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A M A N :EKYMADYANINGNASTITI M I N :0910721004 N A S U R U J :I LMUKEPERAWATAN N A T A K G N A :2009A L T T :J EMBER ,20ME I1991 T A M A L A :J LN .RIAUNO28J EMBER : N A K I D I D N E P T A Y A W I R - SDN JEMBERLOR II( SEKARANG JEMBER LOR1) - SMPNEGER I2 JEMBER - SMANEGER I1J EMBER - JURUSAN KEPERAWATAN UNIVERSITAS BRAWJIAYAR
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0 6 k a y n a b e s si m ti r a r a c e s t u y n e d r e b g n a y g n u t n a j l a w a r e b r e l u k s a v o i d r a k m e t si S -0 0 1 x/meni t saa tsitriahatdan 120-160x/meni ts aa tolahraga .Seitpadenyu t n a g n ir a j u t a u s m a l a d h u b u t h u r u l e s e k g n u t n a j ir a d r il a g n e m h a r a d n a k b a b e y n e m g n u t n a j e k i l a b m e k n a i d u m e k r e li p a k n a d , l o ir e t r a , ir e t r a i r a d i ri d r e t g n a y p u t u t r e t a l u n e v i u l a l e m danvena. g n a y p u t u t r e t t r o p s n a r t m e t s y s u t a u s n a k a p u r e m r e l u k s a v o i d r a K m e t si S n e n o p m o K : t u k ir e b n e n o p m o k a p a r e b e b i r a d i ri d r e t h a r a d a p m o m e p i g a b e s g n u t n a j . 1 is ir t u n n a d n e g is k o i r e t a m a w a b m e p i a g a b e s h a r a d n e n o p m o k . 2 u a t a a i d e m i a g a b e s h a r a d h u l u b m e p . 3 jalandar ikomponen h u b u t h u r u l e s r a g a k i a b g n a y i s g n u f i k il i m e m s u r a h t u b e s r e t n e n o p m o k a g it e K dapa t .t a u k e d a g n a y i si r t u n n a d n e g is k o n a k o s a p a m ir e n e m G N U T N A J . A k il a b r e t a d i m a ri p i t r e p e s k a t e lr e t t u c u r e k u a t a r i p h a u b i t r e p e s k u t n e b r e b g n u t n a J a g n e d napeks( puncak )beradad ibawahdanbassi( alas )beradad iatas .Beratnya250 r a s e b e s g n u t n a j a w h a b n a k a t a g n e m g n a y t a p a d n e p a d A . a s a w e d g n a r o a d a p m a r g 0 5 3 . m c 9 r a ti k e s r a b e l n a d m c 2 1 r a ti k e s g n a j n a p u a t a a s a w e d g n a r o n a g n a t n a l a p e k a p k a t e lr e t g n u t n a J dar onggadada( cavumt horax)t epatnyapadar onggamedias itnum u r a p a r a t n a i d -parukri idankanant u b e si d g n a y g n u t n a j i r a ti g n e m g n a y t u p a l e s t a p a d r e T g n u t n a J m a l a D peirkardium , : n a si p a l a u d i r a d i ri d r e t - Pe irkardiumpairetalsi:l apsianl ua rmeleka tpadat ulangdadadanparu - Pe irkardiumvsieralsi:l apsianpermukaanj antung /epikardium n a ri a c t a p a d r e t i n i n a si p a l a u d e k a r a t n a i D pe ircardium G N U T N A J R U T K U R T S : n a si p a l 3 i r a d i ri d r e t g n u t n a j g n i d n i D . 1 Lapsianl ua r(epikardium) Lapsian epikardium merupakan l apsian pailng ata sdar idinding j antung tersusun s a t a lapsianmesoteilal . 2 Lapsiant engah(Miokardium) Lapsian miokardium yang merupakan lapsian fung isona l jantung yang n a k n i k g n u m e m jantung bekejra sebaga ipompa .Miokardium mempunya isfia t si itmewa yatiu a jr e k e b secaraotonom( miogenik) ,duras ikontrak isl ebihl amadar iototr angkadanmampu berkontrak iss ecarar timik. - Ketebalanl apsianmiokardiumpadas eitapr uanganj antungberbeda-beda . Vent irke l kri i mempunya i lapsian miokardium yang pailng teba l karena i a y n u p m e m bebanl ebihbera tuntukmemompadarahkes rikula iss sitemikyangmempunya i tahananalriandarahl ebihbesa .r - serabu toto tyangt ersusundar iberkas-berkass pria lmelapiisr unagj antung . Kontraks imiokardium“menekan“darahkeluarr uangmenujuarter ibesa .r - Miokardiumt erdri idar iduaberka soto tyatiu isn isitumat irumda n isn isitum vent irkel .Seitapserabu toto tdipsiahkandsikusi nterkalair syangberfungs i mempercepa thantaran impul spada seitap se loto tjantung .Antara isn isitum m u ir t a d an isn isitumvent irkelt erdapatl ubangyangdinamakananoulu sifbrosu syang merupakant empa tmasuknyas erabuti nternoda ldar iatirumkevent irke.l . 3 Lapsiandalam(endokardium)
Lapsian endokardium merupakan lapsian yang membentuk bagian dalam m e m k u t n u n i c il t a g n a s g n a y l e t o d n e n a si p a l n a k a p u r e m n a d g n u t n a j bantu . g n u t n a j n a k l a g g n i n e m n a d i k u s a m e m h a r a d n a ri l a G N A U R – RUANGJ ANTUNG t u b e si d s i p it g n i d n i d r e b 2 u ti a y , g n a u r 4 i r a d i ri d r e t g n u t n a J atirum(serambi )dan 2 t u b e si d l a b e t g n i d n i d r e b vent irkel(biilk) . 1 Atirum . a Atirum kanan berfungs isebaga ipenampung darah rendah ok isgen dar i e k n a k a p m o p i d h a r a d n a i d u m e K . h u b u t h u r u l e s vent irkel kanan melalu i b u t a k dans elanjutnyakeparu. . b At irum kri imene irma darah yang kaya ok isgen dar ikedua parumelalu i4 h a u b vena pulmonalsi .Kemudian darah mengail rke ventirke lkri imelalu i i u l a l e m h u b u t h u r u l e s e k a y n t u j n a l e s n a d b u t a k aorta. a u d e K at irumdipsiahkanolehs eka tyangdsiebu tseptumat iru m. . 2 Vent irkel Merupakanalu ralu roto tyangdsiebu ttrabekula.Alu ryangmenonjo ldsiebu t muskulu spapliarsi ,ujungnyadihubungkandengant ep idaunkatub atirovent irkule rolehs era tyangdsiebu tkordat endinae. . a Vent irkelkananmeneirmadarahdar iatirumkanandandipompakanke parumelalu iarter ipulmonalsi . b Vent irke lkri imeneirmadarahdar iat irumkri idandipompakankeseluruh tubuhmelalu iaorta Keduaventirk eldipsiahkanolehs eka tyangdsiebu tseptumvent irke.l G N U T N A J P U T A K P U T A K . 1 Katupatirovent irkuler a r a t n a k a t e lr e T atirum dan vent irkel .Katup yang telretak diantara atirum kanan dan l e k ir t n e v kanan mempunya i3 buah daun katup (t irkuspid.) Sedangkan katup yang a r a t n a i d k a t e lr e t atirumkri idanvent irkelkri imempunya iduabuahdaunkatup (Mtiral) .
