Kardiologi Klinis
Christian Setiawan
Pembimbing:
dr. Timotius J. Sumampouw, Sp.JP
Contoh kasus di ICU
• Ny. MB /71 tahun Hb 13
• nyeri dada kiri sudah Leu
lama hilang timbul,
memberat tadi pagi 9.29
tembus belakang, rasa Tc 228
sesak+RPD: HPT+
(amlodipine 5mg , minum Ur 27.9
jika ada keluhan)
Cr 0.89
• KU TSS Kes CM SGOT 31
• TD 89/59 N 76 R 24 SGPT 20
• SB 36 SpO2 97% room air
• Sp ves +/+ rh -/- wh -/- Na 143
K 3.83
Tatalaksana
• Terapi awal:
• IVFD NS 14 tpm
• Lansoprazole 2x1 IV
• Ketorolac ekstra IV
• Terapi lanjutan:
• Aspilet 80mg 2 tablet loading lanjut 1x80mg
• Clopidogrel 75 mg 2 tablet loading lanjut 1x75mg
• Atorvastatin 40mg loading lanjut 1x40mg
• ISDN 5 mg SL 3x1 atau bila nyeri dada belum membaik,
dapat diulang 3x jeda 10-15 menit
• Enoksaparin 2x40mg SC
• Rujuk RS Kandou
Follow up di RS Rujukan
• KU TSS Kes CM
• TD 89/59
• N 110
• R 24
• SB 36
• SpO2 90% NRM 15 LPM
• Kep: Conj An -/-, Skl Ict -/-, • Echo intip : RV dilatasi, IVC 2
JVP 5+3 cmH2O cm kolaps < 50%
• Cor: BJ I-II reg, murmur (-),
gallop (-)
• Pul: Sp.Ves ki = ka, Rh -/- , • Pro Cek AGD
wheezing +/+ minimal • Tatalaksana jalan nafas
• Abd: Datar, lemas, NTE (+), BU
(+) normal
• Ext: akral dingin, edema (-) ,
CRT<2”
History is the most important
Chizner MA. Clinical Cardiology Made Ridiculously Simple 5 th Edition. 2018. MedMaster Inc, Miami
Anamnesis
• Keluhan utama yang paling sering:
• Nyeri dada
• Sesak nafas
• Mudah lelah dan lemah
• Batuk dan Batuk darah
• Dada berdebar
• Pusing, hampir pingsan, pingsan
• Kaki bengkak/bertambah berat badan
• Klaudikasio intermitten
Chizner MA. Clinical Cardiology Made Ridiculously Simple 5 th Edition. 2018. MedMaster Inc, Miami
Anamnesis Riwayat saat ini
• OPQRST vs TLOR CPAS
• Onset kapan nyeri mulai? tiba-tiba atau
perlahan?
• Provocative/Palliation muncul/memburuk saat
aktivitas/emosi/dingin/setelah makan? membaik
dengan istirahat/duduk/minum obat dibawah lidah?
• Quality rasa berat, terbakar, ditusuk-tusuk,
diremas-remas, dirobek
• Radiation nyeri dimana? berpindah ke arah mana?
• Severity Tingkat keparahan dinilai 1-10? Nyeri
saat melakukan aktivitas apa?
• Time seberapa sering muncul? berapa lama nyeri?
ada perubahan seiring waktu?
Hernandez A. Pain Assessment Mnemonic. 2025. https://www.osmosis.org/answers/opqrst-pain-assessment-mnemonic
Unstable Angina
• Four Principal Presentation of Unstable Angina:
• † Prolonged (20 min) anginal pain at rest (Rest Angina);
• † New onsetLoading 3 obat
(de novo) yang paling
angina (classpenting:
II or III of the Canadian
CardiovascularAspilet 160-320
Society mg (2-4 tab)
classification) (New-Onset Angina)
• † Recent destabilization of previously stable angina with at
Clopidogrel 150-300 mg (2-4 tab)
least Canadian Cardiovascular Society Class III angina
Atorvastatin
characteristics 40-80mg /angina)
(crescendo Rosuvastatin 20-40mg
(Increasing/Progressive
Angina); or
• † Post-MI angina.
