The heart is
one of the human organs that play a role in the circulatory system At the
heart of oxygen-rich blood coming from the lungs to the tissues throughout
the body pumped.
Basic Function Heart
Is pumping red blood rich in oxygen and nutrients through the large vessels throughout the body and holds back once cleared by the lungs.
Congestive Heart Failure (CHF) / Gagal Jantung
Is a condition in which the heart is unable to pump
blood throughout the body to meet the metabolic needs
Disease risk factors Congestive Heart Failure (CHF) /
Heart Failure
1. Dynamic risk factors:
a. dyslipidemia
b. Hypertension
c. Physical activity
d. Diabetes mellitus
e. smokea.
a. dyslipidemia
b. Hypertension
c. Physical activity
d. Diabetes mellitus
e. smokea.
2. The absolute risk factors
a. History of illness in the family / descent
b. Gender
a. History of illness in the family / descent
b. Gender
Classification System
Disorders Cardiovascular
1. Class I (Asymptomatic) No
limitations on physical activity
There are no symptoms of heart disease with regular activity
There are no symptoms of heart disease with regular activity
2. 2. Class II (Light) Slight
limitation of physical activity
At rest no complaints
Ordinary activity causes the heart isufisiensi symptoms such as fatigue, palpitations (cordis palpitations), shortness of breath or angina pectoris
At rest no complaints
Ordinary activity causes the heart isufisiensi symptoms such as fatigue, palpitations (cordis palpitations), shortness of breath or angina pectoris
3. . Class III (Medium)
a. Many restrictions on physical activity
b. At rest no complaints
c. Activities with less intensity than usual can d. cause symptoms of heart isufisiensi
a. Many restrictions on physical activity
b. At rest no complaints
c. Activities with less intensity than usual can d. cause symptoms of heart isufisiensi
4. 4. Class IV (Heavy)
a. Inability to perform any physical activity
b. Symptoms occur at rest
a. Inability to perform any physical activity
b. Symptoms occur at rest
Pharmacokinetics of heart problems
ABSORBSI
} Absorption mainly occurs in the
small intestine through the process nonsaturable possibility. Delay gastric
emptying or the food may slow the absorption of the drug but did not reduce the
rate of absorption.
} Plasma concentrations vary on each
individual with a certain dose can result in a therapeutic effect on a person,
but can also produce toxic effects on others.
} In the oral administration of drugs
will produce the onset after 0.5-2 hours after dosing with maximum effect is
achieved after 2-6 hours after administration, while the IM administration,
onset produced after 30 minutes with a maximum effect at 4-6 hours after
administration. In the IV administration in a single dose produces onset in
5-30 minutes and the maximum effect occurs in 1-4 hours. Digoxin effects may
persist for 3-4 days
DISTRIBUSI
} At therapeutic plasma
concentrations, approximately 20-30% of drug bound to the protein plasma.Pasien
with complications of severe renal function impairment have smaller
distribution volume compared to patients with normal renal function.
METABOLISME
} A fraction of metabolism occurs in
the hearts and metabolism can also occur by bacteria dilumen gut after oral administration
or after the elimination of bile on IV administration.
ELIMINASI
} Prolonged elimination half-life
would occur in patients with impaired renal function.
} Percentage of daily elimination
medications for heart failure can be calculated by the equation:
} %
eliminasi = 14 + Clearens Kreatinin
(ml/minute/5)
Management
• Stage A.
Patients who have a high risk of
heart failure, for example hipertansi patients, coronary artery disease,
diabetes. Treatment :
ACE Inhibitor (Captopril)
• Stage B.
Patients with heart disease but do
not have symptoms of heart failure, for example: patients with myocardial
infarction, hipertropi right ventricular systole disorders. Treatment :
ACE inhibitor + Beta bloker.
• Stage C.
Patients with heart damage and have
symptoms of heart failure, for example: Dyspenea, fatigue, fluid retention.Treatment : ACE inhibitor + Beta bloker +
Digoksin, bila tejadi udema beri diuretik.
• Stage D.
Patients with symptoms of heart
failure in addition to maximal medical therapy. Examples: Patients with severe,
and hospitalization, treatment after relapse. Treatment : Perlu tindakan operasi Dose adjustments
The principle of the drug in patients with heart failure:
1. Lower starting dose and dose
support.
2. Adjust the dose based on clinical response of
the patient.
3. Adjust dose based on measurement of the drug in plasma.
EmoticonEmoticon