dr dan dc.ppt [read-only] - universitas sumatera...
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![Page 1: DR DAN DC.ppt [Read-Only] - Universitas Sumatera Utaraocw.usu.ac.id/course/download/128-Kesehatan-Anak/kesehatan_anak... · Ada 4 Lapisan GAS. 1. Capsule (Hyaluronic acid) 2. Cel](https://reader034.vdocuments.net/reader034/viewer/2022051405/5a7a7a1c7f8b9a563b8b4c25/html5/thumbnails/1.jpg)
KEL. JANTUNG DIDAPAT (ACQUIRED)KEL. JANTUNG DIDAPAT (ACQUIRED)KELAINAN JANTUNG KARENA INFEKSIKELAINAN JANTUNG KARENA INFEKSI
DI INDONESIA YANG TERBANYAK:DI INDONESIA YANG TERBANYAK:
1.DEMAM REUMATIK(1.DEMAM REUMATIK(DRDR), 2. DIFTERIA DAN ), 2. DIFTERIA DAN
3.ENDOKARDITIS LENTA3.ENDOKARDITIS LENTA
1.DEMAM REUMATIK: OK MENYEBABKAN 1.DEMAM REUMATIK: OK MENYEBABKAN
KEL. JANTUNG KEKEL. JANTUNG KE--2 PADA ANAK SETELAH 2 PADA ANAK SETELAH KEL. JANTUNG KEKEL. JANTUNG KE--2 PADA ANAK SETELAH 2 PADA ANAK SETELAH
KEL.JANTUNG KONGENITAL DI USA. KEL.JANTUNG KONGENITAL DI USA.
DI INDONESIA DR DI INDONESIA DR →→→→→→→→PENYEBAB UTAMA.PENYEBAB UTAMA.
DRDR PERLU DIDIAGNOSA CEPAT, DAN DIOBATI PERLU DIDIAGNOSA CEPAT, DAN DIOBATI
SEGERA SEGERA →→→→→→→→DPT MENCEGAH KEL. KATUP J.DPT MENCEGAH KEL. KATUP J.
[BIAYA BANYAK & ANGKA KEMATIAN TINGGI][BIAYA BANYAK & ANGKA KEMATIAN TINGGI]
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INSIDENS INSIDENS ±± 3% PADA MASA EPIDEMIK DAN 3% PADA MASA EPIDEMIK DAN
INSIDENSNYA INSIDENSNYA ±± 0.3% PD MASA ENDEMIK 0.3% PD MASA ENDEMIK
ETIOLOGINYA:STREP. BETA HEMOL.GRUP A, ETIOLOGINYA:STREP. BETA HEMOL.GRUP A,
--DRDR SERING TERJADI BERSAMAAN URISERING TERJADI BERSAMAAN URI
--ASRAMA MILITER, KELOMPOK MASY. YG ASRAMA MILITER, KELOMPOK MASY. YG
TERISOLIR SERING EPIDEMI.TERISOLIR SERING EPIDEMI.
--INSIDENS INSIDENS DRDR PARALEL DGN INSIDENS URI PARALEL DGN INSIDENS URI
OK GABHS.OK GABHS.
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Rheumatic feverRheumatic fever--pathogenesispathogenesis
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Rheumatic feverRheumatic fever--pathogenesispathogenesis
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Ada 4 Lapisan GAS. 1. Capsule (Hyaluronic acid) 2. Cel wall ( M - protein and M – Asosiated protein ) 3. Gtoup Carbohydrate (N-Acethyl Glucisamine Ribosome) 4. Protoplast membrane
1.
2.
3.
4.
Group A Streptococcus = GAS
4. Protoplast membrane (Protein, Lipid and Glucose)
Structur Antigen GAS sama dgn structur dari sel-sel: 1. Sendi (synovial membrane) 2. Sel-sel myocardium 3. Sel-sel Valvula / katup jantung 4. Sarcolema myocardium dan Sarcolema dari Subthalmic brain dan Nucleus caudatus
Dr.Babu UthmanDone by: Samya : RF and RHD 2007.
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Rheumatic feverRheumatic fever--diagnosisdiagnosis
Subcutaneous nodules(nodules of rheumatoid arthritis are larger)
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Rheumatic feverRheumatic fever--diagnosisdiagnosis
Erythematous patches
with central clearing
Erythema marginatum
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Pathology :-Aschoff bodies antigen
presenting cells- Acute phase : inflammation process
in pericard, myocard & pericard- Chronic phase : injury of the valve- Chronic phase : injury of the valve- Difference of clinical and pathologi
cal manifestation in some countries- Host immunological response
take main role in clinical manifesta tion
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Diagnosis :Diagnosis :
1944 : Dr.T.Duckett Jones : Jones Criteria 1944 : Dr.T.Duckett Jones : Jones Criteria
1955 : Modification of Jones Criteria1955 : Modification of Jones Criteria
1965 & 1984 : Revised of Jones Criteria1965 & 1984 : Revised of Jones Criteria1965 & 1984 : Revised of Jones Criteria1965 & 1984 : Revised of Jones Criteria
1992 : Update Jones Criteria1992 : Update Jones Criteria
Jones Criteria (focused)Jones Criteria (focused)
Problems : over diagnosis or under diagnosis Problems : over diagnosis or under diagnosis
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1965 Jones Criteria (revised)
• Major manifestation• Carditis• Polyarthritis• Chorea• Subcutan nodule
• Minor manifestation• Fever• Arthralgia• Prolonged PR interval ECG
• Increase BSR
Diagnosis
• Subcutan nodule• Erythema marginatum • Increase BSR
• C reactive protein (+)• Leucocytosis• Previous history RF / RHD inactive
Evidence of previous
Strept. Infection
CULTURE / ASTO
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1992 Jones Criteria (Updated)
Major manifestationCarditisPolyarthritis ChoreaSubcutan noduleErythema margina tum
Minor manifestationFeverArthralgiaIncrease BSRC reactive protein (+) LeucocytosisProlonged PR interval ECG
Diagnosis
Erythema margina tum LeucocytosisProlonged PR interval ECG
Evidence of previous Strept. Infection Culture / ASTO
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Treatment RF & RHD (DR & Peny J.Re)• 1. Primary preventions :
• to eradicate Streptococcal infectcion :
• during acute RF attack
• 2. Secondary prevention :
• to prevent relaps of cute RF• to prevent relaps of cute RF
• 3. Relief the symptoms :
• - carditis / CHF
• - arthritis
• - Chorea
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Treatment RF & RHD (DR & Peny. J.Rema)
•1. Primary prevention :
• 1. Benzatine PNC G injection 1 X / i.m.
