst"$%si

%o"one"+ NSTEMI te"jai %a"ena t"o&bosis a%$t ata$ "oses vaso%onst"i%si

%o"one"+ T"o&bosis a%$t aa a"te"i %o"one" i a/a!i en'an aan*a "$t$"

!a% *an' ta% stabi!+ P!a% *an' tia% stabi! ini biasan*a &e&$n*ai inti !ii

*an' besa"# ensitas otot o!os *an' "ena# <b"o$s .a *an' tiis an%onsent"asi a%to" ja"in'an *an' tin''i+ Inti !e&a% *an' .ene"$n' "$t$"

&e&$n*ai %onsent"asi este" %o!este"o! en'an "oo"si asa& !e&a% ta%

jen$ *an' tin''i+ Paa !o%asi "$t$" !a% aat i j$&ai se! &a%"oa' an

!i&osit T *an' &en$nj$%an aan*a "oses inJa&asi+ Se!-se! ini a%an

&en'e!$a"%an sito%in "oin!a&asi see"ti TN6 # an I,-:+ se!anj$tn*a I,-:

%an &e"an'san' en'e!$a"an s2RP i ati (Sjaa"$in# 933:)+

9+?+7 Dia'nosis Dan Pe&e"i%saan NSTEMI

N*e"i aa en'an !o%asi %as s$bste"na! ata$ %aan' %a!a i ei'ast"i$&

en'an .i"i see"ti i e"as# e"asaan see"ti i i%at# e"asaan te"ba%a"# n*e"i

t$&$!#"asa en$# be"at ata$ te"te%an# &enjai e"sentasi 'eja!a *an'



se"in' i te&$%an aa ene"ita NSTEMI+ ;eja!a tia% %as see"ti isnea#

&$a!# iao"esis# sin%o ata$ n*e"i i !en'an# ei'ast"i$&# ba$ atas ata$

!ee" j$'a te"jai a!a& %e!o&o% *an' !ebi besa" aa asien-asien

be"$sia !ebi a"i :@ ta$n+

;a&ba"an EK;# se.a"a sesi<% be"$a eviasi se'&en ST &e"$a%an a!entin' *an' &enent$%an "esi%o aa asien+

T"oonin T ata$ T"oonin I &e"$a%an e"tana ne%"osis &io%a" *an' !ebi

i s$%ai# %a"ena !ebi sesi<% a"iaa eni& jant$n' t"aisiona! see"ti 2K

an 2K-MB+ Paa asien en'an ina"% &io%a" a%$t# enin'%atan a/a!

t"oonin aa ae"a e"ie" sete!a 7-? ja& an aat &eneta sa&ai 9

&in''$ (Sjaa"$in# 933:)+

9+?+? Penata!a%sanaan NSTEMI

Pasien NSTEMI a"$s isti"aat ite&at ti$" en'an e&anta$an EK; $nt$%eviasi se'&en ST an i"a&a jant$n'+ E&at %o&onen $ta&a te"ai a"$s

ie"ti&ban'%an aa setia asien NSTEMI *ait$

V Te"ai antiis%e&ia

V Te"ai anti !ate!etanti%oa'$!an

V Te"ai invasi (%atete"isasi ini "evas%$!a"isasi)

V Pe"a/atan sebe!$& &enin''a!%an RS an ses$a e"a/atan RS+

9+@+ Ko&!i%asi Sin"o&a Ko"one" A%$t

1+ S*o% Ka"io'eni%

9+ A"it&ia Ma!i'nant

7+ ;a'a! Hant$n'

?+ Me.ani.a! "$t$"# MR a%$t# 8SD

@+ ;an''$an >anta"an

9+:+ Henis-Henis Obat Sin"o&a Ko"one" A%$t

9+:+1 Antiis%e&i%

NITRAT Nit"at aat &en*ebab%an vasoi!atasi &b$!$ vena an a"te"io!

e"ie"# en'an ee% &en'$"an'i "e!oa an ate"!oa sein''a aat

&en'$"an'i /a!! st"ess an %eb$t"$an o%si'en+ Nit"at j$'a &ena&ba

o%si'en s$!ai en'an vasoi!atasi e&b$!$ %o"one" an &e&e"bai%i a!i"an

a"a %o!ate"a! (Tja*# 933@)+

Nit"o'!ise"in '!ise"i!t"init"at# t"init"it#nit"ostat# nit"oe"&TTS (!este")+ T"init"at

a"i '!ise"o! ini (14@9)#seba'ai&ana j$'a nit"at !ain*a be"%asiat "e!a%sasiotot e&b$!$# b"on.ia# sa!$"an e&e$# !a&b$n'-$s$s# an %e&i+