i r a d r il a g n e m h a r a d n a k n i k g n u m e M at irum ke vent irkel pada fase diastole dan e s a f a d a p k il a b n a ri l a h a g e c n e m ssitoilk. . 2 KatupSemliunar . a KatupPulmonalt elretakpadaarter ipulmonalsidanmemsiahkanpembuluhi n i d a irventirkelkanan. . b KatupAortat e lretakantaravent irke lkri idanaorta. Keduakatupi n imempunya ibentukyangs amat erdri idar i3buahdaunkatupyang ismetrsi .adanyakatupi n imemungkinkandarahmengail rdar ima isng-ma isng ventirkelkearteirs elamassitoledanmencegahalrianbailkpadawaktudiastole. H A R A D H U L U B M E P . B JENISPEMBULUHDARAH Darahdiedarkankes eluruht ubuhmelalu ipembuluhdarah( vaskuler) .Secara m u m u pembuluhdaraht erdri idar i3l apsianyatiu: . 1Tunikaadven itisamerupakanl apsianpailngl ua rberupaj a irngani ka tyangkuat . . 2Tunikamediamerupakanl apsiant engahyangt erdri idar ioto tpolos . . 3Tunikai n itmamembentukdindingdalamdar ipembuluhdaraht erdri ida irs el- lse . l e t o d n e Celahantaras el-se lendote lmembentukpo ir-por ipembuluhdarah. Pembuluhdarahada3macamyaituarteir ,venadankaplie.r
R E L I P A K a k i n u t h e l o k u t n e b i d a y n a h , si p it t a g n a s g n a y l i c e k h a r a d h u l u b m e p n a k a p u r e m r e li p a K h u l u b m e p a r a t n a t a z n a r a k u t r e p s e s o r p n a k h a d u m e m a g g n i h e s a j a s a m it n i darah . n a g n ir a j u a t a l e s n a g n e d : h a l a d a r e li p a k i s g n u F - nPe ghubungarter idanvena - Tempatt ejradinyapertukaranz at - Absorbs inutrsi ipadausus - Fitlras ipadaginj al - Absorb iss ekre tkelenjar I R E T R A h a r a d n a k ri l a g n e m g n a y h a r a d h u l u b m e p n a k a p u r e m i r e t r A da irj antungkes eluruh . h u b u t Arter imembawadarahyangkayaok isgen ,kecual iarter ipulmonalsi. n a si p a l a g it i r a d n u s u s r e t ir e t r A g n i d n i D r u t k u r t S : x advenit isat erdri idarjia irngani ka tifbrosa x mediat engaht erdri idar ioto tpolo sdan/ataus erabu telas itc x in itmadalam,s uatut uba itpi syangt erbentukdairs el- lse endotheilal :i r e t r a s i n e J k it s a l E i r e t r A . 1 =arteirt erbesa rpadaj antungt ersusunt erutamada irj a irngan . c it s a l e
A . 2 rter iMuscula r=arter ielas itcbercabangmenjad iarter imuscula rberukurans edang d an memiilkis erabu toto tpolo spadadindingnyauntukmerespon s s itmulu ssaraf .Arteiri n idsiebu tarter ipenyebar( penghantar ) ukuranl umennyadiaturs ystemsara,fs ehinggavolumedarahyang dikiirmkeberbaga ibagiant ubuhuntukmemenuh ikebutuhan tertentudapa tdikendailkan t o i r a d n u s u s r e t li c e k i r e t r A . 3 o tdans erabu telasitcdalamj umlahyangberagam . 4 Arteiro lmerupakanarter ikeci ldenganl umens empi tdandidndingmusculart ebal , membawadarahkej airngankapliar .Pembuluhi n idsiebu tarteirt ahanankarenad i bawahpengaruhs ara f ismpatsi, pembuluhi n imenyediakan is ist ahananuntama untuk meningkatkant ekanandarah A N E V Venamerupakanpembuluhdarahyangmengembailkandarahda irs eluruht ubuh a g g n i h e s g n u t n a j e k dinamakanpulapembuluhbailk .Venamempunya iitgal apsian g n a r u k , si p it h i b e l g n a y s o l o p t o t o n a si p a l i a y n u p m e m i p a t e t ir e t r a i t r e p e s kua tdan .) s p a l o k ( s e p m e k h a d u m - Ssitemvenaberdinding itpi sdandapa tmengembang( dsiten isble) .Vena menampung 75%volumedaraht ota ldanmengembailkandarahkej antungdalam tekananyang sangatr endah - Venamemiilk ikatupuntukmencegahbacklfow( aru sbailk )darahkembal ikekaplier : a n e V s i n e J g n ir r a j a n e v g n u j u i r a d l a w a r e b a n e v m e t si S -ja irngkaplia rdenganvenulapostkaplia r a j n e m u t a y n e m g n a y d ivenuladankemudianmenjad ivenakeci,ls edangdanvenabesa .r
G N U T N A J A D A P R A S E B H A R A D H U L U B M E P n a t a k e d r e b g n a y r a s e b h a r a d h u l u b m e p a p a r e b e b a d A letaknyadenganj antungyatiu: r o ir e p u S a v a C a n e V . 1 a w a b m e m g n a y r a s e b a n e v h a l a d a r o ir e p u s a v a c a n e V darahkoto rdairt ubuhbagian . n a n a k m u ir t a u j u n e m s a t a r o ir e f n I a v a C a n e V . 2 b n a i g a b i r a d r o t o k h a r a d a w a b m e m g n a y r a s e b a n e v h a l a d a r o ir e f n i a v a c a n e V awah . n a n a k m u ir t a e k a m g a r f a i d a ir a n o C s u n i S . 3 a b m e m g n a y g n u t n a j i d r a s e b a n e v h a l a d a y r a n o r o c s u n i S wadarahkoto rda irj antung .i ri d n e s si l a n o m l u P s u k n u r T . 4 i r a d r o t o k h a r a d a w a b m e m g n a y r a s e b h a r a d h u l u b m e p h a l a d a k n u r t y r a n o m l u P n a d n a n a k u ti a y 2 i d a j n e m i g a b i d s il a n o m l u p i r e t r A . si l a n o m l u p i r e t r a e k n a n a k l e k ir t n e v ir a d r o t o k h a r a d a w a b m e m g n a y i ri k mpul onaryt runkkekeduaparu-paru. si l a n o m l u P a n e V . 5 i r a d h is r e b h a r a d a w a b m e m g n a y i ri k n a d n a n a k u ti a y 2 i d a j n e m i g a b i d , si l a n o m l u p a n e V u r a p a u d e k -parukeat irumkri.i s n e d n e s A a t r o A . 6 b h a r a d a w a b m e m g n a y r a s e b h a r a d h u l u b m e p u ti a y , a t r o a g n i d n e c s A er ishdar i b a w a j g n u g g n a t r e b g n a y a y n g n a b a c e k ) a t r o a g n u k g n e l( a t r o a s u k r a e k i ri k l e k ir t n e v b h u b u t n a g r o n a g n e d agianatas. s n e d n e s e D a t r o A . 7
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D P n a d J P s u s a k n a n u r u n e p n a g n u r e d n e c e k i d a jr e t u j a m a r a g e N i D 8 8 9 1 n u h a t a r a t n a : h o t n o c ( -1998 d iUSA t e jradi penurunan s ebesar 30% ,s ementara a y a g n a k i a b r e p h e l o n a k b a b e si d g n a y ) % 2 4 a i d e w S i d hidup, seper it mengurang i . n a t a h e s e k p a d a h r e t i g g n it g n a y n a r a d a s e k t a k g n it n a d ) k o k o r ( u a k a b m e t i s m u s n o k a y n a d a u ti a y , a y n k il a b e s g n a y l a h i d a jr e t g n a b m e k r e b a r a g e n i d a r a t n e m e S k b a b e si d g n a y D P n a d J P s u s a k n a t a k g n i n e p n a g n u r e d n e c e k an oleh gaya hidup t a r a b e k " -baratan " (yang sebenarnya d idunia bara t sudah mula idiitnggalkan,) .t u j n a l a is u h a l m u j n a t a k g n i n e p n a d is a si n a b r u h a l a s a m n a b e b h a b m a n e m h a l e t t u b e s r e t n a a d a e k g n a b m e k r e b a r a g e n i D d s u r a h g n a y