Professional Documents
Culture Documents
PROBLEMS
Prof. Dr. dr. Ali Aspar Mappahya, Sp.PD, Sp,JP
Bagian Ilmu Penyakit Dalam
Fakultas Kedokteran Universitas Hasanuddin
BP < 90 mmHg :
Intravenous dopamine (titrated)
Intravenous dobutamine/milrinone
BP = 90-100/>100 mmHg:
Nitroprusside-drips (titrated)
Intravenous Diuretics (Furosemide)
Intravenous NTG
Nesiritide (with caution)
IABP (Intra aortic balloon pumping)
PTCA/CABG/transplantation
After optimizing hemodynamic variables:
ACEI, ARB, BB, hydralazine
Diuretics
Oxygen therapy
Digoxin
NO/intravenous prostacyclin
CARDIAC TAMPONADE
Evidence of elevated pericardial pressure manifested
as elevated systemic venous pressure .
Decreased cardiac output and hypotension;
evidence of decreased peripheral perfusion.
Echocardiography : large pericardial effusion;
RV early diastolic collapse, RA diastolic collapse,
LA diastolic collapse; etc.
Right heart catheterization: Equalization of RA pressure,
LA pressure, PCWP, and Ventricular EDP.
tissue damage
Atypical presentations:
More common in elderly, diabetics, women
Cardiac causes:
ACS
Syndrome X
Pericarditis
MVP
Aortic stenosis
Hypertrophic cardiomypathy
Aortic causes:
Aortic dissection
Penetrating ulcer of aorta
Pulmonary causes :
Embolism
Gastrointestinal causes:
Esophageal spasm, reflux
Gastritis, gastric ulcer
Cholecystitis
Costochondritis :
Tietzes syndrome
Neurologic causes :
Cervical spondylosis
Other compression neuropathy
Herpes
Psychological causes :
Panic disorder
Anxiety
Depression
Hysteria
ECG
Biochemical markers : CK/CKMB, Myoglobin, Troponins
BNP, hsCRP
ACS
Pericarditis
Aortic dissection
Pulmonary embolism
Beta-blockers
Morphine sulfate
- May be administered with nitrates.
ACE inhibitors
CARDIOGENIC SHOCK
Diagnosis :
Decreased urine output(<30 mL/h)
Impaired mental function
Cool extremities
Distended neck vein (jugular vein)
Hypotension with evidence of peripheral and