2. kuliah patofisiologi pjk

8/17/2019 2. Kuliah Patofisiologi PJK

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PENYAKITPENYAKIT

JANTUNG JANTUNGKORONERKORONER

Iwan N. BoestanIwan N. BoestanMedical Faculty of Airlangga University,Medical Faculty of Airlangga University,

Dr. Soetomo Provincial HospitalDr. Soetomo Provincial Hospital

SURABAASURABAA


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PENDAHULUANPENDAHULUAN PJK merupakan penak!t "antun# an# san#at pent!n#PJK merupakan penak!t "antun# an# san#at pent!n# D!$er!ta o%e& "utaan oran#D!$er!ta o%e& "utaan oran# Pene'a' kemat!an utamaPene'a' kemat!an utama

D! A(D! A( PJK I)A 'aru *+,- $et!k */0 "uta+ta&unPJK I)A 'aru *+,- $et!k */0 "uta+ta&un Dana an# $!ke%uarkan *1 m!%ar 2Dana an# $!ke%uarkan *1 m!%ar 2

D! In$ones!aD! In$ones!a Pene'a' kemat!an no * sur3e Ruma&Pene'a' kemat!an no * sur3e Ruma& Tan##a/ Dep.Kes. *44,5 Tan##a/ Dep.Kes. *44,5

D!$asar! o%e& proses pro#res!6 at&erosk%eros!sD!$asar! o%e& proses pro#res!6 at&erosk%eros!smu%a! anak7anakmu%a! anak7anak


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LE(I ATERO(KLERO(I(LE(I ATERO(KLERO(I(

*.*. 8att streak8att streak

,.,. 8!'rous p%a9ue8!'rous p%a9ue

:.:. A$3an;e ;omp%!;ate$5 p%a9ueA$3an;e ;omp%!;ate$5 p%a9ue


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PATHOGENE(I(PATHOGENE(I(

ATERO(KLERO(I(ATERO(KLERO(I(*.*. Response to !n"ur &pot&es!sResponse to !n"ur &pot&es!s

,.,. )ono;%ona% &pot&es!s)ono;%ona% &pot&es!s

:.:. L!po#en!; &pot&es!sL!po#en!; &pot&es!s


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)ANI8E(TA(I KLINI( PJK )ANI8E(TA(I KLINI( PJK

*.*. As!mptomat!k s!%ent mo;ar$!a% !s;&em!a5As!mptomat!k s!%ent mo;ar$!a% !s;&em!a5,.,. An#!na pektor!sAn#!na pektor!s

A.A. An#!na pe;tor!s sta'!%An#!na pe;tor!s sta'!%B.B. An#!na pe;tor!s t!$ak sta'!%An#!na pe;tor!s t!$ak sta'!%menta% an#!na5

:.:. In6ark m!okar$ akutIn6ark m!okar$ akut1.1. Dekompensas! kor$!sDekompensas! kor$!s

0.0. Ar!tm!a "antun#Ar!tm!a "antun#?.?. )at! men$a$ak su$$en $eat&5)at! men$a$ak su$$en $eat&5@.@. sn;opesn;ope


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*.*. A(I)PTO)ATIK (ILENTA(I)PTO)ATIK (ILENT)YO


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,.a. ANGINA PEKTORI( (TABIL (TABLE,.a. ANGINA PEKTORI( (TABIL (TABLEANGINA5ANGINA5

!e"ala #linis!e"ala #linis

A.A. Ner! $a$a saat akt!tasNer! $a$a saat akt!tasB.B. Bers!6at kron!sC, 'u%an5Bers!6at kron!sC, 'u%an5


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,.a. ANGINA PEKTORI( (TABIL (TABLE,.a. ANGINA PEKTORI( (TABIL (TABLEANGINA5ANGINA5

)ekan!sme ter"a$!na !skem!a)ekan!sme ter"a$!na !skem!aa.a. Karena #an##uan kese!m'an#an antaraKarena #an##uan kese!m'an#an antara

sup%a! $an ke'utu&an oks!#en m!okar$sup%a! $an ke'utu&an oks!#en m!okar$'.'. Karena a$ana aterosk%eros!s a%!ranKarena a$ana aterosk%eros!s a%!ran

koroner 'erkuran#koroner 'erkuran#

;.;. Terutama saat ke'utu&an men!n#kat Terutama saat ke'utu&an men!n#kat

akt!tas5akt!tas5$.$. Ter"a$!%a& !skem!a Ter"a$!%a& !skem!a

e.e. Is;&em!a on eortIs;&em!a on eort


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12/31


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Pen#o'atanPen#o'atan Pr!ns!pPr!ns!p

)en"a#a a#ar sup%a! oks!#en se%a%u se!m'an#)en"a#a a#ar sup%a! oks!#en se%a%u se!m'an#$en#an ke'utu&an oks!#en m!okar$$en#an ke'utu&an oks!#en m!okar$

Medi$amentosaMedi$amentosa Go%. N!tratGo%. N!trat


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a.a. Penan#anan 6aktor76aktor res!koPenan#anan 6aktor76aktor res!ko

"u#a pent!n# "u#a pent!n#'.'. Per%u $!pert!m'an#kanPer%u $!pert!m'an#kan

Per;utaneus trans%um!na%Per;utaneus trans%um!na%;oronar an#!op%ast PT


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,.'. ANGINA PEKTORI( TIDAK (TABIL,.'. ANGINA PEKTORI( TIDAK (TABIL

a.a. )!r!p sepert! an#!na sta'!%/ tetap!)!r!p sepert! an#!na sta'!%/ tetap!

