Download - Pencegahan Penyakit Kardiovaskuler
-
7/21/2019 Pencegahan Penyakit Kardiovaskuler
1/59
PENCEGAHAN PENYAKIT
KARDIOVASKULER
Oleh:
Cindy Kesty, S.Ked
!"!#$$!$%
Pe'(i'(in):dr. Erwin Sukandi, Sp.PD-KKV
Tinjauan Pustaka
DEPARTEMEN ILMU PENYAKIT DALAM
FAKULTAS KEDOKTERAN UNIVERSITAS SRIWIJAYA
RSUP DR.MOHAMMAD HOESIN PALEMBANG
2014
$
-
7/21/2019 Pencegahan Penyakit Kardiovaskuler
2/59
*A* IPENDAHULUAN
+
-
7/21/2019 Pencegahan Penyakit Kardiovaskuler
3/59
CVDPK
Peny.
se-e(-/0s12le-
Peny. 0-te-i3e-i4e-
PR
P*
T-'(sis /en0
d0l0'
E'(li 30-2
5
-
7/21/2019 Pencegahan Penyakit Kardiovaskuler
4/59
Indnesi0st-1e, 3eny.Is1e'i1 60nt2n),di0(etes$st,
%th, &th
#7 30d0 ne)0-0(e-1e'(0n)
CVD$3enye(0(1e'0ti0nte-(0ny01 89HO,+$+
!
-
7/21/2019 Pencegahan Penyakit Kardiovaskuler
5/59
$&,5 6t -)'enin))0l
+5 6t -)010n
'enin))0l
+#
+5
"
-
7/21/2019 Pencegahan Penyakit Kardiovaskuler
6/59
;AKTOR RISIKO
-
7/21/2019 Pencegahan Penyakit Kardiovaskuler
7/59
A3li10siSt-0te)iPen=e)0h0n
P-i'e- >Se12nde-
P32l0si
G0y0 hid23 >
lin)12n)0n
Ke(i6010n >inte-/ensi1'2nit0s
*e-isi1 Tin))iAntili3id,
0ntihi3e-tensi,(e-henti 'e-11
&
-
7/21/2019 Pencegahan Penyakit Kardiovaskuler
8/59
Tin6020n P2st010
Re1'end0siKel0s ?
Tin)10t *21ti
De4inisi ?St-0ti4i10si
;01t- Risi1
A3li10siTind010n
Pen=e)0h0n
CVD
#
-
7/21/2019 Pencegahan Penyakit Kardiovaskuler
9/59
*A* II
REKO
-
7/21/2019 Pencegahan Penyakit Kardiovaskuler
10/59
REKO
-
7/21/2019 Pencegahan Penyakit Kardiovaskuler
11/59
TINGKAT *UKTI
TingkatBukti
Keterangan
A D0t0 did030t10n d0-i RCT '2lti3el0t02 'et00n0lisis
* D0t0 did030t10n d0-i RCT t2n))0l0t02 nnBRCT (es0-
C Knsens2s 3ini d0-i 0hli d0n3eneliti0n 1e=il, 3eneliti0n
-et-s3e1ti4
$$
-
7/21/2019 Pencegahan Penyakit Kardiovaskuler
12/59
KUALITAS *UKTI
Keterbatasan Studi lokasi !ang n!ata, penelitian "asil !angtidak disamarkan, "ilang selamapemantauan, tidak ada analisis mengenaiterapi
Pene'20n y0n)tid01 1nsistensi V0-i0(ilit0s te-)0nt2n) 3e-(ed00n 30d0 30sien
*21ti y0n) tid01l0n)s2n)
Pe-(0ndin)0n head to head (e-si40t l0n)s2n)
Ketid01te30t0n 2'l0h 30sien y0n) sedi1it
*i0s 32(li10si Peneliti0n y0n) 'en2n62110n tid01 0d0 e4e1inte-/ensi tid01 di32(li10si 0t02 di32(li10si 30d0
62-n0l y0n) tid01 (e-inde1s
$+
-
7/21/2019 Pencegahan Penyakit Kardiovaskuler
13/59
*A* III
DE;INISI DANSTRATI;IKASI ;AKTOR RISIKO
$5
-
7/21/2019 Pencegahan Penyakit Kardiovaskuler
14/59
DE;INISI
Pen=e)0h0n CVD
Tind010n30d0
tin)10t32(li1 d0nindi/id2
E-0di10si,eli'in0si,
'ini'0lis0si
E4e1 d0-iCVD d0n
dis0(ilit0ste-10it
$!