Collet JP, Thiele H, Barbato E, et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation [published correction appears in
Eur Heart J. 2021 May 14;42(19):1908
Canadian Cardiovascular
Society Grading of Angina
Pectoris
• 1 block =
80m
Campeau L. The Canadian Cardiovascular Society grading of angina pectoris
revisited 30 years later. Can J Cardiol. 2002 Apr;18(4):371-9. PMID: 11992130.
Anamnesis: Riwayat penyakit
dahulu dan obat
• Jantung koroner (pasang ring/kateterisasi
jantung/bypass/serangan jantung)
• Gagal jantung (pembengkakan jantung,
pemeriksaan ekokardiografi)
• Pemasangan alat pacu jantung (pacemaker)
• Riwayat jantung bawaan sejak lahir/jantung
rematik
• Riwayat pengobatan atau obat yang dikonsumsi
saat ini
Chizner MA. Clinical Cardiology Made Ridiculously Simple 5 th Edition. 2018. MedMaster Inc, Miami
Anamnesis: Faktor risiko
koroner
• Merokok
• Hipertensi
• Dislipidemia
• Diabetes mellitus
• Penyakit jantung koroner di keluarga (laki-laki
<55 tahun, Perempuan <65 tahun)
Chizner MA. Clinical Cardiology Made Ridiculously Simple 5 th Edition. 2018. MedMaster Inc, Miami
Anamnesis: Riwayat penyakit
keluarga
• Keluarga meninggal mendadak usia muda (laki-
laki <45 tahun, Perempuan <55 tahun)
• Serangan jantung/pasang ring/bypass
• Hipertensi
• Gula darah
• Penyakit jantung bawaan
• Penyakit jantung kardiomiopati
• Penyakit jantung katup
• Sindrom Marfan
Chizner MA. Clinical Cardiology Made Ridiculously Simple 5 th Edition. 2018. MedMaster Inc, Miami
Anamnesis: Riwayat sosial
• Merokok
• Minum alkohol
• Pengguna obat terlarang (akses vena/peroral)
Chizner MA. Clinical Cardiology Made Ridiculously Simple 5 th Edition. 2018. MedMaster Inc, Miami
Penanda iskemia miokardium
Angina equivalent: Gejala:
- Tua - Sesak nafas
- Perempuan - Mudah lelah
- DM - Tidak nyaman di ulu hati
- CKD - Keringat dingin
Chizner MA. Clinical Cardiology Made Ridiculously Simple 5 th Edition. 2018. MedMaster Inc, Miami - Gigi rahang bawah nyeri
Chizner MA. Clinical Cardiology Made Ridiculously Simple 5 th Edition. 2018. MedMaster Inc, Miami
Gagal jantung
Chizner MA. Clinical Cardiology Made Ridiculously Simple 5 th Edition. 2018. MedMaster Inc, Miami
N Engl J Med. 1971;285:1441-1446
Jantung atau Paru?
Pemeriksaan
Fisik
Chizner MA. Clinical Cardiology Made Ridiculously Simple 5 th Edition. 2018. MedMaster Inc, Miami
Pemeriksaan fisik
• Inspeksi
• Palpasi
• Auskultasi
• Perkusi
KU ?