'.'. Ner! %e'!& pro#res!6 Ner! %e'!& pro#res!6

;.;. 8rekuens! $an %ama 'ertam'a&8rekuens! $an %ama 'ertam'a&$.$. (er!n# saat !st!ra&at(er!n# saat !st!ra&at

e.e. N!trat t!$ak men#uran#! ner!N!trat t!$ak men#uran#! ner!

(er!n# $!se'ut(er!n# $!se'ut pre7!n6ar;t!onFpre7!n6ar;t!onF


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Patos!o%o#!Patos!o%o#!a.a. P%a9ue aterosk%eros!s men#a%am!P%a9ue aterosk%eros!s men#a%am!

trom'os!s/ ak!'at a$ana rupture p%a9uetrom'os!s/ ak!'at a$ana rupture p%a9ue'.'. Ter"a$! "u#a spasme Ter"a$! "u#a spasme

;.;. Ok%us! 'e%um tota%+ !nterm!ttenOk%us! 'e%um tota%+ !nterm!tten

EKGEKG Depres! se#men7(TDepres! se#men7(T

En>!m "antun# 'e%um men!n#katEn>!m "antun# 'e%um men!n#kat

,.'. ANGINA PEKTORI( TIDAK (TABIL,.'. ANGINA PEKTORI( TIDAK (TABIL


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P%&!'BA(A&P%&!'BA(A&a.a. Per%u mon!tor EKG ,1 "amPer%u mon!tor EKG ,1 "am

'.'. D! ruan# I


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B!%a o'at7o'atan t!$akB!%a o'at7o'atan t!$ak'er&as!%'er&as!%

*.*. D!%akukan an#!o#ra koronerD!%akukan an#!o#ra koroner

,.,. PT


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,.;. =ar!ant An#!na pr!n>meta%s,.;. =ar!ant An#!na pr!n>meta%san#!na5an#!na5

*.*. D!temukan t& *404D!temukan t& *404

,.,. Ner! se%a%u saat !st!ra&atNer! se%a%u saat !st!ra&at

:.:. Ter"a$! karena spasme koroner Ter"a$! karena spasme koroner1.1. (pasme 'ers!6at %oka%(pasme 'ers!6at %oka%

0.0. Bukan karena pen!n#katanBukan karena pen!n#katan

ke'utu&an oks!#en o%e& m!okar$ke'utu&an oks!#en o%e& m!okar$?.?. EKGEKG

B!sa ter$apat e%e3as! se#men (TB!sa ter$apat e%e3as! se#men (T


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)a!6estas! k%!n!s)a!6estas! k%!n!s*.*. (er!n# pa$a us!a mu$a(er!n# pa$a us!a mu$a

,.,. Tanpa 6aktor res!ko Tanpa 6aktor res!ko:.:. Ner! ser!n# pa$a ten#a& ma%am pa#!Ner! ser!n# pa$a ten#a& ma%am pa#!

1.1. Ner! san#at &e'atNer! san#at &e'at

EKGEKG*.*. Depres! se#men (T+ e%e3as! se#men (TDepres! se#men (T+ e%e3as! se#men (T

,.,. B!sa $!serta! ar!tm!a "antun#B!sa $!serta! ar!tm!a "antun#



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Pen#o'atanPen#o'atan


T!$ak T!$ak 'erman6aat'erman6aat

n!tratn!trat


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)an!6estas! k%!n!s)an!6estas! k%!n!s

Ge"a%a pro$roma%Ge"a%a pro$roma%

*.*. Da$a terasa t!$ak enak ;&est $!s;om6ort5Da$a terasa t!$ak enak ;&est $!s;om6ort5

,.,. (er!n# saat !st!ra&at(er!n# saat !st!ra&at

:.:. :- pen$er!ta men#e%u& *71 m# ()R(:- pen$er!ta men#e%u& *71 m# ()R(

1.1. @- * m# ()R(@- * m# ()R(0.0. Rasa %ema& $an ke%e%a&anRasa %ema& $an ke%e%a&an