n a t a h e s e k ihadap.i Sementara masalah kurang giiz dan penyaktii nfek is D P n a d J P a y n m a l a d i d k u s u m r e t r a l u n e m k a d it ti k a y n e p ,i s a t a r e t m u l e b h is a m ti k a y n e p a y n l u b m it n a g n e d i g a l h a b m a ti d , is n e l a v e r p n a t a k g n i n e p i m a l a g n e m -I A it r e p e s u r a b ti k a y n e p DSdan lfu burung.) Gambaran t ranssi iepidemiologi diata s n a g n a l u g g n a n e p n a k s a ti r o ir p m e m m a l a d i p a d a h i d s u r a h g n a y n a g n a t n a t i d a j n e m T R K S ( a g g n a T h a m u R n a t a h e s e K i e v r u S li s a H ir a D . a is e n o d n I i d n a t a h e s e k h a l a s a m n a k u k a li d g n a y ) 6 8 9 1 di 7propin is dengan menghaslikan prevalen is penyaki tj antung 5 1 r u m u n a g n o l o g a d a p a y n n i a l n a d k i m e k si --24 t ahun adalah 18,3 per 100.000 5 4 r u m u n a g n o l o g a d a p m a j a t n a g n e d t a k g n i n e m i n i a k g n A . k u d u d n e p --54 t ahun, 6 , 4 7 1 i n k a y pe r100.000 penduduk dan 461 , 9 per 100.000 penduduk pada umur a m a t u b a b e s n a g n e d r a l u k s a v o i d r a k n a it a m e k n a k g n a d e S . s a t a e k n u h a t 5 5 n a d k u d u d n e p 0 0 0 . 0 0 1 r e p 5 , 7 1 h a l a d a a y n n i a l n a d k i m e k si g n u t n a j t i k a y n e p r e b g n a y n a it a m e k katian dengan penyakti tersebut adalah 27,4 per 1 00.000 . k u d u d n e pH U L U B M E P N A D G N U T N A J T I K A Y N E P N A I L A D N E G N E P N A M O D E P . 7 0 0 2 , I R s e k p e D A T R A K A J :I R S E K P E D . H A R A D
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. A SISTEMSIRKULASI k i m e t s i S i s a l u k ri S . 1 m a l a d e k r il a g n e m i ri k m u ir t a i r a D . si r a n o m l u P a n e V i r a d i ri K m u ir t A e k k u s a m h a r a D n a d m u ir t a n a g n u b m a s i d k a t e lr e t g n a y , ) V A (l e k ir t n e v o ir t a p u t a k i u l a l e m i ri k l e k ir t n e v a k r u l a si d h a r a d u l a L . a t r o a b u t a k i u l a l e m a t r o a u j u n e m i ri k l e k ir t n e v i r a D . l e k ir t n e v nke k i m e t si s is a l u k ri s h u r u l e s melalu iarter,iarteiro ldankaplie ryangkemudianmenyatu a n e v k u t n e b m e m -vena .Venadar ibagianbawaht ubuhakanmengembailkandarahke a n e V e k h a r a d n a k il a b m e g n e m h u b u t h a w a b n a i g a b i r a d n a k g n a d e s r o ir e f n I a v a C a n e V u S a v a K peiror .KeduaVenaKavat ersebu takanbermuarakeatirumkanan.i s a l u k ri S . 2 Pulmonal g n a y a y n n i a l V A p u t a k i u l a l e m n a n a k l e k ir t n e v e k r il a g n e m n a n a k m u ir t a i d h a r a D ri l a g n e m n a d n a n a k l e k ir t n e v i r a d r a u l e k h a r a D . ) si l a d i p s u k ir t ( si r a n u li m e S b u t a K t u b e si d . si r a n o m l u p i r e t r a m a l a d e k s ir a n o m l u p p u t a k i t a w e l e m Arter ipulmona ir sbercabang g n is a m g n a y i ri k n a d n a n a k s ir a n o m l u p i r e t r a i d a j n e m -ma isngmengail rkeparu-paru n a n a k - .ik ri u r a p i D -paru ,arter ipulmona ir sbercabangberkail-kal imenjad iarteiro ldankemudian h a u b e s i u l a l e m n a s a p a n r e p n a r u l a s a d a p e k i s u f r e p r e b m e m r e li p a k p a it e S . r e li p a k i d a j n e m a l u n e v n a d a l u n e v i d a j n e m i l a b m e k u t a y n e m r e li p a k a u m e S . s u l o e v l a vena . a n e V -venamenyatumembentukvenapulmona ir syangbesar .Darahmengail rd idalam u p a n e v lmonarsi,l alukembal ikeat irumkri iuntukmenyelesaikan isklu salriandarah. r e n o r o K i s a l u k ri S . 3 g n a y n e g is k o a w a b m e m n a d g n u t n a j n a a k u m r e p h u r u l e s it u p il e m r e n o r o k i s a l u k ri S n a a k u m r e p h u r u l e s it u p il e m r e n o r o k i s a l u k ri S . g n u t n a j t o t o a d a p p u k u c jantungdan a c i u a l a l e m m u i d r a k o i m k u t n u n e g is k o a w a b m e m bang-cabangi ntramiokardia lyang A . li c e k rter ikorone rmeneirma5%dar icurahj antungdanbia smeningka tmencapa i . n a k u lr e p i d a li b % 5 2
c s e d i r e t r a i d a j n e m g n a b a c k u t n e b m e m a r e g e s ir i k r e n o r o k i r e t r A enden santeiro r u j u n e m h a w a b e k n a l a jr e b i ri k r o ir e t n a s n e d n e c s e d i r e t r A . a s k e lf m u k ri s ir e t r a n a d a p a r e b e b g n a b a c r e b n a i d u m e k i ri k n a d n a n a k l e k ir t n e v a r a t n a m u t p e s r o ir e t n a n a i g a b r o ir e t n a n a i g e b i h a r a d r e p m e m k u t n u i l a k septumdanmassaoto tanteiro rvent irke lkri,i i ri k l e k ir t n e v n a d i ri k m u ir t a a r a t n a i d n a i g a b a d a p n a l a jr e b i ri k a s k e lf m u k ri s ir e t r A r u l a i d n a l a jr e b n a n a k r e n o r o k i r e t r A . ir i k l e k ir t n e v l a r e t a l g n i d n d i d i h a r a d r e p m e m a t r e s g n a b a c r e b n a d i ri k l e k ir t n e v n a d n a n a k m u ir t a a r a t n a -cabanguntukmemperdarah i n a i g a b e s a d a P . r o ir e t s o p l e k ir t n e v r a t n a m u t p e s k u s a m r e t , g n u t n a j r o ir e t s o p n a i g a b i h a r a d r e p m e m n a n a k r e n o r o k i r e t r a , g n a r o r a s e b bagianpelsitirkanj antungyang ) V A ( l e k ir t n e v o ir t a s u d o n n a d ) A S ( m u ir t a o n is s u d o n u ti a y g n it n e p . B STRUKTURMAKROSKOPIKMIOKARD Ototj antungt erdri iatass el-se loto tyangs anga tkhusu syangdsiebuts era totot . a ti p s a t a i ri d r e t g n u t n a j t o t o t a r e S -ptiaf liamen tproteinyangdsiebu tmiofliamenyang n a i a k g n a r e b k a t e lr e t satus amal ain .Seitapptiadsiebuts arkomer .Sarkome rpadaoto t a e r a u t a u s k u t n e b m e m k u t n u a y n i p e t n a i g a b a d a p n i a l a m a s u t a s n a g n u b u h r e b g n u t n a j . s u t a l a k r e t n i s u k si d n a g n e d t u b e si d g n a y Areai n imerupakanbagiandenganr essiten a t a k i k u t n e b m e m i n i h a r e a D . t a w e l t a p a d k ir t si l s u r a a g g n i h e s h a d n e r nyangbkua t u t a s n a k ir a t a g g n i h e s , a p u r n a i k i m e d e s l e s r a t n a i s e h o k n a k n a h a t r e p m e m , t a r e s r a t n a g n a j n a o p e s n a k s u r e t s t a p a d l it k a r t n o k t i n u sumbunyakeuntis eblahnya .Dis epanjang
