cor pulmonal.ppt
TRANSCRIPT
7/17/2019 Cor Pulmonal.ppt
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Cor Pulmonal
Rizkiani Juleshodia W
CoAss Kardio Kel. 8UIN Syarif Hidayaullah
Jakara
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!e"nisi
• Kor #ulmonal adalah hi#erensi#ulmonal yan$ dise%a%kan #enyakiyan$ men$enai srukur dan aau#em%uluh darah #aru& hi#erensi#ulmonal men$hasilkan #em%esaran'enrikel kanan (hi#erro" dan aau
dilaasi) dan %erlan*u den$an%er*alannya +aku men*adi $a$al
*anun$ kanan.
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Klasi"kasi
• Aku, #ere$an$an aau #em%e%ananaki%a hi#erensi #ulmonal aku-serin$ dise%a%kan oleh em%oli #aru
masif.
• Kronik, hi#erro" aau dilaasi'enrikel kanan aki%a hi#erensi
#ulmonal yan$ %erhu%un$an den$an#enyaki #aru o%srukif aauresrikif.
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iolo$i
• iolo$i di$olon$kan dalam / kelom#ok,
– Penyaki #em%uluh darah #aru
– 0ekanan darah #ada areri #ulmonal olehumor mediasinum- aneurisma-$ranuloma aau "%rosis
–
Penyaki neuro muskular dan dindin$ dada – Penyaki yan$ men$enai aliran udara #aru-
al'eoli- ermasuk PP1K.
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Penyakit parukronis
Pao"siolo$i
1. Berkurangnya vascularbed paru disebabkanoleh semakinterdesaknya pembuluhdarah oleh paru yang
mengembang ataukerusakan paru
2. Asidosis danhiperkapnia
3. Hipoksia alveolar, yang
akan merangsangvasokonstriksipembuluh paru
4. Polisitemia danhiperviskositas darah.
Hipertro
fdilatasi
ventrikelkanan
Hipertensipulmon
al
!agal "antung
kanan
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Sym#oms and Si$ns (2)
• Anamnesis ada idaknya #enyaki #aru yan$mendasari dan *enis kelainan #aru- se#eri ,
– Chronic productive cough
– Exertional dyspnea
–
Wheezing respirations – Easy fatigability
– Weakness.
• 3ase a+al, #em%esaran 'enrikel idak adakeluhan- le%ih %anyak keluhan aki%a #enyaki
#arunya.• Keluhan im%ul %ila sudah ada $a$al *anun$-
misalnya , – Edem – Right upper quadrant pain.
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Sym#oms and Si$ns(4)
• Pemeriksaan 3isik , – Cyanosis – Clubbing ngers –
istended neck veins – R! heave or gallop "or both# – $rominent lo%er sternal or epigastric
pulsations – Enlarged and tender liver
– ependent edema
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5a%oraory 3indin$s
• Poly6yhemia is ofen #resen in 6or#ulmonale se6ondary o C1P!
• 0he arerial o7y$en sauraion is ofen%elo+ 89
• PC14 may or may no %e ele'aed
– Jika aki%a #enyaki 'askular #aru, normal
– Jika aki%a hi#o'enilasi al'eolar,menin$ka
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C: and Ches Radio$ra#hy
• :C, – Ri$h a7is de'iaion – Peaked P +a'es – !ee# S +a'es are #resen in lead ;<
–
Ri$h a7is de'iaion and lo+ 'ola$e may %enoed in #aiens +ih #ulmonary em#hysema – = +a'es may %e #resen in leads II- III- and a;3
(inferior myo6ardial infar6ion) – Su#ra'enri6ular arrhyhmias are fre>uen and
nons#e6i"6
• 3oo horak,
0am#ak kelainan #aru diserai #em%esaran'enrikel kanan- dilaasi areri #ulmonal-arium kanan yan$ menon*ol
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A: A 'ery #rominen main #ulmonary arery #rodu6es a %ul$e in he 6onour of he hearin his #aien +ih early 6or #ulmonale due o #ulmonary hy#erension "arro%#. B: 1nhe laeral 'ie+- he enlar$ed #ulmonary arery 6an %e seen as a fo6al %ul$e aneriorly.
(Couresy of H :old%er$.)
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6kokardio$ra" danKaerisasi
• kokardio$ra",Normal 5; size and fun6ion %u R; and RAdilaion
•
Kaerisasi *anun$ , – Penin$kaan ekanan *anun$ kanan dan ahanan#em%uluh #aru
– 0ekanan arium kiri dan ekanan %a*i ka#iler #arunormal hi#erensi #ulmonal %erasal dari
#raka#iler dan %ukan dari *anun$ kiri
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Pro$nosis
• Cor #ulmonale has he same#ro$nosis as he underlyin$#ulmonary disease
• 1n6e 6on$esi'e si$ns a##ear- hea'era$e life e7#e6an6y is 4? years-%u sur'i'al is si$ni"6anly lon$er
+hen un6om#li6aed em#hysema ishe 6ause.
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!afar Pusaka
• @orrison 5K e al. Uiliy of a ra#id Bnariurei6 #e#ide assay indiereniain$ 6on$esi'e hear failurefrom lun$ disease in #aiens
#resenin$ +ih dys#nea. J Am CollCardiol. 4DD4 Jan 2<&EF(4),4D4?F.GP@I!, 22884D8
• Ri6h- Suar. $ulmonary hypertension in&arison's (nternal )edicine *+th
ed.*,-/-0.1--2• Sudoyo- Aru W. uku A*ar Ilmu Penyaki
!alam. d /. Jilid E. 4DD. Jakara,PAP!I