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Pendahuluan
Fisiologi
Hamil Perubahan dalam KVS - Hidremia puncak 32 34 mg - Anemia dilusional (vol plasma 30 % + sdm 18 % + Hb 19 %) - Postpartum imbibisi ekstravaskuler ke intravaskuler vol plasma ( 2 minggu) - Frekuensi nadi , prekordium bergeser ke kiri, bising sistolik di apeks + katup pulmonal
Pendahuluan
Fisiologi
Hamil Penyakit Jantung - Hamil 32 36 mg - Partus Kala II - Postpartum
Blood Pressure
Systolic murmurs
Diastolic murmurs
Common
Potentially pathological
EKG changes
Cardiac output : 50 % Fase aktif : 40% Segera post partum : 10-20% Cardiac exam is different during pregnancy Many patients will have an S3 after midpregnancy Diastolic murmurs are usually considered serious Systolic murmurs (flow murmurs) common Displacment of heart is to right and upwards EKG shows left axis deviation and low voltage QRS complexes
Frekuensi : 12 % ( >> demam rheuma dahulu) + kelainan kongenital ( 50 %) + Hipertensi heart disease (peripartum) Mortalitas : 8 -15 %
Penyakit jantung Hipoksia + sianosis - Hasil konsepsi (abortus) - Hasil konsepsi hidup Prematur IUGR Gawat janin
Diagnosa (sulit) - Anamnesis : riwayat sakit jantung - Pemeriksaan fisik : Bising diastolik, presistolik, pansistolik Pembesaran jantung Bising jantung nyaring (thrill) Aritmia berat
Diagnosa
Symptoms - Progressive dyspnea or orthopnea - Nocturnal cough - Hemoptysis - Syncope - Chest pain
Diagnosa
Clinical findings - Cyanosis - Clubbing of fingers - Persistent neck vein distention - Systolic murmur grade 3/6 or greater - Diastolic murmur - Cardiomegaly - Persistent arrhytmia - Persistent split second sound - Criteria for pulmonary hypertension
Risiko
Risiko
Prognosis
Kapasitas fungsi jantung Komplikasi peningkatan beban jantung Kualitas pelayanan kesehatan
Klasifikasi
Kelas I No limitation of physical activity Kelas II Slight limitation of physical activity Kelas III Marked limitation of physical activity Kelas IV Inability to performed any physical activity without discomfort
Penatalaksanaan
Kelas I & II - Preventif & pengenalan dini tanda CHF - Cegah bakterial endokarditis Preventif terhadap infeksi, Smoking, obat suntik dkk - Batasi obat - Labor & delivery
Penatalaksanaan
Kelas I & II Labor & delivery : Partus pervaginam (kecuali indikasi obstetri Kurangi rasa nyeri/painless labor Observasi ketat tanda vital (kontraksi) Intrapartum heart failure (udem paru hipoksia hipotensi) tatalaksana sesuai penyebab
Penatalaksanaan
Kelas I & II - Puerperium: HPP, infeksi, anemia & tromboemboli komplikasi yang serius Sterilisasi stabilisasi KU
Penatalaksanaan
Kelas III & IV - Continued or terminated ? - Vaginal delivery is preferred with epidural analgesia - Surgical procedure could be done in facility with experience with complicated cardiac disease