Kehamilan & penyakit

jantung
 Pendahuluan
 Fisiologi

Hamil Perubahan dalam KVS

- Hidremia  puncak 32 – 34 mg

- Anemia dilusional (vol plasma ↑ 30 % + sdm ↑

18 % + Hb ↑ 19 %)
- Postpartum  imbibisi ekstravaskuler ke
intravaskuler ≈ vol plasma ↑ (± 2 minggu)
- Frekuensi nadi ↑, prekordium bergeser ke kiri,
bising sistolik di apeks + katup pulmonal
 Pendahuluan
 Fisiologi

Hamil Penyakit Jantung

- Hamil 32 – 36 mg

- Partus Kala II

- Postpartum
 Key Cardiovascular Changes During Pregnancy
Blood Flow to Other Organs Increased
Peripheral Vascular Resistance Decreased

Blood Pressure Mid pregnancy decrease

Pulmonary Blood Pressure Unchanged

Heart Size Increased
Cardiac output Increased
Stroke volume Increased
Systolic murmurs Common
Diastolic murmurs Potentially pathological

EKG changes LAD, low voltage

 Cardiac Changes in Pregnancy

 Cardiac output increases around 50% from an

increase in HR and SV (3L/min to 6.2L/min)
 There is an additional 40% increase above that level
during active labor
 Immediately following delivery, cardiac output may be
increased by an additional 10-20%
 Cardiac exam is different during pregnancy
 Many patients will have an S3 after midpregnancy
 Diastolic murmurs are usually considered serious
 Systolic murmurs (“flow murmurs”) common
 Displacment of heart is to right and upwards
 EKG shows left axis deviation and low voltage QRS
complexes
Cardiac Changes in Pregnancy
Hemodynamic Changes in Pregnancy
More Hemodynamic Changes
 Penyakit jantung dalam
kehamilan
 Frekuensi : 12 % ( >> demam rheuma
 dahulu) + kelainan kongenital (± 50
%) + Hipertensi heart disease
(peripartum)

 Mortalitas : 8 -15 %
Penyakit jantung dalam
kehamilan
 Major Causes of Death per
Million Maternities U.K.
18
16
V.T.E.
14
Cardiac
12 Suicide
10 Sepsis
8 Ectopic
6 HT
Haemorrhage
4
AFE
2
0
 Deaths due to Congenital Cardiac
Disease
Primary Pulmonary H.T. 3
Pulmonary H.T. cause 1
unknown
ASD: Eisenmenger’s 2
ASD closed residual 1
pulmonary HT
Bicuspid aortic valve; 1
endocarditis
Coartation repair; 1
endocarditis
Previous ASD; arrythmia 1
 Deaths from Acquired
Cardiac Disease
Puerperal 7
Cardiomyopathy
Cardiomyopathy and 5
myocarditis
Aneurysm thoracic aorta 5
Myocardial Infarction 5
Endocarditis normal 1
valve
Heart Failure cause 2
unknown
Penyakit jantung dalam
kehamilan
 Penyakit jantung  Hipoksia +
sianosis
- Hasil konsepsi † (abortus)
- Hasil konsepsi hidup
 Prematur

 IUGR

 Gawat janin
 Penyakit jantung dalam
kehamilan
 Diagnosa (sulit)
- Anamnesis : riwayat sakit jantung
- Pemeriksaan fisik :
 Bising diastolik, presistolik, pansistolik

 Pembesaran jantung

 Bising jantung nyaring (thrill)

 Aritmia berat
Diagnosa
 Symptoms
- Progressive dyspnea or orthopnea

- Nocturnal cough

- Hemoptysis

- Syncope

- Chest pain
 Diagnosa
 Clinical findings
- Cyanosis

- Clubbing of fingers

- Persistent neck vein distention

- Systolic murmur grade 3/6 or greater

- Diastolic murmur

- Cardiomegaly

- Persistent arrhytmia

- Persistent split second sound

- Criteria for pulmonary hypertension

 Risiko
 Ringan :
 ASD / VSD

 PDA

 Tetralogi fallot yang terkoreksi

 Sedang :
 MS, AS

 Riwayat infark miokard

 Tetralogi fallot yang tidak terkoreksi

Risiko
 Berat :
 Pulmonary hipertension

 Marfan syndrom dengan aorta

yang terganggu
Prognosis
 Kapasitas fungsi jantung
 Komplikasi  peningkatan beban
jantung
 Kualitas pelayanan kesehatan
 Klasifikasi
 Kelas I
No limitation of physical activity
 Kelas II
Slight limitation of physical activity
 Kelas III
Marked limitation of physical activity
 Kelas IV
Inability to performed any physical
activity without discomfort
Penatalaksanaan
 Kelas I & II
- Preventif & pengenalan dini tanda

CHF
- Cegah bakterial endokarditis 

Preventif terhadap infeksi (CC) ,

Smoking, obat suntik dkk
- Batasi obat

- Labor & delivery

Penatalaksanaan
 Kelas I & II
- Labor & delivery :
 Partus pervaginam (kecuali

indikasi obstetri
 Kurangi rasa nyeri

 Observasi ketat tanda vital

(kontraksi)
 Intrapartum heart failure (udem

paru – hipoksia –hipotensi)

tatalaksana sesuai penyebab
Penatalaksanaan
 Kelas I & II
- Puerperium:

 HPP, infeksi, anemia &

tromboemboli  komplikasi
yang serius
 Sterilisasi  stabilisasi KU
Penatalaksanaan
 Kelas III & IV
- Continued or terminated ?

- Vaginal delivery is preferred with

epidural analgesia
- Surgical procedure could be done

in facility with experience with

complicated cardiac disease