:. IN8ARK )IOKARD AKUT:. IN8ARK )IOKARD AKUT


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Hea3 pa!nHea3 pa!n


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Serum mar$erSerum mar$er

).). creatin $inase *+#creatin $inase *+# )en!n#kat $a%am 17 "am/ norma% $a%am ,7: &ar!/)en!n#kat $a%am 17 "am/ norma% $a%am ,7: &ar!/

ka$ar pun;ak pa$a ,1 "amka$ar pun;ak pa$a ,1 "am-.-. +# isoenim *+#/MB+# isoenim *+#/MB )en!n#kat $a%am :7*, "am/ norma% $a%am :71 &ar!/)en!n#kat $a%am :7*, "am/ norma% $a%am :71 &ar!/

pun;ak pa$a *7:? "ampun;ak pa$a *7:? "am0.0. Serum glutamic o1aloacetic transaminaseSerum glutamic o1aloacetic transaminase

*S!'(*S!'(

2.2. 3actic de4idrogenase *3DH3actic de4idrogenase *3DH )en!n#kat $a%am *- "am/ norma% $a%am *-7*1 &ar!/)en!n#kat $a%am *- "am/ norma% $a%am *-7*1 &ar!/

pun;ak pa$a ,171 "ampun;ak pa$a ,171 "am5.5. +ardiac troponin *c(n6, c(n(+ardiac troponin *c(n6, c(n(

:. IN8ARK )IOKARD AKUT:. IN8ARK )IOKARD AKUTPemer!ksaan %a'orator!umPemer!ksaan %a'orator!um


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)enurut HO/ '!%a ter$apat , $ar!)enurut HO/ '!%a ter$apat , $ar!

:. IN8ARK )IOKARD AKUT:. IN8ARK )IOKARD AKUTKr!ter!a $!a#nost!kKr!ter!a $!a#nost!k

*.*.Ner! $a$a an# spes!kNer! $a$a an# spes!k,.,.Peru'a&an EKGPeru'a&an EKG

Ge%om'an# M pato%o#!s/Ge%om'an# M pato%o#!s/

$#$#E%e3as! se#men (TE%e3as! se#men (T

:.:.Pen!n#katan ka$ar en>!mPen!n#katan ka$ar en>!m

"antun# "antun#


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*.*. Ana%#et!kAna%#et!k )orn ,/-7,/0 m# !3/ t!tras!)orn ,/-7,/0 m# !3/ t!tras!

,.,. N!tratN!trata.a. (u'%!n#ua% $!%an"utkan perora%+ !ntra3ena(u'%!n#ua% $!%an"utkan perora%+ !ntra3ena

'.'. E6ek 3eno$!%atas!E6ek 3eno$!%atas! )enurunkan 3enous return)enurunkan 3enous return )enurunkan pre%oa$)enurunkan pre%oa$

;.;. E6ek $!%atas! koronerE6ek $!%atas! koroner

:.:. Asp!r!nAsp!r!n )enurunkan an#ka kemat!an)enurunkan an#ka kemat!an

:. IN8ARK )IOKARD AKUT:. IN8ARK )IOKARD AKUTO'at7o'at an# $!'er!kanO'at7o'at an# $!'er!kan


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1.1. Beta '%o;kerBeta '%o;ker

0.0. A


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(erapi trom7oliti$(erapi trom7oliti$ *7ila onset 8 )- "am*7ila onset 8 )- "am

a.a. Strepto$inaseStrepto$inase

7.7. r/(PAr/(PA

re;om'!nant t!ssue p%asm!no#en a;t!3atorre;om'!nant t!ssue p%asm!no#en a;t!3ator;omp%e5;omp%e5

c.c. Uro$inaseUro$inase

d.d. ASPA+ASPA+

An!so%ate$ p%asm!no#en streptok!naseAn!so%ate$ p%asm!no#en streptok!nasea;t!3ator5a;t!3ator5

e.e. Scu/PAScu/PA

s!n#%e ;&a!n urok!nase7tpe p%asm!no#ens!n#%e ;&a!n urok!nase7tpe p%asm!no#ena;t!3ator5a;t!3ator5



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*.*. Ga#a% "antun# akutGa#a% "antun# akut

,.,. E$ema paru akutE$ema paru akut

:.:. Ar!tm!aAr!tm!a

1.1. Ruptur $!n$!n# 3entr!ke%/ septum I=(5Ruptur $!n$!n# 3entr!ke%/ septum I=(5

0.0. Re#ur#!tas! m!tra% akutRe#ur#!tas! m!tra% akut

?.?. (ok kar$!o#en!k(ok kar$!o#en!k

@.@. kemat!ankemat!an

:. IN8ARK )IOKARD AKUT:. IN8ARK )IOKARD AKUTKomp%!kas!Komp%!kas!


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TERI)AKA(IH TERI)AKA(IH

69an &. Boestan69an &. BoestanMedical Faculty of Airlangga University: Dr. SoetomoMedical Faculty of Airlangga University: Dr. SoetomoProvincial HospitalProvincial Hospital

SURABAASURABAA

2. kuliah patofisiologi pjk

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