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    Gagal Jantung Akut

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    noir
    This document discusses acute heart failure (AHF), including its definition, pathophysiology, clinical subsets, diagnostic studies, treatment, and medications. AHF is the new onset or worsening of heart failure signs and symptoms requiring urgent treatment. It has three phases - initiation, amplification, and a vicious cycle. There are six clinical subsets of AHF including acute decompensated heart failure, hypertensive AHF, pulmonary edema, ACS with HF, cardiogenic shock, and right heart failure. Treatment involves optimizing chronic therapies, diuretics, vasodilators, inotropes, and mechanical circulatory support as needed.

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    Gagal Jantung Akut

    Uploaded by

    noir
    99 views30 pages
    This document discusses acute heart failure (AHF), including its definition, pathophysiology, clinical subsets, diagnostic studies, treatment, and medications. AHF is the new onset or worsening of heart failure signs and symptoms requiring urgent treatment. It has three phases - initiation, amplification, and a vicious cycle. There are six clinical subsets of AHF including acute decompensated heart failure, hypertensive AHF, pulmonary edema, ACS with HF, cardiogenic shock, and right heart failure. Treatment involves optimizing chronic therapies, diuretics, vasodilators, inotropes, and mechanical circulatory support as needed.

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    This document discusses acute heart failure (AHF), including its definition, pathophysiology, clinical subsets, diagnostic studies, treatment, and medications. AHF is the new onset or worsening of heart failure signs and symptoms requiring urgent treatment. It has three phases - initiation, amplification, and a vicious cycle. There are six clinical subsets of AHF including acute decompensated heart failure, hypertensive AHF, pulmonary edema, ACS with HF, cardiogenic shock, and right heart failure. Treatment involves optimizing chronic therapies, diuretics, vasodilators, inotropes, and mechanical circulatory support as needed.

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    © All Rights Reserved
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    Download as pptx, pdf, or txt
    99 views30 pages

    Gagal Jantung Akut

    Uploaded by

    noir
    This document discusses acute heart failure (AHF), including its definition, pathophysiology, clinical subsets, diagnostic studies, treatment, and medications. AHF is the new onset or worsening of heart failure signs and symptoms requiring urgent treatment. It has three phases - initiation, amplification, and a vicious cycle. There are six clinical subsets of AHF including acute decompensated heart failure, hypertensive AHF, pulmonary edema, ACS with HF, cardiogenic shock, and right heart failure. Treatment involves optimizing chronic therapies, diuretics, vasodilators, inotropes, and mechanical circulatory support as needed.

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    © All Rights Reserved
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    of 30

    GAGAL JANTUNG AKUT

    ACUTE HEART FAILURE

    dr. Jusdiono, SpJP, FIHA

    DEFINISI
    New onset or recurrence of gradual of rapidly

    worsening signs and symptoms of HF requiring


    urgent or emergency treatment
    1. Cepat
    : Disfungsi Mendadak
    2. Preload - Afterload Mismatch
    3. Dapat terdapat pada pasien dengan/ tanpa
    kelainan jantung sebelumnya (Mis. Transfusi
    overload)

    3 KOMPONEN GJ
    1. Symptomps : Cape / Sesak
    2. Signs

    : Oedem / Ronchi / Tachycardia


    3. Evidence : Cardiomegaly / S3 Gallop /
    Murmur / Echo

    PATOFISIOLOGI
    3 Fase :
    1. Fase Inisiasi
    2. Fase Amplifikasi
    3. Fase Vicious Cycle

    PATOFISIOLOGI
    Fluid retention
    Capillary interstitial fluid exchange ( pulmonary

    oedema)
    Myocardial pump performance
    Extra cardiac pathologies

    6 SUBSET KLINIS GJA


    1. ADHF ( Acute on chronic )
    2. Hypertensive AHF
    3. Pulmonary Oedema
    4. ACS and HF ( Acute de novo )
    5. Cardiogenic Shock
    6. Right Heart Failure

    ADHF
    1. Environmental : Excess salt and fluid (24%)
    2. Noncompliance with medication (24%)
    3. Adverse medication efforts (16%)
    CCB
    Antiaritmic
    NSAID
    Corticosteroids
    Alcohol

    ADHF
    4. Cardiovascular
    Acute

    Ischemia / Infarction
    Pulmonary Embolism
    Uncontrolled Hypertension
    Aritmia
    Worsening of valve disfunction, endocarditis

    ADHF
    5. Extra Cardiac Illness
    Sepsis,

    Infection, Hypoxia
    Renal Failure
    Thyroid Disease
    Anemia, Blood loss
    Sleep apnea
    Bilateral renal artery stenosis

