Manajemen Terapi Gagal Jantung

dr. Ilham Hariaji, MBiomed

Departemen Farmakologi dan Terapi

Fakultas Kedokteran
Universitas Muhammadiyah Sumatera Utara
 Definition-Heart Failure (HF)
Key Concepts
CO = SV x HR-becomes insufficient to
meet metabolic needs of body
SV- determined by preload, afterload
and myocardial contractility
EF< 40% (need to understand)
*Classifications HF
Systolic failure- dec. contractility
Diastolic failure- dec. filling
Mixed
90/140= 64% EF- 55-65 (75) normal
Keys to understanding HF
All organs (liver, lungs, legs, etc.) return blood to heart
When heart begins to fail/ weaken> unable to pump blood forward-fluid backs up >
Inc. pressure within all organs.
Organ response
LUNGS: congested > stiffer , inc effort to breathe; fluid starts to escape into alveoli;
fluid interferes with O2 exchange, aggravates shortness of breath.

Shortness of breath during exertion, may be early symptoms > progresses > later require
extra pillows at night to breathe > experience "P.N.D." or paroxysmal nocturnal dyspnea .
Pulmonary edema
Legs, ankles, feet- blood from feet and legs > back-up of fluid and pressure in these
areas, heart unable to pump blood as promptly as received > inc. fluid within feet and legs
causes fluid to "seep" out of blood vessels ; inc. weight
Heart Failure
Result of
Compensatory
Mechanisms >

Heart Failure
Heart Failure
Explained
 Heart Failure
Classification Systems
New York Heart Association Functional
Classification of HF
Classes I to IV
ACC/AHA Stages of HF (newer)
Stages A to D
ACC/AHA Stages

NY ASSN Funct Class

PHARMACOTHERAPY OF HEART FAILURE
 DIGITALIS
Mekanisme kerja :
Sifat farmakodinamik utama inotropik
positif, yaitu meningkatkan kontraksi
miokardium.
Pada penderita yang mengalami gangguan
fungsi sistolik, efek ini akan menyebabkan
peningkatan curah jantung sehingga tekanan
darah vena berkurang, ukuran jantung
mengecil, dan refleks takikardi yang
merupakan kompensasi jantung
diperlambat.
 DIGITALIS
Mekanisme kerja :
Efek inotropik positif digitalis didasarkan atas
2 mekanisme, yaitu
a. penghambatan enzim Na+K+adenosin
trifosfatase (NaK-ATPase) yang terikat di
membran sel miokard dan berperan dalam
mekanisme pompa Na+, dan
b. peningkatan arus masuk lambat (slow
inward current) Ca+ ke intrasel pada
potensial aksi.
DIGITALIS
DIGITALIS
MECHANISM OF ACTION

SEE ANTIHIPERTENSIVE DRUGS SLIDE

ACE
ACE INHIBITOR & ARB
ACE INHIBITOR EFFECT
BETA BLOKERS
 Stem Cell

http://www.medecine.unige.ch/recherche/groupes/b_donnees/sujet_536_4.html
 Stem Cell

http://www.intechopen.com/books/pluripotent-stem-cells/pluripotent-stem-
cells-for-cardiac-cell-therapy-the-application-of-cell-sheet-technology
 Stem Cell

http://www.intechopen.com/books/stem-cells-in-clinic-and-research/randomized-
clinical-trials-in-stem-cell-therapy-for-the-heart-old-and-new-types-of-cells-for-
cardiov
Stem Cell
 Simpulan
Gagal jantung adalah ketidakmampuan jantung
untuk mensuplay ke jaringan sehingga terjadi
kekurangan suplay oksigen dan nutrisi ke sel
Tujuan terapi gagal jantung adalah memperbaiki
etiologi gagal jantung sendiri dan berupaya
memperbaiki kinerja jantung senormal mungkin
dengan memodifikasi gaya hidup dan terapi
farmakologi berdasarkan etiologi dan gejala klinis
 Daftar Pustaka
References:
1) Heart Failure in Adults. A Report of the American College of Cardiology
Focused Update: ACCF/AHA Guidelines for the Diagnosis and Management
Circulation is published by the American Heart Association. 7272 Greenville Avenue, Dallas, TX DOI:
10.1161/CIRCULATIONAHA.109.192064
Circulation published online Mar 26, 2009; Rahko, Marc A. Silver, Lynne Warner Stevenson and Clyde
W. Yancy Francis, Theodore G. Ganiats, Marvin A. Konstam, Donna M. Mancini, Peter S. Mariell
Jessup, William T. Abraham, Donald E. Casey, Arthur M. Feldman, Gary S.
2) ACC/AHA 2005 Guideline Update for the Diagnosis and Management of ChronicHeart Failure in
the Adult: A Report of the American College of Cardiology
is published by the American Heart Association. 7272 Greenville Avenue, Dallas, TX DOI:
10.1161/CIRCULATIONAHA.105.16758 Circulation 2005;112;e154-e235; originally published online
Sep 13, 2005; Ornato, Richard L. Page and Barbara Riegel Loren F. Hiratzka, Sharon Ann Hunt, Alice
K. Jacobs, Rick Nishimura, Joseph P. Adams, Jeffrey L. Anderson, David P. Faxon, Valentin Fuster,
Jonathan L. Halperin, Stevenson, Clyde W. Yancy, Elliott M. Antman, Sidney C. Smith, Jr, Cynthia D.
Mancini, Keith Michl, John A. Oates, Peter S. Rahko, Marc A. Silver, Lynne Warner S. Francis,
Theodore G. Ganiats, Mariell Jessup, Marvin A. Konstam, Donna M. Sharon Ann Hunt, William T.
Abraham, Marshall H. Chin, Arthur M. Feldman, Gary
 dr. Ilham Hariaji, MBiomed

Departemen Farmakologi dan Terapi

Fakultas Kedokteran
Universitas Muhammadiyah Sumatera Utara

dr.Ilham Hariaji M,Biomed (FK UMSU)

31
Maret 2016