Inspeksi Tanda
syok
Chizner MA. Clinical Cardiology Made Ridiculously Simple 5 th Edition. 2018. MedMaster Inc, Miami
Palpasi
Chizner MA. Clinical Cardiology Made Ridiculously Simple 5 th Edition. 2018. MedMaster Inc, Miami
Inspeksi
dan
Palpasi
Chizner MA. Clinical Cardiology Made Ridiculously Simple 5 th Edition. 2018. MedMaster Inc, Miami
Inspeksi dan
Palpasi
Chizner MA. Clinical Cardiology Made Ridiculously Simple 5 th Edition. 2018. MedMaster Inc, Miami
Perkusi
• Batas-batas jantung –dari sisi luar ke dalam
(lateral to medial)
• Dextrocardia
• Adanya efusi pleura –redup
• Pneumothorax –hypersonor/tympanic
Chizner MA. Clinical Cardiology Made Ridiculously Simple 5 th Edition. 2018. MedMaster Inc, Miami
Auskultasi
jantung
Chizner MA. Clinical Cardiology Made Ridiculously Simple 5 th Edition. 2018. MedMaster Inc, Miami
Auskultasi jantung
Mauldin A. What Is It, How to Perform It, and More. 2025. https://www.osmosis.org/answers/auscultation
Wiggers diagram
Lilly LS. Pathophysiology of Heart Disease 6 th Edition. A Collaborative Project of Medical Students and Faculty. 2016. Wolters Kluwer
Murmur
Sistolik Diastolik
Lilly LS. Pathophysiology of Heart Disease 6 th Edition. A Collaborative Project of Medical Students and Faculty. 2016. Wolters Kluwer
Auskultasi Paru
Benacka R. Auscultation of lung sounds and murmurs. https://patfyz.medic.upjs.sk/simulatorvzorky/Respiratory%20auscultation.htm
Auskultasi Paru
Benacka R. Auscultation of lung sounds and murmurs. https://patfyz.medic.upjs.sk/simulatorvzorky/Respiratory%20auscultation.htm
Chizner MA. Clinical Cardiology Made Ridiculously Simple 5 th Edition. 2018. MedMaster Inc, Miami
Elektrokardiografi (EKG)
• Irama – sinus vs bukan sinus (atrial, junctional,
ventrikel)
• Laju (Rate) –(normal rate 60-100 x/menit), bradikardia,
takikardia
• Aksis –normal axis, LAD, RAD, extreme RAD (northwest axis)
• Gel P –P pulmonale, P mitrale, normal
• PR interval—normal, memanjang (AV block derajat 1-3),
memendek (jalur aksesoris –WPW)
• Gel QRS complex –morfologi, durasi memanjang LBBB/RBBB
komplit
• Segmen ST Elevasi, depresi
• Gel T (dan Gel U) upright, inversi
• QT interval memanjang (ada penyebab sekunder?), memendek
(sangat jarang)
• Kesimpulan
Sinus vs non-sinus
• Syarat sinus:
• Gelombang P ada
• Gelombang P diikuti QRS (1:1)
regular
• Gelombang P (+) di lead I dan
II, (-) di lead avR, bifasik di
lead V1
• Laju normal: 60-100x/menit
• Nadi ekstrim bradikardia
<50x/menit, takikardia
>140x/menit
• Non-sinus
• Tidak terlihat gelombang P yang
jelas, irama irregularly
irregular Atrial fibrilasi
• Gelombang QRS sempit th
Chizner MA. Clinical Cardiology Made Ridiculously Simple 5 Edition. 2018. MedMaster Inc, Miami
atrial/junctional
Aritmia
Atrium dan
Sinus
Chizner MA. Clinical Cardiology Made Ridiculously Simple 5th Edition. 2018. MedMaster Inc, Miami
??
Aritmia
Ventrikel
Chizner MA. Clinical Cardiology Made Ridiculously Simple 5 th Edition. 2018. MedMaster Inc, Miami
??
Aksis
Chizner MA. Clinical Cardiology Made Ridiculously Simple 5 th Edition. 2018. MedMaster Inc, Miami
PR interval memanjang AV
Block
Chizner MA. Clinical Cardiology Made Ridiculously Simple 5 th Edition. 2018. MedMaster Inc, Miami
EKG khas untuk kelainan
jantung
• Perubahan ST-T ST elevasi, ST depresi, inversi T
• Left ventricular hypertrophy (LVH)
• Adanya bundle branch block lebih khas LBBB, RBBB
lebih jarang
• Poor R-wave progression (PRWP)
• Low QRS voltage (pada limb ekstremitas <5 mm, limb
precordial <10 mm) + electrical alternans
tamponade jantung!
• Q patologis (lebar >40 ms (>1mm), dalam >2 mm,
>25% dibandingkan tinggi R)
• PVC occasional, multiple, bigeminy, trigeminy,
couplet, non-sustained ventricular tachycardia
• QT interval memanjang Long QT syndrome,
pemberian obat-obatan, gangguan elektrolit
Chizner MA. Clinical Cardiology Made Ridiculously Simple 5 th Edition. 2018. MedMaster Inc, Miami
Perubahan
ST-T
Chizner MA. Clinical Cardiology Made Ridiculously Simple 5 th Edition. 2018. MedMaster Inc, Miami
Reciprocal changes
STEMI inferior Reciprocal
lateral
Chizner MA. Clinical Cardiology Made Ridiculously Simple 5 th Edition. 2018. MedMaster Inc, Miami
STEMI lateral reciprocal
inferior
Chizner MA. Clinical Cardiology Made Ridiculously Simple 5 th Edition. 2018. MedMaster Inc, Miami
STEMI ?
