POST PARTUM

CARDIOMYOPATH
Y
CASE REPORT
Daftar Pembahasan

01 02 03
Abstrak Pendahuluan Presentasi Kasus

04 05 06
Diskusi Kesimpulan Roadmap
01
Abstrak
Abstrak
Kehamilan memicu perubahan fisiologis sistem
kardiovaskular untuk memenuhi kebutuhan
metabolik di antara ibu hamil. Pada 75% kejadian
terjadi pada trimester pertama.
● Seorang ibu hamil (29) pasca melahirkan
mengalami gagal nafas dengan tanda-tanda
edem pulmo
● Pasien termasuk usia muda dengan
komorbid utama adalah diabetes mellitus
● Pasien diberikan terapi ventilator selama 3
hari kemudian ekstubasi dengan masa
pemulihan 7 hari
Pendahuluan
Background
Seorang ibu pasca melahirkan berusia 29 tahun
dengan komorbid diabetes mellitus mengalami gagal
nafas dan tanda-tanda bendungan paru. Hal ini
merupakan bagian dari kardiomiopati pasca
melahirkan. Kehamilan pada usia reproduksi akhir
(atau antara usia 40-50 tahun) lebih sering dikaitkan
dengan peningkatan prevalensi faktor risiko
kardiovaskular, terutama diabetes, hipertensi, dan
obesitas.
Importance
Pemeriksaan penurunan fungsi jantung
mungkin bisa dijadikan pertimbangan untuk
dilakukan sebagai skrining pada pasien ibu
hamil dengan risiko tinggi kardiovaskular.
Setelah melahirkan, ibu diberikan edukasi
agar tidak merangsang pengeluaran asi dan
tidak memberikan asi terlebih dahulu agar
mempercepat pemulihan fungsi jantung
Presentasi Kasus

Profil pasien Anamnesis Pemeriksaan fisik

• Ny DJ, 29 tahun
• Pegawai swasta
• Asuransi
• Pasca melahirkan seksio sesaria
(P3A0) atas indikasi BSC 2X
dan segmen bawah rahim tipis
tanggal 15/4/2024 dan pulang
tanggal 16/4/2024
Tanggal 18/4/2024 14:34 Keadaan umum tampak sakit berat
Datang ke IGD Kembali dengan kesadaran somnolen E3M6V4
keluhan sesak berat dan kedua kaki TD 169/98
bengkak sejak sudah 3 hari smrs HR 144x/menit
RR 32x/menit
RPD: Spo2 89% room air  99% nrm 10
- Post SC 4 hari lalu lpm
- Diabetes mellitus gestasional
- Alergi disangkal
- Riwayat pengobatan disangkal
Presentasi Kasus (cont,)

Pemeriksaan Fisik EKG Asesmen

- Mata : CA -/- SI -/- - Impending gagal nafas
- Pulmo : VBS +/+ Rales +/+ - Post partum cardiomyopathy
Wheezing -/- Cor : S1 S2 - Post section caesaria
tunggal reguler murmur (-) - Diabetes Mellitus Gestasional
gallop (-)
- Abdomen : datar supel BU
(+)N, NT (-)
- Ekstremitas : Akral hangat,
CRT<2" udem pitting ++/++
Presentasi Kasus (cont,)
Presentasi Kasus (cont,)
Presentasi Kasus (cont,)
Diskusi

Diagnosis banding Tatalaksana IGD

- Emboli paru - Dilakukan intubasi dengan ett no 7
- Eklamsia premed fentanyl 100mcg + propofol 8cc
- Pneumonia - Dilakukan pemasangan cvc di vena
jugularis
Diskusi

Advice dr Zakky Sp JP Advice dr Andryadi SP AN

- Lasix drip 10 mg/jam - FENTANYL 10MG/JAM
- Captopril 3x6,25 mg - Midazolam 2mg/jam
- Spironolactone 0-25 mg-0 - Furosemid 10mg jam
- Digoxin 0,125 mg-0-0 - NTG 20mcg/menit
- Kebutuhan Cairan 25 cc/kgbb/24 jam - Ganti mode simv vt 350 rr 14 peep 8 fio2
- Target Balanced -500 s/d -1000 ml/24 80
jam
- Target MAP > 65 mmHg , target TD 100-
110 mmhg/70-80 mmHg
- NTG 20 mcg/menit uptitrasi sesuai TD
- RAWAT ICU
- Echo di ICU besok
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