cardiogenic syock

8/15/2019 Cardiogenic syock

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Cardiogenic sCardiogenic syyockockDr Abdul Hakim A SpJPDr Abdul Hakim A SpJP

18 januari18 januari 20020088


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DefnisiDefnisi

e!idakmampuan jan!unge!idakmampuan jan!ung

mengalirkanmengalirkan

dara" secukupnya un!uk memenu"idara" secukupnya un!uk memenu"ikebu!u"an me!abolisme basalkebu!u"an me!abolisme basal

jaringan jaringan

#$J% 1&&'())0


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Three major types of shock Three major types of shock

Hypovolemic shock Hypovolemic shock

* Decreased in!ra+ascular +olume resul!ing ,ormDecreased in!ra+ascular +olume resul!ing ,orm

loss o, blood- plasma- or .uids and elec!roly!esloss o, blood- plasma- or .uids and elec!roly!es

Cardiogenic shock Cardiogenic shock

* Pump ,ailure due !oPump ,ailure due !o myocardial damage ormyocardial damage or

massi+e obs!ruc!ion o, ou!.o/ !rac!smassi+e obs!ruc!ion o, ou!.o/ !rac!s

Distributive shock Distributive shock

* educ!ion o, +ascular resis!ance ,ormeduc!ion o, +ascular resis!ance ,orm

SepsisSepsis Anap"ylaisAnap"ylais

Sys!emic in.amma!ory response syndromeSys!emic in.amma!ory response syndrome

S3S4S3S4


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Shock occurs whenShock occurs when

the rate of the rate of arterial blood ow isarterial blood ow isinadequate to meet metabolic tissueinadequate to meet metabolic tissueneeds and is the consequence ofneeds and is the consequence ofcardiovascular collapsecardiovascular collapse

!ssentials of diagnosis are!ssentials of diagnosis are* Hypotension"Hypotension"

* TachycardiaTachycardia

* #liguria#liguria

* $ltered mental status$ltered mental status

* %eripheral hypoperfusion and hypo&ia%eripheral hypoperfusion and hypo&ia


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%elipu!i @%elipu!i @

ri!eria klinis @ 1; Hipo!ensiri!eria klinis @ 1; Hipo!ensi

DS 9 &0 mmHg DS 9 &0 mmHg

DS B &0 suppor!4 DS B &0 suppor!4

2; Hipoper,usi peri,er2; Hipoper,usi peri,er akral dinginakral dingin

oligouriaoligouria ri!eria "emodinamikri!eria "emodinamik

1; C3 9 2-2 lm m1; C3 9 2-2 lm m22 2 PC7P B 18 mmHg2 PC7P B 18 mmHg

JACC 2000( 2)0


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Penyebab @Penyebab @

3%A3%A

ardiomiopa!i !a"ap ak"irardiomiopa!i !a"ap ak"ir

%iokardi!is%iokardi!is S!enosis Aor!aS!enosis Aor!a

H>C%H>C%

S!enosis %i!ralS!enosis %i!ral A myomaA myoma


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?ak!or Predisposisi?ak!or Predisposisi

Fsia B G< !"Fsia B G< !"

7ani!a7ani!a

D%D% i/aya! 3n,ark Sebelumnyai/aya! 3n,ark Sebelumnya

$? 9 )< E$? 9 )< E

3n,ark uas3n,ark uas

#$J% 1&&'())0


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Pa!ofsiologiPa!ofsiologi

5ila ke"ilangan B '0 E miokard5ila ke"ilangan B '0 E miokard

erusakan miokard !amba"anerusakan miokard !amba"an

pasca in,arkpasca in,ark

penurunan = ,ungsipenurunan = ,ungsi

3%A dgn komplikasi mekanik3%A dgn komplikasi mekanik up!ur 3=S- %3- rup!ur ,ree /allup!ur 3=S- %3- rup!ur ,ree /all

JACC 2000()G@10G)


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Penyebab cardiogenic S"ock pada 3%APenyebab cardiogenic S"ock pada 3%A

egagalan ,ungsi +en!rikel kiriegagalan ,ungsi +en!rikel kiri

:8-


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Penilaian klinisPenilaian klinis

