IT 7 - Penyakit Jantung Katup - ALG
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Transcript of IT 7 - Penyakit Jantung Katup - ALG
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VALVULAR HEART DISEASE
Ali Ghanie
Subbagian Kardiologi Bagian Ilmu Penyakit Dalam FK UNSRI Palembang
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ETIOLOGY
• DEGENERATIF (AGING) • INFILTRATIF (STORAGE DISEASE) • HERRITABLE DISORDERS OF CONN, TISSUE • ISCHEMIC• RHEUMATIC HEART DISEASE• RHEUMATOID ARTHRITIS, SYPHILIS,
COLLAGEN VASC. DISEASE• TUMOR • INFECTIVE
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GENERAL ASPECT
• Valve disorder is related to opening and closing, stenosis or regurgitation
• Generally all the valve can be affected• The most valve affected is mitral and
aortic, while Tricuspid and Pulmonary valve are less and mostly functional or congenital
• Can be isolated or combination
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PATHOGENESIS AND PATHOLOGY OF VALVULAR HEART DISEASE
• Dimulai dari studi patologi Jesse Edward, Ariela Pomerance, William C Roberts yang merupakan pioner penyakit jantung katup. Sejak itu pula dikenal gangguan katup akibat proses degeneratif pada usia lanjut, selain demam rematik.
• Barlow’s dengan studi degenerasi miksomatus, yang merupakan penyebab tersering dari insufisiensi mitral, dan penyebab tersering dari operasi katup mitral.
Perkembangan dalam penyidikan, terutama ekho, memungkinkan diagnosis dini, serta kemajuan tehnik operasi membuat reparasi dan penggantian katup, dan timing operasi lebih presisi.
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MITRAL STENOSIS• PROTOTIPE RHD • DAPAT KONGENITAL, KALSIFIKASI ANULUS • MV PALING SERING TERKENA • 50% RIWAYAT RHD / CHOREA (-)
NORMAL : 2 DAUN DENGAN UKURAN TTP LUASNYA SAMA
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PATOLOGI
• BISA SENDIRI / KOMBINASI
PENEBALAN VALVE DENGAN / TANPA KLASIFIKASI FUSION CUSP
(COMMISURE), SHORTENING / FUSION OF CHORDA TENDINAE
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STAGE DARI MS
1. MINIMAL MVA (Cm2) 2. MILD > 2.5 3. MODERATE 1.4 – 2.5 4. SEVERE < 1.0 5. REACTIVE P.H < 1.0
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SIMPTOM & KOMPLIKASI
• PULMONARY VENOUS HIPERTENSION– DYSPNEA, ORTHOP, PND – ACUTE PULM. EDEMA (PC > 25 MHG) – HEMOPTYSIS RINGAN BERAT – BRONCHITIS
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• PULM. VASC. DISEASE
Reactive Pulmonary Artery Hypertension
Right Ventricular Hypertension
Hoarseness
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• LAIN-LAIN
ATRIAL FIBRILATION EMBOLI SISTEMIK INFEKTIF ENDOKARDITIS
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PENATALAKSANAAN
• Obat yang besifat suportif, mengurangi edema, menurunkan frekwensi jantung dll
• Mekanikal beupa tindakan non bedah valvuloplasti mitral dengan balon, atau tindakan bedah reparasi, atau penggantian katup.
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MITRAL REGURGITATION
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Etiologi 1. Chronic RHD2. Ruptur Chorda3. Mitral Valve Prolapse4. Ischemic Papillary Muscle Dysfunction5. Hypertrophic Cardiomyopathy6. Post Radiation Therapy7. Infektif Endokarditis8. Carcinoid9. Congenital Valve Diasease
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Faktor-Faktor yang Mempengaruhi Pembukaan / Penutupan
1. Ukuran posisi valve2. Panjang insersi chorda3. M. Papilaris4. Ukuran / bentuk LV5. Ukuran dari anulus
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MITRAL REGURGITASI :
1. Primer
2. Sekunder
Harus dibedakan
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KLINIS TERGANTUNG :
1. Derajat MR2. Kecepatan Progresi3. Timbulnya AF4. Timbulnya Pulm. Hipertension5. Endokarditis6. Adanya CAD
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SYMPTOM & SIGN• SERING ASYMPTOMATIC ok kemampuan
adaptasi LA besar• Bila regurgitant volume >> stroke volume
SYMPTOMATIC• Fatigue, Dispnea D’Effort, PND, orthopnoe• Palpitasi (ext. Sistole)• Gejala-Gejala Af – Emboli• Gejala Endokarditis
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FISIS
• Irama sering AF; Collapsing pulse• Jvp normal, kecuali RF failure• Apical impulse hyperkinetik ke kiri bawah• Thrill systolic, systolic parasternal lift. • Right vent. Heave bila RV failure• S3, kadang-kadang diastolic murmur (bukan
MS)• S1 bisa normal, lemah, atau keras• Pan systolic murmur, blowing, high frekwensi
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PEMERIKSAAN
• EKG NSR, AF, LVH• Rontgen, terjadi pembesaran ventrikel kiri,
dan atrium kiri • Phonocardiography• Echocardiography • Catheterization
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DD/
1. TRICUSPID REGURGITATION2. AORTIC STENOSIS3. VENTRICULAR SEPTAL DEFFECT
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THERAPY :
1. Medical therapy tergantung klasifikasi NYHA
2. Surgical Valve Replacement, valve repair
3. Mitral clip
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INFLAMASI : – Rheumatic Fever,– Syphilis, – Rh. Arthritis, – SLE, – Ankyosing Spondylitis, – Reiter Syndrome, – Takayasu,– Methysergide Therapy
