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HEART FAILURE
(GAGAL JANTUNG)
2
I. DEFINISI HEART FAILURE
o Heart failure (HF) is not a diagnosis but a clinical syndrome of
various etiology with a poor prognosis.
Symptoms typical of HF :
(breathlessness at rest or on exercise, fatigue,
tiredness, ankle swelling).
Signs typical of HF :
(tachycardia, tachypnea, pulmonary rales, pleural effusion,
raised jugular venous pressure, peripheral edema,
hepatomegaly).
A
High Risk For Hypertension, Diabetes Mellitus, CAD,
Developing HF Family History of Cardiomyopathy
• Hypertension
• Diabetes Mellitus • Alcohol abuse
• Dyslipidemia • Smoking
• Valvular heart disease • Collagen vascular
• Coronary artery disease disease
• Cardiomyopathy • Thyroid disorder
• Rheumatic fever • Pheochromocytoma
• Mediastinal radiation • Old age
• Sleep apnea disorders • Metabolic syndrome
• Exposure to cardiotoxin
agents
IV. FAKTOR APA SAJA YANG MENENTUKAN
12 FUNGSI VENTRIKEL KIRI?
(Cardiac output (CO) is determined by four factors)
13 V. PATHOPHYSIOLOGY OF HEART FAILURE
Systolic HF (HFrEF)
Diastolic HF (HFpEF)
16
Patterns of ventricular remodeling are
different for HFrEF and HFpEF
Left ventricle
normal
HFrEF HFpEF
Volume Pressure
HFrEF – a condition HFpEF – a condition
overload overload
of volume overload of pressure overload
• characterized by Increased Increased • characterized by
diastolic pressure systolic pressure
eccentric hypertrophy concentric
hypertrophic growth
• results in thinning of Increased Increased
the LV walls, diastolic wall stress systolic wall stress • results in normal
decreased systolic − sized LV cavity with
Series addition of new Parallel addition
function and sarcomeres of new myofibrils − thickened walls and
enlarged LV volume preserved systolic
Chamber Wall function
enlargement thickening
Eccentric Concentric
hypertrophy hypertrophy
Left ventricle Left ventricle
volume pressure
overload overload
17
Different co-morbidities and pathophysiological
processes can lead to different types of heart failure
A range of risk factors and co-morbidities contribute to the development of HF
Age
Smoking Myocardial
Obesity infarction Systolic
Hypertension dysfunction
HFrEF
Coronary HFpEF
artery disease Diastolic
Diabetes LV dysfunction
Dyslipidemia hypertrophy
Acute
infarction
Increased
interstitial
collagen
1. Patient history
2. Clinical examination
3. Special examination
(foremost echocardiography)
Aetiology
NYHA severity index
Ejection fraction
Systolic/diastolic dysfunction
Complicating arrhythmias?
Optimal treatment strategy
20 GAMBARAN KLINIS
GAGAL JANTUNG SIGNS
ABNORMALITIES CAUSES
Cardiomegaly Dilated LV, RV, atria. Pericardial effusion
Ventricular hypertrophy Hypertension, aortic stenosis, Hypertrophic
cardiomyopathy
Normal pulmonary findings Pulmonary congestion unlikely
Pulmonary venous Elevated LV filling pressure
congestion
Interstitial edema Elevated LV filling pressure
Pleural effusions Elevated filling pressure, HF likely if bilateral,
Pulmonary infection, surgery or malignant effusion
Kerley B-lines Increased lymphatic pressure
Hyperlucent lung fields Emphysema or pulmonary embolism
Pulmonary infection Pneumonia may be secondary to pulmonary
congestion
Pulmonary infiltration Systemic disease
23
KEADAAN YANG DIHUBUNGKAN DENGAN
PROGNOSIS JELEK PADA GAGAL JANTUNG
1. DEMOGRAPHICS: 2. CLINICAL:
- Advanced aged* - Hypotension*
- Ischemic etiology* - NYHA class III_IV*
- Resuscitated- - Recent HF-
sudden death* hospitalization*
- Poor compliance --Tachycardia
- Renal dysfunction - Pulmonary rales
- Diabetes - Aortic stenosis
- Anemia - Low BMI
- COPD - Sleep related
- Depression breathing disorders
* = powerful predictors
24
3. ELECTROPHYSIOLOGICAL:
- Tachycardia 4. FUNCTIONAL/
- Q-waves EXERTIONAL:
- Wide QRS* - Reduced work
- LVH - Low peak VO2*
- Complex ventricular- - Poor 6 minutes-
arrhythmias* walk distance
- Low HR variability - High VE/VCO2-
- T-wave alternans slope
- Atrial fibrillation (AF) - Periodic breathing
* = powerful predictors
25
5. LABORATORY: 6. IMAGING:
- Marked elevation of BNP/ - Low LVEF*
NT-pro BNP* - Increased LV vol.
- Hyponatremia* - Low cardiac index
- Elevated troponin* - High LV filling-
- Elevated biomarkers, pressure
neurohumoral activation* - Restrictive mitral-
- Elevated creatinine/ filling pattern
BUN - Pulmonary htn.
- Elevated bilirubin - Impaired RV -
- Anemia function
- Elevated uric acid
* = powerful predictors
EVOLUSI STADIUM KLINIS GAGAL JANTUNG
26
27
Diagnosis
Dokter umum
DEFINITION :
BNP = 600
BNP = 100-400
34 %
OF NYHA CLASS I AND II
42 %
OF NYHA CLASS III AND IV
PATIENTS DIED PATIENTS DIED