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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
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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
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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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