a t r e s is is -sera toto tdeka tdsikus ,membranes els erta-sera tyangberdekatanmenyatu t a p m e t k u t n e b m e m h u a j p u k u c -tempa tpertemuan .Tempa tpertemuani n imerupakan n a t n a b m e j -jembantanbertahananr endahuntukpenyebaranr angsangda irs era tke . n i a l t a r e s N E M A L I F O I M n e m l a i F -fliamenbesa rdis arkomert erbua tdar iproteinkontraktlij antungyang e k n is o y m t n e m a li f ir a d n a l a jr e b g n a y g n a li s n a t a b m rj k u t n e b r e T . n is o y m t u b e si d a u d n a d n it k a u ti a y a u d e k li t k a r t n o k n i e t o r p p u k a c n e m s i p it t n e m a li F . si p it t n e m a li f n is o i m o p o r t l a m r o n n a a d a e k m a l a D . n i n o p o r t n a d s is o i m o p o r t : r o t a l u g e r n i e t o r p t u b e s r e t n i e t o r p a g g n i h e s , a p u r n a i k i m e d e s n it k a l u k e l o m p a it e s e k t a k e l e m r a g a t a k e l e m n is o y m g n a li s n a t a b m e j a y n s u r a h e s t a p m e t n it a k a i d h a r e a d i g n a l a h g n e m a p m o m e m k u t n U . n it k a n e m l a if n a d n is o i m o p o r t e k t a k e l e m n i n o p o r T . is k a r t n o k i d a jr e t it k e f e n a g n e d f ,ototj antungharu smula iberkontrak iss ebga iuntit unggal .Untuk l e s is k a r t n o k -se lmiokardiums ecaras itmutlan ,membranes e lharu smelakukan a y n u t k a w i a u s e s is a si r a l o p e d I S K A R T N O K R E L U K E L O M R A S A D i s a si r a l o p e d h a l a d a i s k a r t n o k a y n i d a jr e t l u k e l o m r a s a D ototj antungdanpelepasan .i s a s k a l e r n a d , g n u t n a j t o t o l e s m a l a d e k m u is l a k x u lf n i ,i s k a l a is n e t o p g n u t n a j t o t o n a g n ir a j ir a d k it a m a r g a i d a r a c e s n a g n o t o P i s k A l a is n e t o P n a s a p e l e P n a d g n u t n a J t o t O i s a s ir a l o p e D
l e S -se loto tjantung berkontraks isendri ikarena sel-se ltersebu tmengalam i l e s u ti a y , n a t n o p s i s a si r a l o p e d -se ltersebu tmenjad ibermuatanpo isit fd ibagian dalam l e s e n a r b m e m a n e r a k i d a jr e t n a t n o p s i s a si r a l o p e D . l e s r a u l n a i g a b n a g n e d n a k g n i d n a b i d e l b a e m r e p t a fi s r e b t a h a ri t si n a a d a e k a d a p g n u t n a j terhadapi on-ionnatirumyangboco r n a k b a b e y n e m m u ir t a n n o i , x u lf n i u t k a w e S . fi ti s o p n a t a u m a w a b m e m n a d l e s m a l a d i d i d a j n e m m u ir t a n n a r u l a s a k a m , u t n e t r e t g n a b m a u t a u s a d a p i a p m a s a l e s i s a si r a l o p e d a k u b r e t g n a y g n u t n a j a l e s p a it e si d e s a tl o v p a d a h r e t a k e p .Hali n imenyebabkan aru s n o i r a s e b -ion nat irum yang bermuatan po isit fmasuk ke dalam se ldan terbentuklah i d f it is o p i d a j n e m t a p e c h i b e l l e s p a it e s e n a r b m e m l a is n e t o p a n e r a k , is k a l a is n e t o p .r a u l n a i g a b n a g n e d n a k g n i d n a b i d m a l a d n a i g a b k m u i s l a K s k u lf n I eDalamSe lOtotJ antung n a r u l a s , k u t n e b r e t i s k a l a is n e t o p u t k a w e S -saluran membran kal isum-nat irum i d a y n a n a p m i y n e p t a p m e t i r a d a m s a l p o ti s m a l a d e k k u s a m m u is l a k n a d a k u b m e m m u is l a k n a r u l a S . g n u t n a j l e s a m s a l p o k r a s m u l u c it e r -natirum merupakan saluran yang r u l a J . a k u b m e m t a p e c h i b e l g n a y m u ir t a n n a r u l a s n a g n e d n a k g n i d n a b i d a k ij t a b m a l h a l a d a i s k a l a is n e t o p a m a l e s g n u t n a j t o t o l e s m a l a d e k k u s a m k u t n u m u is l a k i g a b a g it e k s u l u b u t i u l a l e m transverses.J alur-jaluri n imerupakanpenghubungantarakompartemen i a c rani ntrase ldanekstrase.l g n u t n a J t o t O i s k a r t n o K a m s a l p o ti s m a l a d i d f it k a i s a k o l a d a p m u is l a k n o i n a r a u l e g n e P : 1 e s a F . n i n o p o r t l u k e l o m n a g n e d n a t a k ir e b m u is l a k n o i , a m s a l p o ti s m a l a d i d h a l e t e s : 2 e s a F k a l u k e l o m i r a d r e s e g r e b n is o i m o p o r t n a d n i n o p o r T itns ehinggamemungkinkan n it k a t n e m a li f n a g n e d g n u b a g r e b k u t n u n is o y m g n a li s n a t a b m e j n e d n e p e d e s a P T A n a fi t k a g n e p i d a jr e T : 3 e s a F -mio isndanATPt erura imenjad iadeno isne t a f s o p n a d ) P D A ( t a f s o p i d a k b a b e y n e m P T A n a i a r u g n e p i r a d n a k s a b e b i d g n a y i g r e n E : 4 e s a F nj embatans liang n u y a r e t n i a l a m a s u t a s r e s e g r e b n is o y m n a d n it k a n i m a li F . n is o y m i s a v it k a e r i d a jr e T : 5 e s a F g n u t n a j t u y n e d u t a s n a k n i m r e c n e m i s k a r t n o k p a it e S . t o t o i s k a r t n o k l u b m it a g g n i h e s t a h a ri t s n i r e m o k r a s e s a f : 6 e s a F
o t o i s a s k a l e R t jantung n a t a b m e j ir a d n a k s a b e b i d P D A u t k a w e S -sliang danmoleku lATPl ain beirkatan . n it k a i r a d h a si p r e t n is o y m n a t a b m e j a k a m , n is o y m n i e t o r p n a g n e d Selamat ersediai on s u r e t n a k t o t o n a d g n a l u r e b n a k a s u l k is a k a m , n i n o p o r t n a g n e d n a t a k ir e b k u t n u m u is l a k k a r t n o k r e b is .Pada kenyataanya ,selama satu poten isa laks i tejradi , banyak isklu s n a k it n e h g n e m a y n ri h k a a d a p g n a y a g g n i h e s , t n e m a li f n a r e s e g r e p n a d g n a li s n a t a b m e j k u t n u i g e n e n a k s a b e b m e m g n a y a g it e k P T A l u k e l o m n a i a r u g n e p h a l a d a i s k a r t n o k ir a d r a u l e k m u is l a k a p m o m e m se lotot .Tanpakalisum,t rpomio isnmenghamba tdaerah h e l o n a k i a r u i d g n a y P T A i g a l a d a k a d it n a d t a k ir e t g n a li s n a t a b m e j t a p m e t n it k a a d a p a t a b m e j n a n u y a t a u b m e m g n a y n is o y m e s a P T A -sliang(kontrak is )terhenit .Sel-se loto t s a y n n a r b m e m l a is n e t o p e k i l a b m e k emula dan saluran kailum peka votlase terbuka . l a is n e t o p n a k h il u i m e m n a d l e s i r a d r a u l e k a r e g e d s , fi ti s o p n o i n a k a p u r e m g n a y m u il a K . e v it a g e n g n a y t a h a ri t si t a k g n it e k i l a b m e k l e s a r t n i k ir t si l R E F I R E P I S A L U K R I S N A R U T A G N E P . C fi r e p h a r a d n a ri l a a k i m a n i D e rmerupakanunsure ifisologi syangpailngpen itng : a n e r a k r a l u c s a v n a g n ir a j t a fi s a d a p g n u t n a g r e b r e fi r e p i d g n u t n a j h a r u c i r a d i s u b ir t si D . 