4. dr dan dc
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drdcTRANSCRIPT
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KEL. JANTUNG DIDAPAT (ACQUIRED)KEL. JANTUNG DIDAPAT (ACQUIRED) KELAINAN JANTUNG KARENA INFEKSI KELAINAN JANTUNG KARENA INFEKSIDI INDONESIA YANG TERBANYAK:DI INDONESIA YANG TERBANYAK:1.DEMAM REUMATIK(DR), 2. DIFTERIA DAN 1.DEMAM REUMATIK(DR), 2. DIFTERIA DAN 3.ENDOKARDITIS LENTA3.ENDOKARDITIS LENTA1.DEMAM REUMATIK: OK MENYEBABKAN 1.DEMAM REUMATIK: OK MENYEBABKAN KEL. JANTUNG KE-2 PADA ANAK SETELAH KEL. JANTUNG KE-2 PADA ANAK SETELAH KEL.JANTUNG KONGENITAL DI USA. KEL.JANTUNG KONGENITAL DI USA. DI INDONESIA DR DI INDONESIA DR PENYEBAB UTAMA.PENYEBAB UTAMA.DR PERLU DIDIAGNOSA CEPAT, DAN DIOBATI DR PERLU DIDIAGNOSA CEPAT, DAN DIOBATI SEGERA SEGERA DPT MENCEGAH KEL. KATUP J.DPT MENCEGAH KEL. KATUP J.[BIAYA BANYAK & ANGKA KEMATIAN TINGGI][BIAYA BANYAK & ANGKA KEMATIAN TINGGI]
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INSIDENS ± 3% PADA MASA EPIDEMIK DAN INSIDENS ± 3% PADA MASA EPIDEMIK DAN INSIDENSNYA ± 0.3% PD MASA ENDEMIK INSIDENSNYA ± 0.3% PD MASA ENDEMIK ETIOLOGINYA:STREP. BETA HEMOL.GRUP A, ETIOLOGINYA:STREP. BETA HEMOL.GRUP A, -DR SERING TERJADI BERSAMAAN URI-DR SERING TERJADI BERSAMAAN URI-ASRAMA MILITER, KELOMPOK MASY. YG -ASRAMA MILITER, KELOMPOK MASY. YG TERISOLIR SERING EPIDEMI. TERISOLIR SERING EPIDEMI.-INSIDENS DR PARALEL DGN INSIDENS URI -INSIDENS DR PARALEL DGN INSIDENS URI OK GABHS. OK GABHS.
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Pathology :-Aschoff bodies antigen presenting cells- Acute phase : inflammation process
in pericard, myocard & pericard- Chronic phase : injury of the valve- Difference of clinical and pathologi cal manifestation in some countries- Host immunological response take main role in clinical manifesta tion
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Diagnosis :Diagnosis :
1944 : Dr.T.Duckett Jones : Jones Criteria 1944 : Dr.T.Duckett Jones : Jones Criteria 1955 : Modification of Jones Criteria1955 : Modification of Jones Criteria
1965 & 1984 : Revised of Jones Criteria1965 & 1984 : Revised of Jones Criteria
1992 : Update Jones Criteria1992 : Update Jones Criteria
Jones Criteria (focused) Jones Criteria (focused)
Problems : over diagnosis or under Problems : over diagnosis or under diagnosis diagnosis
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1965 Jones Criteria (revised)• Major
manifestation • Carditis• Polyarthritis• Chorea• Subcutan nodule• Erythema
marginatum
• Minor manifestation
• Fever• Arthralgia• Prolonged PR
interval ECG• Increase BSR• C reactive protein
(+)• Leucocytosis• Previous history
RF / RHD inactive
Evidence of previous Strept. Infection CULTURE / ASTO
Diagnosis
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1992 Jones Criteria (Updated)Major manifestation CarditisPolyarthritis ChoreaSubcutan noduleErythema margina tum
Minor manifestationFeverArthralgiaIncrease BSRC reactive protein (+) LeucocytosisProlonged PR interval ECG
Evidence of previous Strept. infection
Diagnosis
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13.
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GABHS – Cardiogenik GABHS – Cardiogenik Rheumatic fever / RHD - pathogenesisRheumatic fever / RHD - pathogenesis
Jones Criteria Mayor “CAPOCHES”
19.
