cor pulmonale

Cor PulmonaleCor Pulmonale

R.Mohammad Yogiarto

BAG / SMF Ilmu Peny.Jantung dan Kedokteran Vaskuler

FK UNAIR / RSU dr.Soetomo

S U R A B A Y A

SESAK NAPAS SESAK NAPAS

ADALAH KELUHAN YANG DISAMPAIKAN PENDERITA YANG MEMPUNYAI SIFAT SANGAT SUBYEKTIP sebagai :

PERASAAN YG TERTEKAN TERCEKIK PERASAAN YG MEMERLUKAN BERNAPAS

LEBIH DALAM / LEBIH KUAT SERINGKALI DISERTAI RASA CEMAS

ETIOLOGI SESAK NAPAS

I.PENYAKIT JANTUNG

1.KELAINAN MIOKARD -HIPERTENSI -PENY.JANTUNG KORONER -KARDIOMIOPATI -MIIOKARDITIS2.KELAINAN KATUP JANTUNG3.KELAINAN JANTUNG KONGENITAL4.ARITMIA5.INTOKSIKASI OBAT YG MEMBERI SIFAT INOTROPIK NEGATIP6.ANEMIA7.KELAINAN PERIKARD

ETIOLOGI SESAK NAPAS

I.PENYAKIT JANTUNG

1.KELAINAN MIOKARD -HIPERTENSI -PENY.JANTUNG KORONER -KARDIOMIOPATI -MIIOKARDITIS2.KELAINAN KATUP JANTUNG3.KELAINAN JANTUNG KONGENITAL4.ARITMIA5.INTOKSIKASI OBAT YG MEMBERI SIFAT INOTROPIK NEGATIP6.ANEMIA7.KELAINAN PERIKARD

ETIOLOGI SESAK NAPASETIOLOGI SESAK NAPAS

II. PENYAKIT PARU

1.PENY.PARENKHIM PARU2.PENY.SALURAN NAPAS 3.PENY.VASKULER PARU4.KOLAPS PARU5.PENY.PLEURA

ETIOLOGI SESAK NAPAS

III.PENYAKIT METABOLIK (Dm,Uremia,asidosis)IV.PENYAKIT NEURO MUSKULER (myastenia gravis)

V.PENYAKIT HEMATOLOGIK (Anemia,leukemia,perdarahan)

VI.OBESITAS

VII.PSIKOSOMATIK

ETIOLOGI SESAK NAPAS

III.PENYAKIT METABOLIK (Dm,Uremia,asidosis)IV.PENYAKIT NEURO MUSKULER (myastenia gravis)

V.PENYAKIT HEMATOLOGIK (Anemia,leukemia,perdarahan)

VI.OBESITAS

VII.PSIKOSOMATIK

Summary of pressure within atria and ventriclesSummary of pressure within atria and ventricles

“WEDGE”RV250-5

mm Hg

RA5

PA2510

SVC

LV<150<10

LA

Ao<150<90

IVC

mm Hg

15

12

10

d s d10

5

a cv

25

15

5

50

a c v

x25

15

5 a

v

y

y

c

T P T PR

T P T PR

150

100

50

d s d

100

a c v

COR PULMONALECOR PULMONALE

DEFINISI

ETIOLOGI / PATOFISIOLOGI

KLINIS / DIAGNOSIS

PERAWATAN

PENCEGAHAN

DEFINISI :DEFINISI :

"COR - PULMONALE""COR - PULMONALE"

MPA

RA

RV

AO

LA

LV

RVE FUNGSIRVH STRUKTUR

PARU

ETIOLOGIETIOLOGI

I. P.P.O.M.

II. HIPOVENTILASI KHRONIS

III. KELAINAN PB. DARAHPARU

ETIOLOGIETIOLOGI

I. P.P.O.M. : • Bronkhitis chr. • TBC paru• Emfisema P. • Pneumocon.• Asma bronkh.

II. HIPOVENTILASI KHRONIS

1. Kel. DD. TorakKipo skoliosisObesitasPektus ekskatus

2. Kel. pusat pernapasan

ETIOLOGIETIOLOGI

III. KELAINAN PB. DARAH PARU1. Intraluminer

Emboli paruTrombosis > pada pembuluh art. pulm.Hipertensi pulm. primervaskulitis difuse

2. Ekstra luminerTBCFibrosis post radiasiMetastase Ca.SarcoidosisPneumococ.

Ao 150/90

LA10

LV150/0-0"WEDGE"

12

SVC

RA5

IVC

25/0-5RV

"WEDGE”12 ~ PCWP ~ V.P ~ L,A ~ 10

BRONCH. PULM. DISEASEBRONCH. PULM. DISEASE

OBSTRUKSIBRONCH.

ALVEOLI PRESS

VASOKONSTRIKSI PULM.

HIPERTENSI PULM.

RVH

COR PULMONALE

COMPENSATA DECOMPENSATA

VENTILASI

HIPOKSEMI

POLISITEMI

VASCULER BED.

PVR

ATHEROSKLEROSIS

BR. MOTOR TONE

SPASME BRONCH.

KLINIS :KLINIS :

I. AKUT : Emboli - paru masive

Trombosis besar

(lebih jarang dijumpai)

II. KHRONIS : Lebih sering dijumpai dalam klinik

DIAGNOSADIAGNOSA

Ax : Penyakit Paru dasar / Batuk / Sesak

Fisik : • Sesak. CyanosisBendungan vena leherBarrel chest emfisema

• Ronkhi ~ peny. paru dasarWheezing

• Jantung : S1 melemah

S2 (hipertensi pulm.)