AORTIC REGURGITATION
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DISRUPTIVE • Infective Endocarditis• Trauma• Dissection of Aorta
CONGENITAL :Marfan ; Ehler – Danlos ; Pseudoxanthoma Elasticum . Osteogenesis Imperfecta ; Myxomatous Degenaration VSD
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STRUCTURAL
• UNICUSPID / BICUSPID VALVE • SINUS VALVE ANEURYSMA• FENESTRASI AORTIC VALVE• AORTIC ANEURYSM
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STRESS :- Hypertension- Renal Failure
KLINIS : - Bisa Asimptomatik bbp tahun - Angina ; tanda-tanda LV Failure- Angina OK Selerosis atau tekanan
diastolik (wide pulse pressure)- Abdominal pain infarct bowel palpitation (forceful contraction)
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Klinis
- Karakteristik Fisis- Pulse Presure besar, Water Hamer
Pulse (Corrigan’s Pulse)- LV Heave- M Diastolic, Blowing High Pitch- Austin Flint m- Periferal Arterial Pulsation
continue
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- Karakteristik Fisik :• De musset’s sign goyang kepala • Landolfi’s sign mata (pupil)• Muller’s sign uvula• Gerhardt’s sign spleen• Quincke’s sign kuku • Pistol shot femoral artery (systole)• Traube’s sign femoral artery
(systole/diastole)• Duroziez’s sign bruit femoral artery• Hill’s sign TD popliteal > brachial
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- E K G- E C H O- RONTGEN
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AORTIC STENOSIS
Menurut Lokasi : 1. Valvular 2. Subvalvular 3. Supravalvular
CONGENITAL / ACQUIREDValvular Acquired Rheumatic Fibrocalcifikasi
B1 / Tricuspid
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CONGENITAL Unicuspid Unicomisural Tricuspid dgn FUSI
Commisura Hypoplastic Anulus
SUBVALVULAR HOUR GLASS
HIPOPLASTIK MEMBRANOUS
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Etiologi : 1/3 disertai MS /MI OK Rheumatic 2/3 isolataed AS/AI NON Rheumatic
Klinis :• Sincope, Dizzines, Angina, tanda-tanda
LV failure• m Sistolik, Ejection, LSK ICS II• Dapat disertai AR blowing m diastolik • Spliting bunyi 2 paradox (a2 ) pulsus
tardos
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LAB
• EKG, LVH & LV STRAIN, dapat juga LAH• Rontgen shoe heart, poststenotic
dilation• Ekhokardiogram• Medical Simptomatis• Surgical Comisurotomi Valvuloplasty
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1. VALVULAR PALING SERING2. INFUNDIBULAR (SUBVALLULAR)3. PULMONARY ARTERY STENOSIS
(SURRA VALVULAR)
PULMONAL STENOSIS
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VALVULAR PULMONIC STENOSIS • Sama• Sering dengan kelainan kongenital lain
– ASD, VSD, TOF– PAS– AS (SUP. VALV)
• Biasanya stabil (tidak progres OK. Fibrosis / CALC). Stenosis bisa OK Infundibular Hipertrophy
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Klinis• Sering Asimptomatik, bila td rv 100 mmHg
(sistolik)• Tanda-tanda kelainan kongenital• tanda R-L shunt bila ada defek septum (Central
Cyanosis)• RV – Lift• Biasanya Thrill (+)• P2 biasanya melemah ; Systolic Ejection Click (+)• Systolic M OK PS ; dapat pula OK TR• KG RVH• Thorax Foto Post Stenoti Dilatation• Ekhokardiography
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PULMONIC REGURGITASI
• Umumnya Benigna• Jarang Isolated secara kongenital,
biasanya dengan VSD : TOF • Biasanya – B1 / QUODRI – CUSPID• Sekunder pada Pelebaran PA• Infektif Endokarditis (Rheumatic)
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Klinis• Asimptomatik, kecuali pulm hypertension• RV impulse kadang-kadang (+), pulsasi PA• Kadang-kadang (+)• Thrill (+) • P2n • Splitting 2nd sound (RVstroke vol & Pulm.A.
Dilation) • Ejection Click • m Diastolic RV Austin Flint m Graham Still m
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EKG : N / RVHRONTGEN : JANTUNG KANAN >
SEGMEN PA >> HILLAR DANCE THERAPY : TIDAK KHUSUS
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Etiologi :– RHD, PVLM Hypertensi, RV Failure
Trauma, Kongenital, TV Prolapse, Ebsten Endokarditis, MCI, Endomyocard, Fibrosis
– Jarang Kawat Pace Maker, Hipertiroidi • 15% RHD Organik, Inkompetence > Stenotik• Perbandingan 2 : 1 • Umumnya disertai MS & > Dominan
TRICUSPID REGURGITATION
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KLINIS :
• Riwayat Simptomatik Lama• Progresive Fatigue, Edema, Anoreskia• Minimal Orthopne, PND• Wasting / Cahexia (Anorexia, Metabolik
, prot ) • Cyanosis• Jaundice
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Klinis
• Venous Pulse (leher) { Ventricularized Venous Pulse } DD / Carotid Pulse Antecubiti ; Varicose Vein, Hepatic • Lift Parasternal • Sistolik m Sternal Bawah Kiri ; Xiphoid
ME Dgn Inspirasi
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Klinis
• Kadang-kadang Diastolik M High Flow• Hepar >> • Edema / Ascites (Pressure & Renal NA
Retention Hipoalbuminemia)
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LAB : 1. EKG2. RONTGEN3. EKHO THERAPY :1. Medical2. Surgical
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TRICUSPID STENOSIS
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