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Treatment RF & RHD• 1. Primary preventions :• to eradicate Streptococcal infectcion : • during acute RF attack• 2. Secondary prevention :• to prevent relaps of cute RF• 3. Relief the symptoms :• - carditis / CHF• - arthritis• - Chorea
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Treatment RF & RHD
•1. Primary prevention :• 1. Benzatine PNC G injection 1 X / i.m.• (BW > 27 kg 1,2 million unit)• (BW < 27 kg 600.000 unit)• 2. Pencilline V : 250 mg/400.000 unit QID• / oral : 10 days• Erythromycine : 40 mg /kg BW / day• TID-QID / oral : 10 days• Clindamycine, Nafcillin, Amoxycillin, • Cefalexin
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•Duration secondary prevention•Categori Duration
• RF with carditis & permanent minimal 10 years• valve abnormalities until 40 yrs or longlife
• RF with carditis without perma 10 years or until• nent valve abnormalities adult
• RF without carditis 5 years or until 21 years
Treatment RF & RHD
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Relief the symptoms
•A. Carditis :• Anti inflammatory • - Carditis : Prednison : 2 mg/kg BW/day tapp.
– 2-6 weeks off– - Mild Carditis : Aspirin 90-100 mg/kg BW 4-6– 4-8 weeks week
•B. Arthritis• - Aspirin : 100 mg/kg BW/ day : 2 weeks• 2-3 weeks : doses decrease
Treatment RF & RHD
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•C. Heart Failure :• - Bedrest - Digoxin• - Diuretics - Vasodilator• - Fluid & salt restriction•D. Chorea :•- Physical stres & emotional must be controlled•- Anti inflammation drug : controversial•- Phenobarbital : 15-30 mg TID-QID•- Haloperidol : 0,5 mg ---> 2 mg TID•- Valproic acid / Chlorpromazine / Diazepam
Treatment RF & RHD
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Table. Guidelines for Bed Rest and Ambulation and Recommended antiinflammatory agents
• Arthritis Carditis Carditis Carditis• alone minimal moderate severe•Bed Rest 1-2 wk 2-3 wk 4-6 wk 2-4 mo•Indoor ambulation 1-2 wk 2-3 wk 4-6 wk 2-3 mo•Outdor activity 1-2 wk 2-3 wk 4-6 wk 2-3 mo•(school)•Full activity 1-2 wk 2-3 wk 4-6 wk 2-3 mo
•Prednisone 0 0 2-4 wk 2-6 wk•Aspirin 0 0 2-4 wk 2-6 wkMinimal Carditis Questionable cardiomegaly ; Moderate carditis definite but mild cardiomegaly, Severe carditis, marked cardiomegaly or CHF
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Surgical treatment and invasive intervention•Surgical treatment :•1. Valve Replacement :• - MR• - MS• - AR•2. Valvuloplasty
•Invasive Intervention :•- Ballon Mitral Valvuloplasty (BMV) with • Inoue ballon : MS
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DCDCDecompensatio CordisDecompensatio Cordis
Gagal JantungGagal Jantung
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Conto: Mitral insuffisiensiSetiap ventric.sist, ada darah naik ke Atrium Kilama2Stagnasi di Atrium Ki V.Pulm. vasc.paru pe-numpukan cairan inf. Batuk kronik.
darah masuk ke Ao Jantung kerja keras (HR=Tachycardia)Jantung membesar (Cardiomegali), Bila kerja,perlu O2 banyak napas
(Dyspnoe d’effort, sampai orthopnoe ). Tanda2 DC kiri
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PS darah berkurang masuk ke A.Pulm. Darah banyak ter kumpul dalam V.Ki, A.Ki VCS (TVC) VCI (Hepatomegali) Edem pretibial, Edema dorsal pedis, Ascites Jantung kerja keras (Cardiomegali) dan Kalau kerja sesak napas (Tachypnoe). Freq.Jantung naik (Tachycardi)
Tanda DC Kanan
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PENGOBATAN DCPENGOBATAN DC1. DIGITALIS1. DIGITALIS2. DIURETIK2. DIURETIK
Dosis dan cara pemberianDosis dan cara pemberianharus diperlajari baik-baikharus diperlajari baik-baik
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Terima kasih