Pemeriksaan penunjang :Pemeriksaan penunjang :

EKG : RAD / RVHAritmia S.V / V.

Rö : Paru ~ penyakit paru dasarCor. RVH

DL : Polisitemia

Pa O2 , Pa CO2 Tes fungsi paru yg menurunEchocardiogram.

PERAWATAN COR PULM.PERAWATAN COR PULM.

I. TERHADAP PENYAKIT PARU

II. TERHADAP HIPERTENSI PULMONAL

III. TERHADAP JANTUNG

PERAWATAN PENYAKIT PARUPERAWATAN PENYAKIT PARU

1. Antibiotika (infeksi)2. Oksigen Hipoksemi / asidosis

Dosis 02 1-3 L/m/15 jam/hari Low flow bila :

Pa 02 < 50 mmHg, Payah jantung kong.PolisetimiaKognitif

Pa 02 > 50 mmHg, Aktifitas Insomnia

IPPB3. Bronchodilator4. Mucolytic / expect5. Corticosteroid6. Fisioterapi

PERAWATAN KARDIOLOGISPERAWATAN KARDIOLOGIS

1. TIRAH BARING

2. DIET R.G.

3. DIURETIKA

4. DIGITALIS

5. VASODILATOR

HIPERTENSI PULMONAL

VASOKONSTRIKSIHIPOKSEMIA

HIPERTENSI PULMONAL

VASOKONSTRIKSIHIPOKSEMIA

02 TERAPI : Vasodilator HP

Toleransi aktivitas S.T Neurologis Polisitemia

Phlebotomi Viskositas Hip. pulm.

PCV > 50 %

O2 VASODILATORO2 VASODILATOR

Sesak napasSesak napas

Sesak napasNyeri dadaBatuk darahBatuk

HipertensiLVH

S3 gallopRonki

PerokokBronkitis kronisRö : Cor N

Hiperinflasi

BB >, usia pertengahan

Perokok, bronkitis kronis

Hipertensi ringan ?

Penyakit

jantung

Penyakit

paru

RPDDP, Lab.

RPDDP, Lab.

Faal paru BGA EKG exercise Kateterisasi -

istirahat Echo -

exercise

SESAK NAPASSESAK NAPAS KAUSAKAUSA

Bronkodilator

Hasil baik Hasil jelek Hasil baikP. Paru Congestive

H.F

Diuretik

+ digitalis

Dx

Dx

Tx

Summary of pressure within atria and ventriclesSummary of pressure within atria and ventricles

“WEDGE”RV250-5

mm Hg

RA5

PA2510

SVC

LV<150<10

LA

Ao<150<90

IVC

mm Hg

15

12

10

d s d10

5

a cv

25

15

5

50

a c v

x25

15

5 a

v

y

y

c

T P T PR

T P T PR

150

100

50

d s d

100

a c v

Alveolar-capillary membraneAlveolar-capillary membrane

Capillary Lumen

Perivascular Space

Bronchiole

Venule

Arteriole

Alveolus

Lymphatic Channel

Hydrostatic Pressure 10-12 mmHg

Oncolic Pressure 25 mmHg

Tight Interstitial Space

Evolution of cardiogenic pulmonary edemaEvolution of cardiogenic pulmonary edema

A. Interstitial Edema B. Early Alveolar Edema C. Complete Alveolar Flooding

Stage II Stage III

Capillary Lumen Capillary Lumen Capillary Lumen

Alveoli Alveoli Alveoli

Hydrostatic Pressure Hydrostatic Pressure Hydrostatic Pressure18 mmHg > 25 mmHg > 28-30 mmHg

Systemic Venous

Pressure

CLINICAL INDICATORSSystemic Congestion

Sugular venous distentionVolume in distensible organs

HepatomegalySplenomegaly

Serous effusionPeripheral edema

Diminished Systemic PerfusionWeakness

FatigueExercise tolerance

Excertional dyspneaMental confusionTissue hypoxia

Metabolic acidosisPulmonary Congestion

DyspneaOrthopneaInterstitial &

alveolar edemaAlveolar ventilation

Diminished Pulmonary PerfusionDyspnea

TachypneaAlveolar perfusion

HypoxiaCyanosis

CONGESTIVE HEART FAILURECONGESTIVE HEART FAILURE

RIGHT HEART DYSFUNCTION

BACKWARD EFFECTS

FORWARD EFFECTS

RIGHT HEART DYSFUNCTION

BACKWARD EFFECTS

FORWARD EFFECTS

LEFT HEART DYSFUNCTION

FORWARD EFFECTS

BACKWARD EFFECTS

LEFT HEART DYSFUNCTION

FORWARD EFFECTS

BACKWARD EFFECTS

Emptyingright heart

Emptying into pulmonary artery

Volume to lungs

Volume to left heart

Organ perfusion

Right ventricular diastolic

volume & pressure

Systemic venous

pressure & volume

Renal retention salt & water

Systemic venous pressure & volume

Renal retention salt & water

Organ perfusion

Left ventricular diastolic volume

& pressure

Pulmonary artery

pressure

Ejection into

aorta

Emptying of

left heart

C.O

C.O