1 g n u t n a j u j u n e m i l a b m e k g n a y h a r a d h a l m u j a d a p g n u t n a g r e b g n u t n a j h a r u c e m u l o v . 2 h a r a D n a ri l A p is n ir P a r a D n a ri l A hmelalu ipembuluhdarahbergantungpadaduava irableyangs ailng : n a n a w a lr e b . 1Tekananantarakeduaujungpembuluhdarahmeningkat ,alriandarahmeningkat darahmengail rmelaluis eluruhs rikulas idar iarter ikeujungpembuluhvenas ebgai er sponst erhadapperbadaant ekanan .Perbedaant ekanandtientukanmelalu:i a t a R i r e t r A h a r a D n a n a k e T . a -Rata( MeanArteira lPreasure-MAP) adalaht ekananyangt erbentukdalampembuluharter ibesars epanjangwaktudan merupakancerminankompilan sdanvolumedarahr at-ratadalams ystemarter.i MAPnorma ladalah100mmHgdandapa tdiperkriakandar iTekananDarahSsitoilk (systoilcBloodPressure, SBP )dandiastoilc( DiastoilcBloodPreasure ,DBP )dengan : s u m u r MAP=( SBP+{(2xDBP} ) :3 atau MAP=DBP+{(SBP-DBP:}3)
e r u s a e r P l a ir t A t h g i R ( n a n a K m u ir t A n a n a k e T . b -RAP) Bergantungpadakeseimbanganantaraalrianbailkvenadanf ungs ipemompanaan . n a n a k m u ir t a . 2Ressiten isterhadapalriandarahmenurun ,alriandarahmeningkat. Ressitens imerupakanobstruks ialriandarah .Berkatianerat danberbanding h u l u b m e p m a l a d n a h a b u r e p t i k i d e s ; h a r a d h u l u b m e p n e m u l n a r u k u n a g n e d k il a b r e t . is n e t si s e r p a d a h r e t r a s e b g n a y n a h n a b u r e p n a k b a b e y n e m h a r a d Alriandarahs anga t . h a r a d h u l u b m e p n e m u l n a r u k u n a h a b u r e p p a d a h r e t e v it is n e s is n e t si s e r i h u r a g n e p m e m g n a y n i a l r o t c a F adalahpanjangpembuluhdarahdan . h a r a d s a ti s o k si v h a r a D n a ri l A n a t a p e c e K m a g u j n a t a p e c e k , r e fi r e p m e t s y s e k h a r a d a y n ri l a g n e m n a g n e D enurunkarena n a g n a b a c r e p g n a p m a n e p s a u l a d a p t a k g n i n e m e v it a l e r n a d f is e r g o r p g n a y n a g n a b a c r e p s a u l a d a p i d a jr e t r a s e b g n a y n a t a k g n i n e p , r e li p a k t a k g n it a d a P . h a r a d h u l u b m e p i n i n a t a b m a lr e P . h a r a d n a ri l a n a t a p e c e k n a k n u r u n e m a g g n i h e s h u l u b m e p g n a p m a n e p e m mungkinkant ejradinyapertukaranmakanandanmetaboilcpadakaplier. h a r a D n a ri l A i s u b ir t s I D h a r a d n a ri l a a g g n i h e s n a h a b u r e p i m a l a g n e m s u r e n e m s u r e t n a g n ir a j n a h u t u b e K a k a m , n a g n ir a j e m si l o b a t e m a y n t a k g n i n e m n a g n e D . n a k a i u s e si d s u r e n e m s u r e t s u r a h h a ri l a darahharu sdiitngkatkangunamemasokok isgendannutir iss ertauntuk . e m si l o b a t e m r i h k a l is a h g n a u b m e m K I S N I R T S K E N A R U T A G N E P r a s e b r e p m e m n a g n e d n a k t a k g n it i d t a p a d n a g r o m e t si s e k u j u n e m g n a y h a r a d n a ri l A s y s u t a u s ir a d h a r a d n a k h a d n i m e m u a t a g n u t n a j h a r u c temorganyangr ela itve itdakakit f n a g n e d s it a p m i S f a r a S m e t si S h e l o r u t a i d a y n a u d e K . fi t k a h i b e l g n a y n i a l n a g r o m e t s y s e k : e m si n a k e m t u y n e d n a t a k g n i n e m i u l a l e m g n u t n a j h a r u c n a k t a k g n i n e m s it a p m is f a r a s n a g n a s g n a R . 1 .i s k a r t n o k n a t a u k e k n a d g n u t n a j e s . 2 rabu t ismpa it sadrenergikmeluass ampaij airnganpembuluhdarahperfiert erutama l o ir e t r a
. 3Perubahanperangsangans ara f ismpatsis ecaras elekit fakanmerangsangr esepto rafla k u t n u n i a l g n a y n a k r a b e l e m n a d u t n e t r e t l o ir e t r a a p a r e b e b n a k ti p m e y n e m a t e b n a d redsit irbus idarahkej a irngankaplie ryangmembutuhkan. n e g a a k a m , f a r a s i u l a l e m n a r u t a g n e p n i a l e S -agenhumoralj ugamempunya i , n ir f e n i p e , n i m a l o k e t e k i s e r k e y n e m g n a y l a n e r d a a ll u d e m i t r e p e s k si s n u r t s k e h u r a g n e p g e k p a d a h r e t n o p s e r i a g b e s n ir f e n i p e r o n n a d iatan ismpatsid ipembuluhdarahperfier . h a r a d i r a d l a s a r e b g n a y n i a l t a Z -vasopre isn,angioten isns,erotonindanendhoteiln n i n i k i d a r b i t r e p e s ( h a r a d i r a d l a s a r e b g n a y t a z n a k g n a d e S . is k ir t n o k o s a v m a l a d n a r e p r e b .r o t a li d o s a v i a g a b e s n a r e p r e b ) e n i m a t si h n a d K I S N I R T S N I N A R U T A G N E P s n o p s e r i a g a b e s h a r a d n a ri l a n a h a b u r e p u ti a y ( h a r a d n a ri l a i s k ir t s n i n a r u t a g n e P g n a y n a g n ir a j m a l a d g n it n e p n a r e p r e b t a g n a s )l a c o l n a g n ir a j n a h a b u r e p p a d a h r e t . h a r a d n a ri l a n a n u r u n e p k u t n u i s n a r e l o t n a s a t a b r e t e k i k il i m e m e m si n a k e M pengaturani nst irks imenyebabkanpenurunanketersediaanok isgendan n a g n e d i s a t a i d g n a y ) n a h u t u b e k n a t a k g n i n e p n u p u a m i a l p u s n a n u r u n e p a n e r e k ( is ir t u n . n a g n ir a j e k h a r a d n a ri l a n a k t a k g n i n e m h a r a d n a ri l a n a h a b u r e p a w h a b n a k s a l e j n e m g n a y i r o e t a u d t a p a d r e T in i .i si r t u n n a d n e g is k o n a h u t u b e k n a g n e d n a ti a k r e b n u r u n e m i si r t u n n a r a t n a h a li b u a t a n a k a t a k g n it i d m si l o b a t e m a li b = r o t a li d o s a v i r o e T . 1 h e l o n a k li s a h i d g n a y ) 2 H n a d + K n o i, 2 O C , e n is o n e d a ( r o t a li d o s a v t a z n a t a k g n i n e p i d a jr e t a n g n ir a j g is k o g n a r u k i r o e T . 2 endannutrsi i=nutrsi iberperanpenitngdalammempertahankan , is ir t u n g n a r u k a li B . s o l o p t o t o l e s is k a r t n o k h e l o n a k li s a h i d g n a y h a r a d h u l u b m e p s u n o t .i s a t a li d o s a v a y n i d a jr e t n a k b a b e y n e m , is k a r t n o k r e b u p m a m k a d it s o l o p t o t o l e s a li d o s a v i r o e t n a n i k g n u m e K tas idant eor ikurangok isgenataunut ir ist ejrad ibersamaan .i s a t a li d o s a v n a k l a m it p o g n e m k u t n u i a g b e s h a r a d n a r a il a r u t a g n e m k u t n u n a u p m a m e k i k il i m e m a g u j n a g n ir a J n a t a k g n i n e P . )i r e t r a h a r a d n a n a k e t ( is u f r e p n a n a k e t n a h a b u r e p p a d a h r e t s n o p s e r r e p n a n a k e t fus idiatas idenganpenurunanr essitens idanpenurunant ekananperfus i h a r a d n a ri l a n a k n a h a t r e p m e m k u t n u n a u p m a m e K . is n e t si s e r n a t a k g n i n e p n a g n e d i s a t a i d .i s a l u g e r o t u A t u b e si d i s u f r e p n a n a k e t n a h a b u r e p m a l a d n a t s n o k