Reciprocal ?
Kelainan aritmia?
Chizner MA. Clinical Cardiology Made Ridiculously Simple 5 th Edition. 2018. MedMaster Inc, Miami
STEMI ?
Reciprocal ?
Chizner MA. Clinical Cardiology Made Ridiculously Simple 5 th Edition. 2018. MedMaster Inc, Miami
Lead EKG tambahan
ST elevasi bukan STEMI
Chizner MA. Clinical Cardiology Made Ridiculously Simple 5 th Edition. 2018. MedMaster Inc, Miami
Tamponade
Chizner MA. Clinical Cardiology Made Ridiculously Simple 5 th Edition. 2018. MedMaster Inc, Miami
LVH
Chizner MA. Clinical Cardiology Made Ridiculously Simple 5 th Edition. 2018. MedMaster Inc, Miami
RVH
Chizner MA. Clinical Cardiology Made Ridiculously Simple 5 th Edition. 2018. MedMaster Inc, Miami
EKG kelainan selain jantung
• QT interval memanjang gangguan elektrolit
• Kelainan paru
• Aksis RAD/ extreme RAD
• P pulmonale
• RVH
• RBBB
• Multifokal atrial takikardia
Chizner MA. Clinical Cardiology Made Ridiculously Simple 5 th Edition. 2018. MedMaster Inc, Miami
Chizner MA. Clinical Cardiology Made Ridiculously Simple 5 th Edition. 2018. MedMaster Inc, Miami
Foto Thorax
• AP atau PA
• Inspirasi adekuat atau tidak
• Penilaian jantung
Chizner MA. Clinical Cardiology Made Ridiculously Simple 5 th Edition. 2018. MedMaster Inc, Miami
AP atau PA
Misra R, Planner A, and Uthappa M. A to Z Radiology. Cambridge University Press 2007
Inspirasi adekuat atau tidak
Misra R, Planner A, and Uthappa M. A to Z Radiology. Cambridge University Press 2007
Penilaian jantung
Misra R, Planner A, and Uthappa M. A to Z Radiology. Cambridge University Press 2007
Penilaian hilus dan trakea
Misra R, Planner A, and Uthappa M. A to Z Radiology. Cambridge University Press 2007
Penilaian paru-paru dan pleura
Misra R, Planner A, and Uthappa M. A to Z Radiology. Cambridge University Press 2007
Penilaian tulang dan jaringan
lunak
Misra R, Planner A, and Uthappa M. A to Z Radiology. Cambridge University Press 2007
Contoh kelainan jantung
Chizner MA. Clinical Cardiology Made Ridiculously Simple 5 th Edition. 2018. MedMaster Inc, Miami
Contoh kelainan jantung
Misra R, Planner A, and Uthappa M. A to Z Radiology. Cambridge University Press 2007
Contoh kelainan arteri
pulmonal
Misra R, Planner A, and Uthappa M. A to Z Radiology. Cambridge University Press 2007
Contoh kelainan aorta
Misra R, Planner A, and Uthappa M. A to Z Radiology. Cambridge University Press 2007
Contoh kelainan paru
Misra R, Planner A, and Uthappa M. A to Z Radiology. Cambridge University Press 2007
Chizner MA. Clinical Cardiology Made Ridiculously Simple 5 th Edition. 2018. MedMaster Inc, Miami
Pemeriksaan laboratorium
• Pemeriksaan standard • Faktor risiko CAD
• DL • Profil lipid (total
• GDS cholesterol, HDL, LDL,
• Fungsi liver Trigliserida)
(SGOT/SGPT • GDP, G2PP, HbA1c
alternative marker • Elektrolit (Natrium,
infark jantung)
Kalium, Chlorida,
• Fungsi ginjal (Ur/Cr) Magnesium, Calsium)
• Enzim jantung (bila
ada) / NT-proBNP (bila • Pasien atrial
ada) fibrilasi/ gagal
jantung
• TSH dan FT4
Chizner MA. Clinical Cardiology Made Ridiculously Simple 5 th Edition. 2018.
MedMaster Inc, Miami
Chizner MA. Clinical Cardiology Made Ridiculously Simple 5 th Edition. 2018. MedMaster Inc, Miami
Terima kasih
