KL0AwA1UARuRA1AN PAUA 1AN1uN0

ln: lntensive Review lor 1he Lmereenov Medioine 0ualifvine Lxamination,

edited bv Robert essler, MU, 1aku 1aira, MU, Mo0raw-ill, 2010, Pe 108- 219
LEH :
MARIA PENTANIA RAFRA
C111 06 055
PEMBIMBING :
dr. RIYANTI KASIM
SUPERVISOR:
dr. RATNAWATI, SpAn
DIBAWAKAN DALAM RANGKA TUGAS KEPANITERAAN KLINIK
BAGIAN ANASTESIOLOGI TERAPI INTENSIVE DAN MANAJEMEN NYERI
FAKULTAS KEDOKTERAN
UNIVERSITAS HASANUDDIN
MAKASSAR
ANA10Ml
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P SKLUS JANTUNG
P SSTEM KONDUKS JANTUNG
PLNAKl1 1AN1uN0 l3KLMlK UAN
PLNAKl1 1AN1uN0 K0R0NLR
JEJAS
ATHEROSKEROSIS
PLAK TIDAK
STABIL
RUPTUR PLAK
ATHEROTROMBOSIS
OKLUSI
ISKEMIA
INFARK
P Suplai darah yang tidak cukup ke
miokardium
P Pengangkutan oksigen yang tidak adekuat
P Kebutuhan oksigen miokardium yang
meningkat
PATOGENESIS PATOGENESIS
Gangguan transport lipid
Inflamasi
Deposisi plak
bersatu bersatu
Plaque diam Plaque diam Plaque rupture Plaque rupture
Erosi Erosi
Angina pectoris stabil Angina pectoris stabil
Thrombosis Thrombosis
Thrombus Thrombus
Sindroma koroner akut:
W Unstable angina
W Myocardial infarction :
- Non Q waves
- Q waves
W Sudden death
Ku!Iah PJK, 2004 Ku!Iah PJK, 2004 66
UlA0N03l3
W EKG
W BIOMARKER JANTUNG
W TREATMILL TEST
W ECHOCARDIOGRAPH
W STRESS ECHO
M0CARUlAL lNlARC1l0N M0CARUlAL lNlARC1l0N
M0CARUlAL lNlARC1l0N M0CARUlAL lNlARC1l0N
Acute inferior myocardial infarction Acute inferior myocardial infarction
M0CARUlAL lNlARC1l0N M0CARUlAL lNlARC1l0N
Septal wall myocardial infarction Septal wall myocardial infarction
M0CARUlAL lNlARC1l0N M0CARUlAL lNlARC1l0N
Extensive (whole) anterior myocardial infarction Extensive (whole) anterior myocardial infarction
M0CARUlAL lNlARC1l0N M0CARUlAL lNlARC1l0N
nferior wall myocardial infarction with a possible nferior wall myocardial infarction with a possible
posterior wall infarction posterior wall infarction
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Nitrogliscrin
Antikougulun
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1rombolitik oun kutctcrisusi iuntung
0aeal 1antune Koneestif
P O= HR X SV
P SV ditentukan oleh:
Respon kompensatorik Cl untuk mempertahankan
Cardiao output
Peningkatan
aktivitas
adrenergik
simpatis
Aktivasi
sistemRAA
Hipertrofi
ventrikeI
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Duouk tcguk. Diurctik. Nitrut. Morlin
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PLNAKl1 KA1uP 1AN1uN0
ang paling sering dijumpai:
P Stenosis Mitral
P Regurgitasi Mitral
P Stenosis aorta
P Regurgitasi aorta
Mitral 3tenosis
Hipertrofi atrium kiri
DiIatasi atrium kiri
Kongesti vena puImonaIis
Kongesti paru Hipertensi paru
Hipertrofi ventrikeI kanan CO
terfiksasi
1erapi
P Atrium Fibrilasi Anti aritmia
P Pencegahan embolisasi sistemik
P Valvulotomi mitral perkutan dengan balon
3tenosis Aorta
Hipertrofi ventrikeI kiri
VentrikeI kiri memperbesar
tekanan dan memperpanjang
waktu ejeksi
TimbuI gejaIa- gejaIa progresif,
titik kritis pada stenosis aorta
1erapi
P Angina Nitrogliserin
P Tanda- tanda gagal jantung Diuretik dan
digitalis
P Operasi katup jantung
Iugat Kembaii.