• (BW > 27 kg 1,2 million unit)
• (BW < 27 kg 600.000 unit)• (BW < 27 kg 600.000 unit)
• 2. Pencilline V : 250 mg/400.000 unit QID
• / oral : 10 days
• Erythromycine : 40 mg /kg BW / day
• TID-QID / oral : 10 days
• Clindamycine, Nafcillin, Amoxycillin,
• Cefalexin
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•Duration secondary prevention
•Categori Duration
• RF with carditis & permanent minimal 10 years
• valve abnormalities until 40 yrs or longlife
Treatment RF & RHD
longlife
• RF with carditis without perma 10 years or until
• nent valve abnormalities adult
• RF without carditis 5 years or until 21 years
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Relief the symptoms
•A. Carditis :
• Anti inflammatory
• - Carditis : Prednison : 2 mg/kg BW/day tapp.
– 2-6 weeks off
Treatment RF & RHD
– 2-6 weeks off
– - Mild Carditis : Aspirin 90-100 mg/kg BW 4-6
– 4-8 weeks week
•B. Arthritis• - Aspirin : 100 mg/kg BW/ day : 2 weeks
• 2-3 weeks : doses decrease
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•C. Heart Failure :
• - Bedrest - Digoxin
• - Diuretics - Vasodilator
• - Fluid & salt restriction
•D. Chorea :
•- Physical stres & emotional must be controlled
Treatment RF & RHD
•- Physical stres & emotional must be controlled
•- Anti inflammation drug : controversial
•- Phenobarbital : 15-30 mg TID-QID
•- Haloperidol : 0,5 mg ---> 2 mg TID
•- Valproic acid / Chlorpromazine / Diazepam
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Table. Guidelines for Bed Rest and Ambulation and Recommended
antiinflammatory agents
• Arthritis Carditis Carditis Carditis
• alone minimal moderate severe
•Bed Rest 1-2 wk 2-3 wk 4-6 wk 2-4 mo
•Indoor ambulation 1-2 wk 2-3 wk 4-6 wk 2-3 mo
•Outdor activity 1-2 wk 2-3 wk 4-6 wk 2-3 mo
•(school)
•Full activity 1-2 wk 2-3 wk 4-6 wk 2-3 mo
•Prednisone 0 0 2-4 wk 2-6 wk
•Aspirin 0 0 2-4 wk 2-6 wk
Minimal Carditis Questionable cardiomegaly ; Moderate carditis definite but mild cardiomegaly,
Severe carditis, marked cardiomegaly or CHF
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Surgical treatment and invasive intervention
•Surgical treatment :
•1. Valve Replacement :
• - MR
• - MS
• - AR• - AR
•2. Valvuloplasty
•Invasive Intervention :
•- Ballon Mitral Valvuloplasty (BMV) with
• Inoue ballon : MS
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DCDC
Decompensatio CordisDecompensatio CordisDecompensatio CordisDecompensatio Cordis
Gagal JantungGagal Jantung
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Conto: Mitral insuffisiensi
Setiap ventric.sist, ada darah naik
ke Atrium Ki→→→→lama2
Stagnasi di Atrium Ki
→→→→V.Pulm. →→→→vasc.paru →→→→pe-
numpukan cairan →→→→inf. →→→→Batuk kronik.
↓↓↓↓ darah masuk ke Ao →→→→Jantung kerja keras (HR↑↑↑↑=Tachycardia)
Jantung membesar (Cardiomegali), Bila kerja,perlu O2 banyak napas ↑↑↑↑
(Dyspnoe d’effort, sampai orthopnoe ). Tanda2 DC kiri
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PS darah berkurang masuk ke
A.Pulm. Darah banyak ter
kumpul dalam V.Ka →→→→A.Ki →→→→ VCS
(TVC↑↑↑↑) →→→→ VCI (Hepatomegali) →→→→
Edem pretibial, Edema dorsal
pedis, Ascites →→→→ Jantung kerja
keras (Cardiomegali) dan Kalau keras (Cardiomegali) dan Kalau
kerja sesak napas (Tachypnoe).
Freq.Jantung naik (Tachycardi)
Tanda DC Kanan
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PENGOBATAN DCPENGOBATAN DC
1. DIGITALIS1. DIGITALIS
2. DIURETIK2. DIURETIK
Dosis dan cara pemberianDosis dan cara pemberian
harus diperlajari baikharus diperlajari baik--baikbaik
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�Terima kasih