-
7/21/2019 Pencegahan Penyakit Kardiovaskuler
15/59
SCORE
Ne)0-0 -isi1 tin))i d0n -end0h
Knse3: 0te-s1le-sis3-ses y0n) (e-1el0n62t0n
P-i-it0s 30d0 ! tin)10t: 30sien didi0)nsis CVD,indi/id2 0si't'0ti1 den)0n -isi1 tin))i, s den)0n1el20-)0 'ende-it0 CVD 3-e'0t2-, s y0n) d0t0n) 1e3-01ti1
$"
-
7/21/2019 Pencegahan Penyakit Kardiovaskuler
16/59
KARAKTERISTIK
Indi/id2 Seh0tTid01 'e-11
A1ti/it0s 'in. "') 5 'enit
-
7/21/2019 Pencegahan Penyakit Kardiovaskuler
17/59
$&
-
7/21/2019 Pencegahan Penyakit Kardiovaskuler
18/59
STRATI;IKASI ;AKTOR RISIKO
CVD te-dete1si 'el0l2i 3e'e-i1s00n in/0si4 > nnBin/0si4 D< ti3e $ > + den)0n F $ 4.-isi1 CV > 1e-2s010n -)0n t0-)et GGK 8L;G 5 'l'enit$,&5'+
SCORE F $7
Sangat tinggi
;01t- -isi1 t2n))0l 'enin)10t se3e-ti disli3ide'i0 40'ili0l d0n hi3e-tensi (e-0t D< ti3e $ > + t0n30 401t- -isi1 CVD 0t02 1e-2s010n -)0n t0-)et GGK 'de-0t 8L;G 5B"@ 'l'enit$,&5'+ SCORE F "7 d0n $7
Tinggi
SCORE F $ d0n "7
#oderat
SCORE $7
Renda"
$#
-
7/21/2019 Pencegahan Penyakit Kardiovaskuler
19/59
PENANDA RISIKO CVD
hsCRP
;i(-in.)enIn4l0'0si3l01
tid01 st0(il
H.'.sisteinL3PLA+T-'(ti1
-23t213l01
$@
-
7/21/2019 Pencegahan Penyakit Kardiovaskuler
20/59
TEKNIK PENCITRAAN UNTUK
DETEKSI DINI CVD
Sten.sis1.-.ne-
-
7/21/2019 Pencegahan Penyakit Kardiovaskuler
21/59
Coronary Angiography Calcium Scoring
(NICE, 2!"
+$
-
7/21/2019 Pencegahan Penyakit Kardiovaskuler
22/59
Ankle#$rachial Inde%
++
-
7/21/2019 Pencegahan Penyakit Kardiovaskuler
23/59
PENYAKIT TERKAIT CVD
CVDIn4l2en0
GGK
OSA
Dis42n)sie-e1til
Peny01it02ti'2n
Pe-idntitis
Peny01it/0s12le-
+5
-
7/21/2019 Pencegahan Penyakit Kardiovaskuler
24/59
*A* IV
APLIKASI TINDAKANPENCEGAHAN CVD
+!
-
7/21/2019 Pencegahan Penyakit Kardiovaskuler
25/59
CVD
;.3e-il0B12
Ke(i0s00n
-
7/21/2019 Pencegahan Penyakit Kardiovaskuler
26/59
;AKTOR PERILAKU
-
7/21/2019 Pencegahan Penyakit Kardiovaskuler
27/59
KE*IASAAN
-
7/21/2019 Pencegahan Penyakit Kardiovaskuler
28/59
+#
-
7/21/2019 Pencegahan Penyakit Kardiovaskuler
29/59
NUTRISI
As0' le'01 6en2h $7 d0-i tt0l 10l-is2(stit2si den)0n 0s0' le'01 tid01
6en2h
As0' le'01 t-0ns tid01 6en2h di2s0h010n
sedi1it '2n)1intid01 'en)ns2'si'010n0n y0n) di3-ses
" ) )0-0' 3e- h0-i
5 J !" ) se-0t 3e- h0-i, d0-i 3-d21 (i6iB(i6i0n, (20h d0n s0y2-
+@
-
7/21/2019 Pencegahan Penyakit Kardiovaskuler
30/59
Cont&&&
+ ) (20h ? + ) s0y2- 3e- h0-i 8+B53-si
I10n 'ini'0l +h0-ii10n y0n)
(e-le'01
P-d21 y0n) 'en)0nd2n) 0l1hlse(0i1ny0 di(0t0si se(0ny01 + )el0sh0-i
8+ )h0-i 2nt21 3-i0 d0n $ )el0sh0-i 8$
)h0-i 2nt21 0nit0.