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Prolonged PR interval
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ORS ORS
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Left bundle branch block
P P Supraventricular Supraventricular Tachycardia Tachycardia
O O Rate : 150 Rate : 150- -250 250 bpm bpm
O O Rhythm : regular Rhythm : regular
O O P waves : frequently buried in preceding T waves P waves : frequently buried in preceding T waves
O O PR interval : usually not possible to measure PR interval : usually not possible to measure
O O QRS : normal QRS : normal
P P Atrial Atrial Flutter Flutter
O O Rate : Rate : atrial atrial : 250 : 250 350 350 bpm bpm; ventricular : slow/fast ; ventricular : slow/fast
O O Rhythm : usually regular Rhythm : usually regular
O O P waves : "saw teeth appearance P waves : "saw teeth appearance
O O PR interval : variable PR interval : variable
O O QRS : usually normal, may be widened QRS : usually normal, may be widened
O O onduction ratio : 2:1, 4:1, 6:1 onduction ratio : 2:1, 4:1, 6:1
P P Atrial Atrial Fibrillation ( Fibrillation (AFib AFib) )
O O Rate : Rate : atrial atrial : > 350 : > 350 bpm bpm; ventricular : slow/fast ; ventricular : slow/fast
O O Rhythm : irregular Rhythm : irregular
O O P waves : no true P waves; chaotic P waves : no true P waves; chaotic atrial atrial activity activity
O O PR interval : none PR interval : none
O O QRS : normal QRS : normal
P P Ventricular Tachycardia Ventricular Tachycardia
O O Rate : 100 Rate : 100 250 250 bpm bpm
O O Rhythm : regular Rhythm : regular
O O P waves : none or not associated with QRS P waves : none or not associated with QRS
O O PR interval : none PR interval : none
O O QRS : wide (>0.10 sec), bizarre appearance QRS : wide (>0.10 sec), bizarre appearance
P P Ventricular Fibrillation Ventricular Fibrillation
O O Rate : indeterminate Rate : indeterminate
O O Rhythm : chaotic Rhythm : chaotic
O O P waves : none P waves : none
O O PR interval : none PR interval : none
O O QRS : none QRS : none
P P Atrial Atrial Extrasystole Extrasystole (AES) / Premature (AES) / Premature Atrial Atrial ontraction (PA) ontraction (PA)
O O Rhythm Rhythm : irregular due to the premature beat : irregular due to the premature beat
Rate Rate : depends on its basic rhythm : depends on its basic rhythm
PP wave wave : unusual compare to basic rhythm : unusual compare to basic rhythm
PR interval PR interval : normal, maybe shorten : normal, maybe shorten
QRS QRS : normal : normal
LX1RA3310LL LX1RA3310LL
P P Ventricular Ventricular Extrasystole Extrasystole (VES) / Premature Ventricular (VES) / Premature Ventricular
ontraction (PV) ontraction (PV)
O O Rhythm Rhythm : irregular due to the premature beat : irregular due to the premature beat
Rate Rate : depends on its basic rhythm : depends on its basic rhythm
PP wave wave : none : none
PR interval PR interval : none : none
QRS QRS : > 0.12 sec : > 0.12 sec
O O Threatening VES : Threatening VES :
'R on T' VES 'R on T' VES
VES > 6 times/min VES > 6 times/min
Bigemini Bigemini VES VES
Multifocal VES Multifocal VES
onsecutive VES onsecutive VES
LX1RA3310LL LX1RA3310LL