review pediatrik
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Review kardiologi anak
Debora
FAKULTAS KEDOKTRAN N
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Children are not little adults Adults are not big chi
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DIAGNOSIS PENYAKIT JANTUNG
1. Diagnosis Kausal
2. Diagnosis Anatomis
3. Diagnosis Fungsional
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DIAGNOSA KAUSAL
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DIAGNOSIS KAUSAL
Penyakit Jantung pada Anak TIDAK SAMA dengan Pe
Jantung pada Dewasa
Penyebab : 80 % bawaan (kongenital)
Gejala : sangat tidak jelas
Tatalaksana : 75 % surgical intervention
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Etiologic Basis of Congenital Heart
Diseases
1. Primary genetic factors 10%
1) Chromosomal 5-10%
2) Single mutant gene 3%
2. Genetic-environmental interaction 90%
1) Multifactorial inheritance (majority)
2) Risks to offspring of an affected parent
3) Environmental contribution
Drugs
Infections
Maternal conditions
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A N S I T I O N
A L C I R C U
L A T I O N
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DIAGNOSIS ANATOMIS
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ATRIAL SEPTAL DEFECT
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COARCTATION OF THE AORTA PULMONIC STENOSIS AORTIC S
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DIAGNOSIS FUNGSIONAL
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CHD
ACYANOTIC
↑Pulmonary Blood
Flow
ASD,
VSD,
PDA
Obstruction to
blood flow fromventricles
Coartation ofaorta,
Aortic stenosis,Pulmonic Stenosis
CYANOTIC
↓ Pulmonaryblood flow
ToF,Trikuspid atresia
Mixed bloodflow
TGA,Truncus arteriosus
Hipoplastic left hea
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Diagnosa Fungsional
PINKShunts ( L to R) :
• ASD
• VSD
• PDAStenosis:
• AS
• PS
• Coarctation
• HLHS
BLUE
• TOF
• TGA
• Tricuspid atresia
• Truncus
• TAPVR
• Ebstein’s
• Single ventricle
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Presentation of CHD
1. Shock like symptoms
2. Cyanosis
3. Congestive symptoms
4. Exercise intolerance
5. Asymptomatic heart murmur
6. Abnormality in routine chest PA
7. Chest pain
8. Syncope/ seizure/ fainting
9. Airway obstruction/ dysphagia
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CARDIAC CYANOSIS
1. Kebiruan mukosa mulut, lidah, kelopak mata,ya
bertambah jelas saat menangis.
2. Tidak timbul segera setelah lahir
3. Takipnea tanpa distres pernafasan
4. Suhu tetap hangat.
5. Tes hiperoksia positip
AWAS : anemia, pigmen kulit, hipotermi,asfiksia
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PEMERIKSAAN FISIK
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CARDIAC AUSCULTATION AREAS
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HEART SOUND
• Ejection click = AS or PS
• Loud S2 = Pulmonary HTN
• Single S2 = one semilunar valve (truncus), anterior aorta (TGA), pulmo
• Fixed, split S2 = ASD, PS
• Gallop (S3) – may be due to cardiac dysfunction/ volume overload
•
Muffled heart sounds and/or a rub = pericardial effusion ± tamponad
Types of Murmurs
• Systolic Ejection Murmur (SEM) = turbulence across a semilunar valve
• Holosystolic murmur = turbulence begins with systole (VSD, MR)
• Continuous murmur = pressure difference in systole and diastole (PDA
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FOTO POLOS DADA
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ELEKTROKARDIOGRAFI
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8 STEP IN ECG
Step 1 : Rate
Step 2 : Rhythm
Step 3 : Axis
Step 4 : Precordial leads
Step 5 : Hyperthrophy
Step 6 : Block
Step 7 : Ischemia, injury etc
Step 8 : Miscelaneous
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KEGAWATAN JANTUNG
PADA BAYI DAN ANAK
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PEDIATRIC
CARDIAC
EMERGENCY
PROBLEMS
DYSRHITHMIA
HYPERTENSIVE
CRISIS
TAMPONADE
THROMBO
EMBOLIC
CYANOTIC
SPELS
SHOCK
HEART FAILURE
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PRESENTASI KLINIS YG SELALU ADA PADAGAWAT JANTUNG
1. Takipnea
2. Sianosis3. Renjatan
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GAGAL JANTUNG
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Pemahaman gagal jantung
Gagal jantung bukanlah suatu keadaan klinis
hanya melibatkan satu sistem tubuh melainka
SINDROMA KLINIK akibat kelainan jantung yan
ditandai dengan suatu bentuk respons hemod
ginjal, syaraf dan hormonal yang nyata.