5
-
7/21/2019 Pencegahan Penyakit Kardiovaskuler
31/59
LATIHAN ;ISIK
L0tih0n 4isi1 di0'ete- 0-te-i 1-ne-,
'i1-si-12l0si, 42n)si endtel 3e-42si
'i10-di2'
L0tih0n 4isi1 /l2'e 3l0s'0, /is1sit0sd0-0h, 0)-e)0si t-'(sit, 01ti/it0s
t-'(liti1, -isi1 0-it'i0 -isi1 1l2si
1-ne-
Re1'end0si:
+,"B" 60''in))2 intensit0s 'de-0t, 0t02
$B+," 60''in))2l0tih0n y0n) intens.
5$
-
7/21/2019 Pencegahan Penyakit Kardiovaskuler
32/59
Cont&&
L0tih0n 4isi1 3e-ide F $ 'enit
(e-l0n)s2n) se30n60n) 'in))2
P0sien y0n) se(el2'ny0 tel0h 'ende-it0
in40-1 'i10-d 012t, 'en60l0ni CA*G, PCI,
0n)in0 3e1t-is st0(il, CH; st0(il
l0tih0n0e-(i1 den)0n intensit0s 'de-0t
se(0ny01 F 5 10li'in))2 d0n 5 'enit 3e-
sesi.
5+
-
7/21/2019 Pencegahan Penyakit Kardiovaskuler
33/59
;AKTOR PSIKOSOSIAL
Knselin) 3-i/0t)-23
Te-03i 3e-il012B1)niti4
-
7/21/2019 Pencegahan Penyakit Kardiovaskuler
34/59
*ERAT *ADAN
** 30d0 30sien y0n) o'ereight 8I
-
7/21/2019 Pencegahan Penyakit Kardiovaskuler
35/59
KLASI;IKASI I
-
7/21/2019 Pencegahan Penyakit Kardiovaskuler
36/59
KLASI;IKASI TEKANAN DARAH
8ESC, +$+
KategoriTekanan Dara"
Sistolik %mm1g(
Tekanan Dara"
Diastolik %mm1g(
+ptimal $+ d0n #
*ormal $+B$+@ d0n0t02 #B#!
*ormaltinggi
$5B$5@ d0n0t02 #"B#@
1ipertensi
grade $!B$"@ d0n0t02 @B@@
1ipertensi
grade '$%B$&@ d0n0t02 $B$@
1ipertensi
grade F $# d0n0t02 F $$
1ipertensi
sistolikF $! d0n @
5%
-
7/21/2019 Pencegahan Penyakit Kardiovaskuler
37/59
KLASI;IKASI TEKANAN DARAH
8NC VII
KategoriTekanan Dara"
Sistolik %mm1g(
Tekanan Dara"
Diastolik %mm1g(
*ormal $+ d0n0t02 #
Pre"ipertensi $+B$5@ d0n0t02 #B#@
1ipertensi
grade $!B$"@ d0n0t02 @B@@
1ipertensigrade '
F $% d0n0t02 F $
5&
-
7/21/2019 Pencegahan Penyakit Kardiovaskuler
38/59
TEKANAN DARAH
Penil0i0n )0y0 hid23 30d0 30sienhi3e-tensi
Hi3e-tensi )- $B+ d0n 30d0 30sien (e-isi1
CVD 'de-0t te-03i (0t d030t dit2nd0
(e(e-030 'in))2
Hi3e-tensi )- $ t0n30 401t- -isi1 l0in
(0t d030t dit2nd0 (e(e-030 (2l0n ?