Be"%asiat vasoi!atasi be"asa"%an te"bent$%n*a nit"o'eno%sia (NO) a"i

nit"at i se!-se! e&b$!$+ NO ini be%e"ja &e"e!a%sasi se!-se! ototn*a#

sein''a e&b$!$# te"$ta&a vena &eni!atasi en'an !an's$n'+ A%ibatn*a#

Te%anan a"a t$"$n en'an esat an a!i"an a"a vena *an' %e&ba!i %e

jant$n' ("e!oa) be"%$"an'+ Pen''$naan o%si'en jant$n' &en$"$n an

beban*a i%$"an'i+ A"te"i %o"one" j$'a i e"!eba"# tetai tana ee% !an's$n'te"aa &io%a"+

Nit"at o"'ani% iabso"bsi en'an bai% !e/at %$!it# &$%osa s$b!in'$a!# an

o"a!+ Pen''$naan*a e" o"a! $nt$% &enan'$!an'i se"an'an an'ina a%$t

se.a"a ee%ti# be'it$ $!a seba'ai "o<!a%sis jan'%a ene%# &isa!n*a

!an's$n' sebe!$& &e!a%$%an a%tivitas be"tena'a ata$ &en'aai sit$asi

!ain *an' aat &en'in$%si se"an'an+ Se.a"a int"avena i '$na%an aa

e%o&ensasi te"tent$ ste!a ina"% jant$n'# ji%a i'o%sin an i$"eti%a

%$"an' &e&be"i%an asi!+

Reso"si n*a a"i $s$s bai%# tetai &en'a!a&i 6PE (<"st ass e\e.t) a&at

tin''i in''a an*a sei%it obat &en.aai si"%$!asi besa"+ "otein !as&a

%$"an' !ebi :35# /a%t$ a"$ 1-? &enit+ Di a!a& ati an e"it"osit# at ini

.eat i "o&ba% &enjai &etabo!it %$"an' a%ti en'an asi! a%i" '!ise"o!

an .o9+ Seba!i%n*a# abso"bsi s$b!in'$a! ata$ o"o&$%osa! .eat se%a!i %a"ena

&en'ina"i <s"t ass e\e.t+ Ee% n*a ses$a 9 &enit an be"taan se!a&

73 &enit+ Abso"bsin*a a"i %$!it (t"ans%$tan) j$'a bai%# &a%a i '$na%an $!a

a!a& bent$% sa!e an !este" en'an e!easan te"at$" (Tja*# 933@)+

To!e"ansi $nt$% ee% an'inan*a aat te"jai esat aa en''$naan o"a!#

t"ans%$tan an int"a vena se.a"a %ontini$# se"ta aa osis !ebi tin''i+ ;$na&en'ina"%an*a# ena%n*a iaa%an &asa bebas nit"at se!a&a %$"an'

!ebi 13 ja&a"i+ Te"ai sebain*a jan'an i enti%an se.a"a &enaa%#

&e!ain%an be"an's$"-an's$" '$na &en.e'a "ea%si ena"i%an+

Dosis aa se"an'an a%$t an'ina e%to"is i be"i%an se.a"a s$b!in'$a! (i

ba/a !ia) 3#? 1 &' seba'ai tab!et# sa* ata$ %as$! (a"$s i'i'it)# ji%a

e"!$ aat i $!an' ses$a 7 @ &enit+ Bi!a ee% s$a i.aai obat a"$s

i %e!$a"%an a"i &$!$t (Tja*# 933@)+

Iso"bia-init"at iso"i!# so"biin# .eo.a"+ De"ivat-nit"at si%!is ini (14?:)

sa&a %e"jan*a en'an nit"o'!ise"in# tetai be"siat !on'-a.tin'+ Di inin'

e&b$!$ at ini i $ba &enjai nito'eno%sia (NO) *an' &en'a%tivasi

eni& '$ani!si%!ase an &en*ebab%an enin'%atan %aa" .;MP (.*.!o-

'$ani!&onoosate) i se! otot o!os an &eni&b$!%an vasoi!atasi+ Se.a"a

s$b!in'$a! %e"jan*a a!a& 7 &enit an be"taan sa&ai 9 ja&# se.a"a s"a*

&asin'-&asin' 1 &enit an 1 ja&# sean'%an o"a! &asin'-&asin' 93 &enit

an ? ja&+

Reso"sin*a j$'a bai%# tetai %a"ena <"st ass e\e.t besa"# bioavaibi!itas n*a

an*a %$"an' !ebi 945# "otein !as&a %$"an' !ebi 735# /a%t$ a"$ 73-

:3 &enit+ Di a!a& ati at ini i "o&ba% esat &enjai 9 &etabo!it a%ti





Perbedaan UA .S/0M" S/0M"

.yeri ada 93 Menit Be"at 73 &enit

03; ST De"esi ST De"esi ST E!evasi#

ato!o'is

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93M:D/rop

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