Penyebab non kardiac "arus disingkirkanPenyebab non kardiac "arus disingkirkan

"ipo+olemia- sepsis- emboli paru- diseksi"ipo+olemia- sepsis- emboli paru- diseksi

aor!a- !amponade jan!ung;aor!a- !amponade jan!ung; Penilaian klinis "arus cepa! dilakukan@Penilaian klinis "arus cepa! dilakukan@

1;ekanan Dara"1;ekanan Dara"

2; Hear! a!e2; Hear! a!e

); Auskul!asi Jan!ung paru); Auskul!asi Jan!ung paru

'; Per,usi peri,er'; Per,usi peri,er Pemasangan S/an Ian dan Ar!ery line KKKPemasangan S/an Ian dan Ar!ery line KKK Pemeriksaan $CH>Pemeriksaan $CH>


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Penanganan F%F%Penanganan F%F%

Fsa"a resusi!a!i, dan Supor!i, Fsa"a resusi!a!i, dan Supor!i,

Pemberian >ksigen +en!ilasi ygPemberian >ksigen +en!ilasi yg

adek/a!adek/a!

oreksi I) asam basa dan elek!roli!oreksi I) asam basa dan elek!roli!

%enga!asi nyeri%enga!asi nyeri

Penangan Ari!miaPenangan Ari!mia


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Penanganan FmumPenanganan Fmum

Pasien dgn gangguan per,usi !apiPasien dgn gangguan per,usi !api

+olume in!ra+askuler cukup+olume in!ra+askuler cukup

3no!ropik3no!ropik

=asopressor=asopressorsegera diberikan KKsegera diberikan KK


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Hemodynamic C"arac!eris!ics inHemodynamic C"arac!eris!ics in

DiLeren! ypes o, S"ockDiLeren! ypes o, S"ock

ype ype PreloadPreload C>C> P=P= S=S=

Hemmorr"agicHemmorr"agic

Anap"ylac!icAnap"ylac!ic

CardiogenicCardiogenic

Sep!icSep!icHyperdynamic4Hyperdynamic4

Sep!icSep!ic

Hypodynamic4Hypodynamic4

/


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Hipo!ensi inganHipo!ensi ingan

Dobu!aminDobu!amin lebi" dipili"lebi" dipili"

meningka!kan aliran koronermeningka!kan aliran koroner meningka!kan kon!rak!ili!asmeningka!kan kon!rak!ili!as

meningka!kan cura" jan!ungmeningka!kan cura" jan!ung

menurunkan =$DPmenurunkan =$DP

Hipo!ensi SedangHipo!ensi Sedang DopaminDopamin lebi" dipili"lebi" dipili"

=asokons!roksi peri,er=asokons!roksi peri,er

memper!a"ankan per,usi organ +i!almemper!a"ankan per,usi organ +i!al Hipo!ensi 5era!Hipo!ensi 5era!

#orepine,rin#orepine,rin

memaksimalkan !ekanan dara"memaksimalkan !ekanan dara"


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DopamineDopamineAn endogenous precursor o, norepinep"rine /i!"An endogenous precursor o, norepinep"rine /i!"

mul!iple dose6rela!ed eLec!smul!iple dose6rela!ed eLec!s

o/ Dose 0;< 6 ) mgkgmin4o/ Dose 0;< 6 ) mgkgmin4

ββ22 and dopaminergic D4 eLec!sand dopaminergic D4 eLec!s

* $n"anced blood .o/ !o renal and$n"anced blood .o/ !o renal and

splanc"nic bedssplanc"nic beds

%odera!e Dose < 610 mgkgmin4%odera!e Dose < 610 mgkgmin4

* Posi!i+e ino!ropic eLec!sPosi!i+e ino!ropic eLec!s

Hig" Dose B10 mgkgmin4Hig" Dose B10 mgkgmin4

αα6ac!ions +asocons!ric!ion46ac!ions +asocons!ric!ion4


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$Lec!s o, 3no!ropic Agen!s$Lec!s o, 3no!ropic Agen!s

and =asodila!orsand =asodila!ors

$pinep"rine$pinep"rine αα11 ,β,β11, (β, (β22)) 0;02 * 0;


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3A5P


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cardiogenic syock

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