3e-(0i1i )0y0 hid23
5#
-
7/21/2019 Pencegahan Penyakit Kardiovaskuler
39/59
Cont&&
Hi3e-tensi )- 5 d0n )- $B+ den)0n -isi1CVD tin))is0n)0t tin))i (0t di(e-i10n
se)e-0
St0tin di(e-i10n 30d0 3ende-it0
hi3e-tensi den)0n CVD 0t02 SCORE F "7 Anti3l0telet 3ende-it0 hi3e-tensi y0n)
3e-n0h 'en)0l0'i CVD3en2-2n0n 42n)si
)in60l-isi1 CVD tin))i
5@
ALGORIT
-
7/21/2019 Pencegahan Penyakit Kardiovaskuler
40/59
ALGORIT
-
7/21/2019 Pencegahan Penyakit Kardiovaskuler
41/59
ALGORIT
-
7/21/2019 Pencegahan Penyakit Kardiovaskuler
42/59
PE
-
7/21/2019 Pencegahan Penyakit Kardiovaskuler
43/59
DIA*ETES
-
7/21/2019 Pencegahan Penyakit Kardiovaskuler
44/59
Cont&&
St0tin 'en)2-0n)i -isi1 CVD 30d0
di0(etes. T0-)et 1leste-l LDL +,"
''lL 8$ ')dL, 1leste-l tt0l !,"
''lL, 1leste-l LDL $,# ''lL 8&')dL
Te-03i 0nti3l0telet den)0n 0s3i-in tid01
di-e1'end0si10n 30d0 3ende-it0 di0(etes
y0n) tid01 te-(21ti 'ende-it00te-s1le-sis
!!
HIPERLIPIDE
-
7/21/2019 Pencegahan Penyakit Kardiovaskuler
45/59
HIPERLIPIDE
-
7/21/2019 Pencegahan Penyakit Kardiovaskuler
46/59
-
7/21/2019 Pencegahan Penyakit Kardiovaskuler
47/59
O*AT ANTILIPID
+bat 2ara Ker;a
Inhi(it- 5Bhid-1siB5B'etil)l2t0-ilB= A-ed21t0se 8st0tin
drug o) choice, 1leste-lLDL
;i(-0t t-i)lise-id0, HDL
Se12est-0n 0s0' e'3ed28anion e%change resin
1leste-l tt0l d0n LDL, t-i)lise-id0
Ni0sin 80s0' ni1tin0t t-i)lise-id0, HDLInhi(it- 0(s-(si1leste-l sele1ti48eeti'i(
!&
-
7/21/2019 Pencegahan Penyakit Kardiovaskuler
48/59
ANTIPLATELET
;0se 012t d0-i ACS d0n hin))0 $+ (2l0n
sel0n62tny0 1'(in0si 0nti3l0telet den)0n
3en)h0'(0t P+Y$+ 8t-i10)-el- 0t02 3-0s2)-el
d0n 0s3i-in di-e1'end0si10n
Kl3id)-el 8% ') dsis loading, &" ') dsish0-i0n30d0 30sien y0n) tid01 d030t 'ene-i'0
t-i10)-el- 0t02 3-0s2)-el
P0d0 40se 1-ni1 8 $+ (2l0n setel0h in40-1
'i10-d, 0s3i-in di-e1'end0si10n 2nt213en=e)0h0n
!#
-
7/21/2019 Pencegahan Penyakit Kardiovaskuler
49/59
Cont&&
Se-0n)0n is1e'i1 t-0nsien nnB10-die'(li1
0t02 st-1e is1e'i1 di3i-id0'l ? 0s3i-in 0t02
1l3id)-el s060 di-e1'end0si10n
Intle-0nsi te-h0d03 di3i-id0'l 8s01it
1e30l01l3id)-el0s3i-in P0sien den)0n nnB10-die'(li, 1e60di0n
is1e'i1 se-e(-0l, 0nti10)2l0n tid01
di-e1'end0si10n
As3i-in 0t02 1l3id)-el tid01 di-e1'end0si10n30d0 indi/id2 t0n30 CVD 10-en0 tin))iny0 -isi1
3e-d0-0h0n
!@
-
7/21/2019 Pencegahan Penyakit Kardiovaskuler
50/59
*A* V
SI
-
7/21/2019 Pencegahan Penyakit Kardiovaskuler
51/59
SCORE y0n) di3010i leh ESC 2nt21
'enst-0ti4i10si 401t- -isi1 30d0 ne)0-0Bne)0-0 di
(en20 E-30
P0-0'ete- y0n) di)2n010n 0d0l0h
enis 1el0'in
Usi0
Ke(i0s00n 'e-11
Te10n0n d0-0h
Kleste-l tt0l
Indi/id2 di1el'3110n 'en60di -isi1:
S0n)0t tin))i 6i10 SCORE F $7 Tin))i 6i10 SCORE F "7 d0n $7
-
7/21/2019 Pencegahan Penyakit Kardiovaskuler
52/59
Pen0nd0 -isi1 CVD di1el'3110n 'en60di +
y0it2:
In4l0'0si 8hsCRP d0n 4i(-in)en T-'(ti1 8h'sistein d0n L3PLA+
Penye(0( CVD 0d0l0h 0te-s1le-sis 30d0
3e'(2l2h d0-0h y0n) (e-h2(2n)0n den)0n
3eny01it l0in se3e-ti:
In4l2en0, )0)0l )in60l 1-ni1, OSA, dis42n)si
e-e1til, 3eny01it 02ti'2n, 3e-idntitis se-t0
3eny01it /0s12le- setel0h -0di0si d0n
t-0ns3l0nt0si.