N A R U T A G N E P . D CURAHJ ANTUNG h a r u C Jantung . ti n e m r e p l e k ir t n e v p a it h e l o a p m o p i d g n a y h a r a d e m u l o v h a l a d a g n u t n a j h a r u C h a b u r e b a y n r a s e B -ubaht ergantungkebutuhanj a irnganperfie rakanok isgendannut ir is . a t a r g n u t n a J h a r u C -ratadalah5L/menti .Curahj antungj ugat ergantungbesars erta u k u rant ubuh ,makadipelrukans uatui ndikatorf ung isj antungyangl ebihakurat ,yatiu n a g n e d g n u t n a j h a r u c i g a b m e m n a g n e d t a p a d i d g n a y , ) x e d n i c a i d r a c ( g n u t n a j s k e d n i 8 , 2 r a ti k e s u ti a y , h u b u t n a a k u m r e p s a u l – 3,6l tier/menti/m2. e m u l o V sekuncupadalahvolumeyangdikeluarkanolehventirke lperdeitk .Sektia rdua . k il o t si s a m a l e s n a k r a u l e k i d k il o t s a i d r i h k a a d a p l e k ir t n e v m a l a d h a r a d e m u l o v a g it r e p g n u t n a J h a r u C u t n e n e P r o t k a F u t n a j is n e u k e r f g n u t n a g r e t g n u t n a j h a r u C ngdanVolumesekuncup . e r f = g n u t n a J h a r u C kuen isj atungxvolumes ekuncup a r a t n a i d l e k ir t n e v i r a d i s a s k a l e r e d o ir e p a k a m , t a b m a l n i k a m e s g n u t n a j t u y n e d a li B , l e k ir t n e v n a is i g n e p u t k a w n a k t a k g n i n e m a g g n i h e s , a m a l h i b e l i d a j n e m g n u t n a j t u y n e d k r a u l e k i d g n a y h a r a d n a d r a s e b h i b e l e m u l o v r e b l e k ir t n e v anl ebihbanyak .Bliacurah e k n a k t a k g n i n e m n a g n e d n a k li b a t si d t a p a d g n u t n a j h a r u c , n u r u n e m p u c n u k e s cepatan :. g n u t n a j t u y n e d J t u y n e D n a r u t a g n e P antung f a r a s m e t si s k is n ir t s k e n a r u t a g n e p h a w a b i d a d a e b r a s e b n a i g a b e s g n u t n a j is n e u k e r F s a r a p t u b a r e s ; m o n o t o impa it sdan ismpa it smempersaraf inodu sSAdanAV , . sl u p m i is k u d n o k i s n e u k e r f n a d n a t a p e c e k i h u r a g n e p m e m l a m r o n g n u t n a j a d a P . g n u t n a j t u y n e d i s n e u k e r f i g n a r u g n e m : si t a p m is a r a p f a r a s is a l u m it S n a t a p e c e k n a k n a h a t r e p m e m m a l a d n a n i m o d h u r a g n e p r e b t a h a ri t si n a d denyutj antung .t i n e m r e p t u y n e d 0 8 r a ti k e s t i k a y n e p a d a p n a n i m o d h u r a g n e p r e B . g n u t n a j t u y n e d t a p e c r e p m e m : si t a p m is i s a l u m it S i s a s n e p m o k n a k n a h a t r e p m e m m a l a d n a d g n u t n a j is n e u k e r f n a r u t a g n e p m a l a d g n u t n a j . g n u t n a j p u c n u k e s e m u l o v n a r u t a g n e P m p u c n u k e s is I erupakanj umlahdarahyangdipompakankelua rdar ima isng-ma isng
n a b e b : l e b a ir a v a g it i r a d g n u t n a g r e t p u c n u k e s is I .t u y n e d r e b g n u t n a j p a it e s l e k ir n e v .r i h k a n a b e b n a d , s a ti li t k a r t n o k , l a w a . 1 BebanAwal t u b a r e s n a g n a g e r e p t a j a r e d h a l a d a l a w a n a b e B miokardiumpadaakhi rpengi isan a m a l e s m u i d r a k o i m t u b a r e s n a g n a g e r e p : g n il r a t S m u k u H n a g n e d i a u s e s i n i l a H . l e k ir t n e v n a t a u k e k n a k t a k g n i n e m n a k a e l o t s a i d r i h k a e m u l o v n a t a k g n i n e p i u l a l e m e l o t s a i d e ri d g n a y t e r a k h o t n o c i a g a b e S . k il o t si s t a a s a d a p i s k a r t n o k gangkanmak isma lakan h a l a d a l a w a n a b e b n i a l a t a k n a g n e D . n a k s a p e li d t a a s n a t e r p e j n a t a u k e k h a b m a n e m . k il o t si s /i s k a r t n o k r e b m u l e b e s k il o t s a i d t a a s l a m is k a m g n a g e r e m l e k ir t n e v n a u p m a m e k :l a w a n a b e b u t n e n e p r o t k a F l a w a n a b e b n a k n u r u n e m l a r ti m i s n e is if u s n I • l a w a n a b e b n a k n u r u n e m l a r ti m s is o s n e t S • n a k g n a d e S . l a w a n a b e b n a k t a k g n i n e m i s a l u k ri s e m u l o v n a t a k g n i n e p , is l a u k ri s e m u l o V • .l a w a n a b e b n a k n u r u n e m i s a l u k ri s e m u l o v n a n u r u n e p t a b O • -obatan ,oba tvasokonst irkto rmeningkatkanbebanawal .Sedangkanobat-oba t .l a w a n a b e b n a k n u r u n e m r o t a li d o s a v 2 .BebanAkhri n a k a p m o m e m t a p a d k u t n u l e k ir t n e v g n i d n i d n a g n a g e t a y n r a s e b h a l a d a r i h k a n a b e B t a b m a h g n e m g n a y n a n a h a t a y n r a s e b n a k r a b m a g g n e m r i h k a n a b e B . k il o t si s t a a s h a r a d u j ri h k a n a b e B . l e k ir t n e v n a g n o s o g n e p gadapa tdiar itkans ebagais uatubebanpada a m a l e s h a r a d g n o r o d n e m n a d , a t r o a r a n u li m e s p u t a k a k u b m e m k u t n u i ri k l e k ir t n e v . k il o t si s / si k a r t n o k :i h u r a g n e p i d r i h k a n a b e B ri h k a n a b e b n a k t a k g n i n e m a t r o a s is o n e t S • h k a n a b e b n a k t a k g n i n e m r e fi r e p i s k ir t n o k o s a V • ri ri h k a n a b e b n a k t a k g n i n e m i s n e t r e p i H • ri h k a n a b e b n a k t a k g n i n e m a i m e ti si l o P • t a b O o -oabatan ,vasodliato rmenurunkanbebanakhi,rs edangkanvasokonst irkto r .r i h k a n a b e b n a k t a k g n i n e m l e k ir t n e v a jr e k n a k t a k g n i n e m n a k a r i h k a n a b e b s it s a r d a r a c e s n a t a k g n i n e P ,menambah .l e k ir t n e v n a l a g a g e k t a b i k a r e b t a p a d n a d n e g is k o n a h u t u b e k 3 .Kontraktlitias t o t o n a u p m a m e k n a k a p u r e m s a ti li t k a r t n o K -ototj antunguntukmenguncupdan