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Adaptation in heart failure
BP = CO x SVR
BP = SV x HR x SVR
Frank-Starling
Remodelling
SA system
SA system SA system
RAAS
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Kompetensi
katup
Preload Afterload
Kontraktilita
Heart rate
Sinergistik
Kontraktilitas
viskositas darah
endotel
CONTRACTILITY
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STROKEVOLUME
PRELOAD
CONTRACTILITY
AFTER
-SYNERGISTICCONTRACTION
-VALVULARCOMPETENCE
HEARTRATE
CARDIACOUTPUT
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HEMODYNAMICSMyocardiContracti
Stroke Volume Preload
Cardiac Output Afterload
Blood Pressure Heart Rate
Systemic Vascular Resistance
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presents immediately at birthanemia, acidosis, hypoxia, hypoglycemia, hypocalcemia, sep
presents at 1 day (congenital)PDA in premature infants
presents in first month (congenital)HPLV, aortic stenosis, coarctation, VSD presents later
presents later (acquired)myocarditis, cardiomyopathy (dilated or hypertrophic), SVT, serheumatic fever
The causes of CHF depend on “the ag
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Neonatal congestive heart failure
Dysfunction• Myocarditis
• Cardiomyopathy — think inborn error of metabolism
• Coronary artery anomaly
• Arrhythmias
Volume
•
Unrestrictive ventricular septal defect(s)• Truncus arteriosus
Pressure — think ductal-dependent left-sided obstruction
• Hypoplastic left heart syndrome
• Critical aortic stenosis
• Critical coarctation of the aorta
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Hypertension, Anemia, sepsis
Bronchoplumonary dysplasia in premature
Acute corpulmonle due to airway obstruction
Toxins: digitalis, calcium channel blockers, Beta blockers
Pediatric CHF – Non Cardiac Etiology
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KLINIS
infants:
irritable, poorfeeding (earlyfatigue), failure tothrive, respiratorysymptoms
*always considerin patients withrespiratorysymptoms
LABORATORY
-CBC: anemia orinfection
-Blood gas:respiratoryalkalosis ormetabolicacidosis
-Renal and
hepatic function
Thorax RÖ
-Cardiomegaly isalmost alwayspresent-Increasedpulmonary bloodflow
PENUNJANG
ECG
ECHO
Pulse oxymetri
Hyperoxia test
2. Block the
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Activates the
RAAS
Sympathetic NervousSystem
salt & fluidretention
workload weakness of heart muscle
Inssuficientblood pump
blood vesselsContractility
workload
1. Increase force
of contraction
3. Block the SNS
RAAS
4. Increase urine
production
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CARDIAC CYANOSIS
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Central Cyanosis vs. Acrocyanosis
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Newborn Problems - Cyanosis
Cardiac Cyanosis
Does not respond to oxygen
Does not respond to ventilation
Usually no respiratory distress
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Differential Diagnosis of cyanosis
1. Not enough oxygen in
Apnea : neurologic and drugs
Diffusion barrier : RDS, aspiration, pneumonia
Obstruction: pneumothorax, head position
2. Oxygen “mal-absorption” Shunting lesions : cardiac
non-cardiac : PPHN, Hematologic
Methemoglobinemia : carboxyhemoglobinemia
3. Too much oxygen out
sepsis
low flow, high extraction
acrocyanosis
hyperviscosity/polycythemia
extravasated (e.g. bruising)
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squating
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Treatment of CYANOTIC SPELLS
Knee-chest or squatting positioning (increases afterload thus
decreasing R to L shunting)
Manual external aortic compression be low level of renal art
Morphine, 0.1-0.2 mg/kg IV or SC (to treat hyperpnea and
decrease systemic catecholamines)
Oxygen (perhaps limited value)
Intravenous volume expansion, 10 cc/kg isotonic
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Treatment of CYANOTIC SPELLS
Sodium bicarbonate 1-2 mEq/kg/dose
Propanolol, 0.15-0.25 mg/kg IV over 2-5 minutes(to block be
in infundibulum therefore lessening RV outflow obstruction
Phenylephrine, 0.1 mg/kg IM or SC(increases afterload there
decreasing R to L shunt)
General anesthesia (if severe/prolonged spells)
interim prophylactic treatment with propranolol while await
Knee chest
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Knee chest
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Thank You
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