*e(e-030 te1ni1 3en=it-00n 30d0 CVD y0it2
EKG, e110-di)-04i st-es, s1inti)-04i
-0din21lid0, 3en=it-00n 0-te-i 10-tis, s1-
10lsi2' 1-ne-, A*I d0n
-
7/21/2019 Pencegahan Penyakit Kardiovaskuler
53/59
A3li10si tind010n 3en=e)0h0n CVD 'en=0123
(e(e-030 3in 3entin) y0it2:
;01t- 3e-il012, 1e(i0s00n 'e-11, n2t-isi,
l0tih0n 4isi1, 401t- 3si1ssi0l, (e-0t (0d0n,
te10n0n d0-0h, D
-
7/21/2019 Pencegahan Penyakit Kardiovaskuler
54/59
"!Thank
-
7/21/2019 Pencegahan Penyakit Kardiovaskuler
55/59
L0st-i
A3010h 3en=e)0h0n ini h0ny0 (e-l012 30d0 30sien 401t- -isi1
-end0hBtin))i 0t02 30d0 indi/id2 y0n) tel0h =/dM
Pen=e)0h0n 0)0- tid01 te-60di 1'3li10si, 'is0l st-1e
dih0-0310n tid01 le(ih 30-0h
Pene-030n d0n ed210si 2nt21 l0tih0n 4isi1, l0tih0n 4isi1 y0n)
dis0-0n10nM
0l0n s0nt0iintensit0s 'de-0t 8"'in))2
L0-i 0t02 (0d'intn$'in))2
Ste40ni Pen2-2n0n ** ide0l (e-030M *e-030 l0'0M
I
-
7/21/2019 Pencegahan Penyakit Kardiovaskuler
56/59
S2nd0-i
G2ideline d0-i l20-, 033li=0(le 0t02 tid01 2nt21 -0n)
Indnesi0M
NC)2ideline y0n) (i0s0 di)2n010n
"%
-
7/21/2019 Pencegahan Penyakit Kardiovaskuler
57/59
N0di0
O'e)0 5 d0n CVDM
CEYKA
Unt21 d1te- 2'2', 3e'e-i1s00n 030 y0n) (is0
dil01210nM
EKG
*e-d0s0-10n te-i, 30sien d0t0n) 2si0, ! t0h2n,
3e-11, disli3ide'i0ed210si (0)0i'0n0M
Psi1l)is d0n 1ein)in0n 30sien 2nt21 (e-henti
'e-11
L01210n 3ende10t0n 30d0 30sien
"&
-
7/21/2019 Pencegahan Penyakit Kardiovaskuler
58/59
Nis0
Pe'010i0n 0nti 3l0telet, 03010h se'20 -0n)
den)0n 401t- -isi1 3e-l2 di(e-i10nM
tid01
Pen=e)0h0n 030 y0n) (is0 dil01210n 30d0 30sien
den)0n PADM
Se4ti P-4il li3id y0n) 'enin)10t10n -isi1 0te-s1le-sisM
"#
-
7/21/2019 Pencegahan Penyakit Kardiovaskuler
59/59
Retn
Hi3e-tensi 3-i'e-, 13n di=2-i)0i 0d0ny0
0te-s1le-sisM
*0)0i'0n0 3en0t0l01s0n00nny0M
"@