    HEMODYNAMIC SUBSET

    Cardiac Index
    L/min/m2

    Warm and Dry

    Warm and Wet

    Cold and Dry

    Cold and Wet

    2,2

    18
    PCWP or LVEDP

    HEMODYNAMIC SUBSET
    Optimize
    Chronic Tx

    Cardiac Index
    L/min/m2

    Warm and Dry

    Warm and Wet

    Cold and Dry

    Cold and Wet

    2,2

    18
    PCWP or LVEDP

    HEMODYNAMIC SUBSET
    Warm and Dry

    Diuretic +/
    Adjuvant Tx

    Warm and Wet


    2,2

    Cold and Dry

    Cold and Wet

    18
    PCWP or LVEDP

    Cardiac Index
    L/min/m2

    HEMODYNAMIC SUBSET

    Cardiac Index
    L/min/m2

    Vasodilator
    +/ Inotropes

    Warm and Dry

    Warm and Wet

    Cold and Dry

    Cold and Wet

    2,2

    18
    PCWP or LVEDP

    HEMODYNAMIC SUBSET
    Warm and Dry

    Warm and Wet


    2,2

    Cold and Dry

    Cold and Wet

    18
    PCWP or LVEDP

    Cardiac Index
    L/min/m2
    Diuretic +/
    Vasodilator +/
    Inotropes

    Volume Overload

    Cardiac
    Output

    WET

    18
    PCWP or LVEDP

    Symptoms :
    Shortness of breath,
    Pulmonary congestion,
    Peripheral edema,
    Jugular venous
    distention

    Cardiac Output

    2,2
    Cardiac Index
    L/min/m2
    COLD

    PCWP or LVEDP

    Symptoms
    Cold,
    Clammy
    extremities,
    Altered mental
    status

    CLASSIFICATION OF HEART FAILURE


    American Heart Association Classification
    Stage A : Patients are at high risk for heart failure
    but
    have not developed structural heart
    disease and have no
    symptoms
    Stage B : Patients have developed structural heart disease
    have not (yet) developed symptoms
    Stage C : Patients with past or current heart failure
    symptoms in association with structural damage
    to the
    heart
    Stage D : Patients with end stage, or terminal heart failure
    requiring special treatment strategies

    NEW YORK HEART ASSOCIATION CLASIFICATION

    Class

    Functional State

    Symptoms

    No limitation

    Asymptomatic during
    usual daily activity

    II

    Slight limitation

    Mild symptoms
    (dyspnea, Fatique, or
    chest pain) with ordinary
    daily activity

    III

    Moderate Limitation

    Symptoms noted with


    minimal activity

    IV

    Severe Limitation

    Symptoms arrest

    DIAGNOSTIC STUDIES
    Basic Laboratory testing
    Screening for cardiac enzymes
    B-Natriuretic Peptide
    ECG
    Chest X-Ray
    Echocardiography
    Pulmonary artery catheterization
    Peak flow / end tidal CO2

    ESTABLISH THE DIAGNOSIS


    Physical :
    Vital sign : Hypertermi (sepsis), hypothermia (thyroid
    disease), Bradicardia ( AV block, Hyperkalemia, drug,
    severe hypoxia)
    Signs of congestion : jugular venous distention,
    abdominal jugular reflux, audible 3rd heart sound
    Pulmonary , leg exam

    VASODILATORS
    Vasodilators

    Dosing

    SE

    Other

    NTG

    10 20 mg/min
    200 mg/min

    Hypotension
    Headache

    Tolerance or
    continuous use

    ISDN

    1 mg/hour
    10 mg/hour

    Hypotension
    Headache

    Tolerence or
    continuous use

    Nitroprusside

    0,3 mg/kg/min
    5 mg/kg/min

    Hypotension
    Isocyanate
    Toxicity

    Light Sensitive

    INOTROPES
    Short term inotropic support maintain systemic

    perfusion and preserve end-organ performance


    Deleterious effect upon patients with preserved or
    moderately depressed ventricular function and
    congestion
    Not demonstrated improved outcomes

    INOTROPES
    Debutamine : 2-20 mg/kg/min
    2. Dopamin
    : <3 mg/kg/min : renal effect
    3-5 mg/kg/min : Inotropic effect
    >5 mg/kg/min : Vasopressor effect
    1.

    VASSOPRESSORS
    Norepinephrine
    : - No bolus
    - 0,2 1,0 mg/kg/min
    2. Epinephrine
    : - Bolus 1mg can be given I.V
    during resuscitation, repeated
    every 3-5 min
    - 0,05 0,5 mg/kg/min
    1.

    RESPIRATORY THERAPY
    CPAP improves

    Lung mechanics : recruiting Atelectatic alveoli, Improving


    pulmonary compliance, reducing work of breathing
    Hemodynamics : reducing preload and afterload

    Recommends acute cardiogenic pulmonary edema


    Start at 10 15 CmH2O

    Mechanical Circulatory Support


    Renal Replacement Therapy
    IABP ( Intra Aortic Ballon Pump )
    Extracorporeal ventricular assist devices
    ECMO ( Extra Corporeal Membrane

    Oxygenation)

    DRUG FOR HEART FAILURE


    Proven morbidity and mortality benefit
    B Blocker
    ACE Inhibitors
    ARB
    Aldosterone Antagonist
    ISDN Hydralazine

    DRUG FOR HEART FAILURE


    Improved symptoms and no prove mortality benefit
    Digoxin
    Nexiritide
    I.V Vasodilators
    Inotropic Agents

    TherapyforHeartDisease
    Mechanical Support Devices
    CRT (cardiac resynchronization therapy )
    VADs ( Ventricular Assist Devices)

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