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Syndromes
KELOMPOK C
DEFINITION
AHFS
Coronary
EPIDEMIOLOGY
Incidence and prevalence:
One hundred to 400 new cases of heart failure are diagnosed per 100,000 persons per year
One thousand or more new cases are diagnosed per 100,000 persons over age 65 per year
There are approximately 1,000 to 2,000 cases of heart failure per 100,000 persons
Five thousand or more cases are diagnosed per 100,000 persons over age 65; heart failure is the most common inpatient
diagnosis in the U.S. in patients over age 65
Heart failure occurs at some stage in patients with most forms of severe heart disease, regardless of the underlying cause
Demographics:
Heart failure is more common in men than in women between 40 and 75 years of age, but among persons over age 70, both
sexes are affected equally
The prevalence of heart failure is estimated to be 25% greater in black persons than in white persons
Dilated and hypertrophic forms of cardiomyopathy may run in families, and specific genetic defects are known. Susceptibility
to myocardial infarction, which is a frequent cause of heart failure, may have a genetic component. Hypertension is frequently
familial. Hemochromatosis can lead to both cardiomyopathy and accelerated coronary artery disease
RISK FACTORS
Obesity
Cigarette smoking
Pregnancy
Diabetes
Physical inactivity
Renal insufficiency
CLINICAL CLASIFICATION
PATHOPHYSIOLOGY
AHFS are characterized by severe hemodynamic and neurohormonal abnormalities
that may cause myocardial injury and/or renal dysfunction or may be a result of it
These abnormalities may be caused or precipitated by ischemia, hypertension, atrial
fibrillation, other noncardiac conditions (e.g., renal insufficiency), or untoward drug
effects
Congestion
Myocardial injury
Renal impairment
Congestion
High LV diastolic pressure resulting in pulmonary and systemic congestion with or without
low cardiac output is the main reason for presentation in the majority of patients . Systemic
congestion manifests clinically by jugular venous distention with or without peripheral
edema and gradual increases in BW are often seen ..
Body weight is often used as a marker of congestion in both inpatient and outpatient
settings. However, recent data suggest a more complex relationship among BW, congestion,
and outcomes. Although an increase in BW predicts hospitalization, a reduction in BW in
response to different therapies may not necessarily result in decreased hospitalization or
mortality.
Myocardial injury
Renal impairment
MANAGEMENT OF ACUTE
HEART FAILURE SYNDROME
Pharmalogical Treatment
Acute Management
Oxygen
Oxygen
Oxygen
Diuretics
Opiates
Vasodilators
Nesiritide
Inotropes
Vasopressors
Dopamine
After stabilization
Angiotensin-converting
enzyme
/angiotensin receptor blocker
inhibitor
Beta-blocker
Mineralocorticoid
antagonist
(aldosterone)
receptor
Digoxin
Non-pharmacological/non-device
therapy
Ventilation Non-invasive ventilation
Continuous
Ventricular
assist devices
Ventricular
Ultrafiltration
Venovenous
isolated ultrafiltration is
sometimes used to remove fluid in
patients with HF, although is usually
reserved for those unresponsive or
resistant to diuretics.
REFERENCES