t o t o n i e t o r p i s k a r e t n i ir a d l is a h n a k a p u r e m s a ti li t k a r t n o k n a t a k g n i n e P . g n a b m e g n e m a nk -it mio isnyangdiaktfikanolehkal isum .Peningkatankontraktlitia sototj antung k u t n u l e k ir t n e v n a u p m a m e k h a b m a n e m a r a c n a g n e d p u c n u k e s h a r u c r a s e b r e p m e m . k il o t si s a m a l e s a y n is i n a k g n o s o g n e m G N U T N A J H A R U C I H U R A G N E P M E M G N A Y R O T K A F
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. A CoronaryHear tDisease i s i n if e D a m a t u b a b e y n e p i d a j n e m n a d g n ir e s g n il a p g n a y g n u t n a j a d a p n a u g g n a g s i n e J ) 8 0 0 2 , n i a Z (. a is e n o d n I i d u t a s r o m o n n a it a m e k i r a n o r o k i r e t r a n a ti p m e y n e p a n e r a k n a k b a b e si d a m a t u r e t g n a y g n u t n a j ti k a y n e P l k s o r e t a s e s o r p t a b i k a ero is sataus pasmeataukombinas ikeduanya.( Abdu l ) 7 0 0 2 , d ij a Mg n u t n a j ti k a y n e p ( r e n o r o k i r e t r a t i k a y n e p / r e n o r o k g n u t n a j ti k a y n e P a d a p s is o r e l c s o r e t r a n a d s u s u h k i s a t s e fi n a m u t a u s n a k a p u r e m ) k if o r t s o r e h t r a a g n a b a c r e p a d a p k u t n e b r e t e u q a l P . r e n o r o k i r e t r a narter iyangkearahateiron . x e lf m o r ri s ir e t r a a d a p g n a r a j k a g a n a d n a n a k a ir a n o r o k i r e t r a , ir i k Alriandarah g n a y a r a t n e m e s n u p u a m n e n a m r e p a r a c e s is k u r t s b o i m a l a g n e m t a p a d l a t si d e k l a r e t a l o k i s a l u k ri S . n a l a p m u g g n e p u a t a e u q a l p i s a l u m u k a h e l o n a k b a b e s i d s a g n a r a k u t r e p t a b m a h g n e m g n a y s u s a m o r e t r a i s k u r t s b o r a ti k e s i d g n a b m e k r e b r a k o i m e k i si r t u n n a d dium . e k t a u k e d a g n a y n e g is k o y l p p u s n a k a i d e y n e m k u t n u l a r e t a l o k i s a l u k ri s n a l a g a g e K h a r a d n a ri l a n a u g g n a g , a ir a n o r o k i r e t r a t i k a y n e p a y n i d a jr e t t a b i k a r e b g n a y l e s n a d ) k r a f n i e r p a n i g n a n a d s ir o t k e p a n i g n a ( n e n a m r e p k a d it i s k u r t s b o a n e r a k r t s b o uks ipermanen( miocardi nfarct.)( Pusa tPendidikanTenagaKesehatan ) 3 9 9 1 , s e k . p e D e s a e s i D t r a e H y r a n o r o C i g o l o it E . a Menuru tZain ,2008 a m o r e t a u a t a s is o r e l k s o r e t a s e s o p h a l a d a K J P a y n i d a jr e t a m a t u b a b e y n e p 2 a d A . si s o b m o r t s e s o r p n a d - Aterosklerossi g n u t n a j ti k a y n e P korone rdsiebabkanoleht erbentuknyaplakd iarter i , n a h i b e lr e b g n a y l o r e t s e l o k s a t a i ri d r e t i n i k a l P . g n u t n a j h a r a d h u l u b m e p k u p m u n e m n a a m a l e k a m a l g n a y h a r a d h u l u b m e p i d n i a l n a h a v n a d , m u is l a k s ) a ir a n o r o k i r e t r a ( g n u t n a j h a r a d h u l u b m e p g n i d n i d m a l a d i d ertaarte i u a t a s is o r e l k s o r e t a u a t a ir e t r a n a s a r e g n e p t u b e si d i n i s e s o r p . n i a l t a p m e ti d . a m o r e t a - Trombossi k u t n u h a i m a l a s e s o r p u t a u s , h a r a d n a u k e b m e p k u t n u s i d e m h a li t si h a l a I i d a jr e t a ti k a k iJ . a k u l i m a l a g n e m a ti k a k ij n a h a r a d r e p n a k it n e h g n e m i d , a m o r e t a ndingpembuluhdarah itdakl ag iilcin ,dandtiempa tyangada l e s i n i n a k a s u r e k -selt rombosti( untukpembekuandarah )akanberkumpu l n a g n e d t u n e si d i n i h a r a d n a u k e B . t u b e s r e t n a k a s u r e k i p u t u n e m k u t n u . s u b m o r t - Fakto rir iskoada2 f akto ryakn:i g n a y r o t k a F itdakdapa tdiubah :geneitka ,gende,rs ertau isa.
, s e t e b a i d , is n e t r e p i h , i g g n it l o r e t s e l o k , k o k o r e m : h a b u i d t a p a d g n a y r o t k a F . a g a r h a l o g n a r u k a t r e s s e r t s , n a k u m e g e k - U isadangender - Riwaya tkeluarga - Merokok - Makanandankolesterol o r o C s i n il K i s a t s e fi n a M naryHear tDisease a k a m , a m a l g n a y u t k a w m a l a d n a d n a h a lr e p a y n k u t n e b r e t i n i ti k a y n e p a n e r a K .i n i l a h i u h a t e g n e m k a d it a ti r e d n e p n a k a y n a b e k , a y n g n a y a S . s a f a n k a s e s a t r e s , ) a n i g n a ( a d a d i r e y n u ti a y l a w a g n il a p a l a j e g a y n a s a i B i d a j n e m g n a y g n u t n a j n a g n a r e s tanda pertama penyaki t ini . Menuru t peneilitan l a g g n i n e m g n a y a ti n a w % 3 6 n a d a ir p % 0 5 i r a d , n u h a t 0 5 a m a l e s t r a e H m a h g n i m r a F a l a j e g i a y n u p m e m k a d it ) g n u t n a j n a g n a r e s ( r e n o r o k g n u t n a j ti k a y n e p a n e r a k k a d a d n e m . a y n m u l e b e s t K J P a n e r a k a n i g n a u a t a a d a d i r e y N “ imbu lsetelahmelakukanak itvtia sdanhliangkeitka g n a y n e g is k o n a k t a p a d n e m k a d it g n u t n a j t o t o a n e r a k l u b m it i r e y n a s a R . t a h a ri t si r e b 2 a m a l e s g n u s g n a lr e b a y n a s a i b , p u k u c -3 menti , itdak lebih dar i10 menti .Tiga cara : K J P a n e r a k a d a d i r e y n i l a n e g n e m . a Rasanyer iitdakbertambahparahs aa tmenairknafas. . b Biasanya terasa d itengah dada ,bsia menyeba rkessi ikiir ,kedua l engan , . g n a h a r n a d r e h e l e k u a t a . c Dadat erasas eperits esak,t erbaka ,rt ertusuk-tusuk ,ataut ertekan . ) 8 0 0 2 , n i a Z ( y r a b o r o C i g o l o i s if o t a P Hear tDisease i r a d k i m e k si s n o p s e r n a k a p u r e m k r a f n i li a i d r a c i m n a d r e n o r o k g n u t n a j ti k a y n e P u a t a n e n a m r e p a r a c e s a ir a n o r o k i r e t r a n a ti p m e y n e p h e l o n a k b a b e s i d g n a y m u i d r a k o i m l e s h e l o n a k u lr e p i d n e g is k O . n e n a m r e p k a d it -se lmiokardial ,untukmetabolsimeaerob t a h a ri t si t a a s a d a p g n u t n a j i g r e n e k u t n u n a k s a b e b i d e t a p s o h p ir T e n is o n e d A a n a m i d i d g n u t n a j a jr e k k u t n u n a k u lr e p i d g n a y n e g is k o a y n k a y n a B . n e g is k o % 0 7 n k a h u t u b m e m O V M ( n o it p m u s n u C n e g y x O l a i d r a c o y M i a g a b e s t u b e s 2) , yang dinyatakan oleh j n a t a p e c r e p antung ,kontraks imiocardia ldant ekananpadadindingj antung .
