cor pulmonale
TRANSCRIPT
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