n a t a k g n i n e p p a d a h r e t n a k i a u s e y n e m h a d u m n a g n e d t a p a d l a m r o n g n a y g n u t n a J n a k e n e m k u t n u i s k a r t n o k n a d n a t a p e c r e p h a b m a n e m n a g n a d n e g is k o n a n a k e t n a t u t n u t t a k e s e k h a r a d e m u l o v -seka tjantung .Pada jantung yang mengalam iobstruks ialrian . i d a jr e t g n a y n a t u t n u t p a d a h r e t i p u k u c n e m t a p a d k a d it h a r a d i a l p u s , l a i d r a c o i m h a r a d n a d a is k o n a n a k b a b e y n e m t a p a d n a i g a b e s n u p u a m l a t e l i s k u r t s b o a y n a d a n a a d a e K y a p u r e b c i b o r e a s is il o k il g i a p u r e y n e m i si d n o k u t a u s amemenuh ikebutuhanok isgen. t a p a d g n a y k i b o r e a s is il o k il g i r a d t a b i k a n a k a p u r e m t a t k a l m a s a n a n u b m i n e P s is o d is a n a d a i m o r k o p i H . g n u t n a j n a l a g a g e k n a d a i m ti r si d a y n i d a jr e t is is o p si d e r p i a g a b e s n u r u n e m i s k a r t n o k n a t a u k e K . l e k ir t n e v i s g n u f u g g n a g g n e m t a t k a l ,gerakan dinding . k it e n i k o p i h i d a j n e m k i m e k si n e m g e s n a g n a r u g n e p , e m u l o v e k o r t s n a n u r u n e p n a k b a b e y n e m i ri k l e k ir t n e v n a l a g a g e K n a n a k e t n a d e l o t s a i d r i h k a n a n a k e t t a a s a d a p i ri k l e k ir t n e v n a t a k g n i n e p , t u p t u o c a i d r a c t a t r e s si l a n o m l u p i r e t r a a d a p n a k a s e d anda-tandakegagalanj antung. a ir a n o r o k i r e t r a a d a p i s k u r t s b o a d a p g n u t n a g r e t a i m e k si n a d n a t u j n a l e K i m e k si i r a d i s a t s e fi n e m a g i T . a y n n a r u k u a t r e s i s a k o l , ) a r a t n m e s u a t a n e n a m r e p ( , a r a t n e m e s s u ir a n o r o k i r e t r a n a ti p m e y n e p , si r o t c e p a n i g n a h a l a d a l a i d r a c o i m preinfarks i t a s u P ( i r a n o r o k i r e t r a a d a p n e n a m r e p i s k u r t s b o u a t a k r a f n i l a i d r a c o i m n a d , a n i g n a .) 3 9 9 1 , s e k . p e D n a t a h e s e K a g a n e T n a k i d i d n e P . B Hear tFaliure i s i n if e D t a p a d i g a l k a d it g n u t n a j a n a m i d i si d n o k i a g a b e s n a k is i n if e d i d g n u t n a j l a g a G n a k a p m o m e m cukupdarahkej a irngant ubuh.( HarbanuHMairyonodanAnwa r ) 7 0 0 2 , o n o y r a M k u t n u h a r a d a p m o m e m m a l a d g n u t n a j n a l a g a g e k u t a u s h a l a d a g n u t n a j l a g a G ) 2 8 9 1 , i d a n u J n a w a n r u P ( . h u b u t n a h u t u b e k i h u n e m e m a a p m o m e p n a l a g a g e k u t a u s h a l a d a f it s e g n o k g n u t n a j n a l a g a g e K n( d imanacardiac i a g a b e s i d a jr e t n i k g n u m i n i l a h , ) h u b u t k il o b a t e m n a h u t u b e k i p u k u c n e m k a d it t u p t u o g n a y n e g is k o s a ti s a p a k u a t a h a r a d h u l u b m e p , g n u t n a j n a u g g n a g i r a d r i h k a t a b i k a u t u b e k i p u k u c n e m t a p a d k a d it g n u t n a j n a k t a b i k a g n e m g n a y h a r a d m a l a d a w a b r e t han ) 3 9 9 1 , n i m s a Y e d e G h u L i N ( . n a g r o i a g a b r e a d a p n e g is k o
e r u li a F t r a e H i g o l o it E p u k u c i g o l o i m e d i p e a r a c e S . l a h k a y n a b h e l o n a k b a b e si d t a p a d g n u t n a j l a g a G g n a b m e k r e b a r a g e n i d , g n u t n a j l a g a g i r a d b a b e y n e p i u h a t e g n e m k u t n u g n it n e p r e n o r o k i r e t r a t i k a y n e p danhipertens imerupakanpenyebabt erbanyaks edangkand i p u t a k g n u t n a j ti k a y n e p h a l a d a k a y n a b r e t b a b e y n e p i d a j n e m g n a y g n a b m e k r e b a r a g e n a p a r e b e b a d a P . is ir t u n l a m t a b i k a g n u t n a j ti k a y n e p n a d keadaans angats uil tuntuk n u t n a j l a g a g i r a d b a b e y n e p n a k u t n e n e m g .Terutamapadakeadaanyangt ejrad i . a ti r e d n e p a d a p n a a m a s r e b Facto rir iskokoroners epert idiabete sdanmerokokmerupakanf acto ryang h u r a g n e p r e b padaperkembangandar igagalj antung .Selain tiubera tbadans erta e d l a t o t l o r e t s e l o k o is a r a y n i g g n it ngankolestero lHDLj ugadikatakans ebaga iir isko . g n u t n a j l a g a g n a g n a b m e k r e p n e d n e p e d n i a p a r e b e b a d a p g n u t n a j l a g a g o k is ir n a k t a k g n i n e m n a k it k u b i d h a l e t is n e t r e p i H , e m si n a k e m a p a r e b e b i u l a l e m g n u t n a j l a g a g n a k t a b i k a g n e m t a p a d i s n e t r e p i H . n a it il e n e p a m r e t sukhipertrop iventirke lkri.i n a k g n u b u h i d n a d g n u t n a j l a g a g n a g n e d n e is a p a d a p n a k u m e ti d g n ir e s a i m ti r A .i s n e t r e p i h a ti r e d n e p a d a p i ri k l e k ir t n e v i p o r t r e p i h k u s a m r e t l a r u t c u r t s n a n i a l e k n a g n e d a k l u b m i n e m , g n u t n a j a d a p g n u s g n a l a r a c e s k e f e r e b t a p a d l o h o c l A ngaga l l o h o c l A . )i s a li r b if l a ir t a g n ir e s r e t ( a i m ti r a t a b i k a g n u t n a j l a g a g n u p u a m t u k a g n u t n a j 2 r a ti k e s g n u t n a j l a g a g n a k t a b i k a g n e m t a p a d -3%dar ikasus. t a b O – obatankemoterapis epert idoxorubicindandanoba tant ivriuss epert i y n e m t a p a d a g u j n i d u v o d iz ebabkangagalj antungakiba tefekt ok iskl angsungt erhadap . g n u t n a j t o t o ) 7 0 0 2 , o s o t n a S r a w n A n a d o n o y r a M H u n a b r a H ( e r u li a F t r a e H i s a k if i s a l K s a l e K Deifni is Istliah 1 Kilendengankelainanj antungt etapit anpa k is if s a ti v it k a n a s a t a b m e p i s g n u f si D ventirke lkri i k it a m o t m is a g n a y 2 Kilendengankelainanj antungyang Gagalj antung irngan
s a ti v it k a n a s a t a b m e o t i k i d e s n a k b a b e y n e m k is if 3 Kleindengankelainanj antungyang s a ti v it k a n a s a t a b m e p k a y n a b n a k b a b e y n e m k is if g n a d e s g n u t n a j l a g a G 4 Kilendengankelainanj antungyangs egala n a k b a b e y n e m n a k a a y n k is if s a ti v it k a k u t n e b n a h u l e k t a r e b g n u t n a j l a g a G e r u li a F t r a e H i g o l o i s if o t a P n a h u t u b e k n a t a k g n i n e p p a d a h r e t s n o p s e r e b t a p a d l a m r o n g n a y g n u t n a J g n a y i s a s n e p m o k e m si n a k e m n a k a n u g g n e m g n a y e m si l o b a t e m berva iras iuntuk k it e t a p m is f a r a y s m e t si s s n o p s e r :i t u p il e m n i k g n u m i n I .t u p t u o k a i d r a k n a k n a h a t r e p m e m g n u t n a j t o t o n a r a b e l e p n a d n a g n a c n e g n e p , r o t p e s e r o m e k u a t a r o t p e s e r o r a b p a d a h r e t i r e t r a i s k n ir y t s n o k o s a v , e m u l o v n a t a k g n i n e p p a d a h r e t n a k i u s e y n e m k u t n u rena ldan m u r e s p a d a h r e t n o p s e r a t r e s n is n e t o i g n a n i n e r m e t si s is a v it k a -serums odiumdan . n a ri a c i s b r o s b a e r ir a d H D A i s a l u g e r h a r a d e m u l o v a y n a d a h e l o t a p e c r e p i d i s a s n e p m o k e m si n a k e m n a l a g a g e K is is e r n a t a k g n i n e p g n a t n e n e m k u t n u n a k a p m o p i d g n a y i s a l u k ri s tens ivaskule roleh l e k ir t n e v n a is i g n e p u t k a w a k e d n e p r e p m e m g n u t n a j n a t a p e c e K . g n u t n a j n a g n a c n e g n e p i s a n e g is k o a y n g n a r u k r e b n a k b a b e y n e m t u p u o k a i d r a k a y n n u r u n e m , a ir a n o r o k i r e t r a n a d . d r a k o i m a d a p i s a t a li d t a b i k a h a r a d h u l u b m e p g n i d n i d n a n a k e t n a t a k g n i n e P menyebabkan a d a p a m a t u r e t )i p o r t r e p i h ( g n u t n a j n a r a s e b m e p n a d n e g is k o n a t u n u t n a t a k g n i n e p . n a a p m o m e p e m si n a k e m n a l a g a g e k n a k b a b e y n e m g n a y , n a k a s u r e k u a t a k i m e k si g n u t n a j :r e m ir p s n o p s e r e m si n a k e m a g it a d a , g n u t n a j l a g a g p a d a h r e t s n o p s e r i a g a b e S a k g n i n e m . 1 tnyaakitvtia sadrenergic ismpatsi n o m r o h o r u e n i s a v it k a t a b i k a l a w a n a b e b a y n t a k g n i n e m . 2 l e k ir t n e v i v o r t r e p i h . 3 :t u k ir e b i a g a b e s n a k r a b m a g i d t a p a d s it a m e k s a r a c e S
S n a u g g n a G trukturJ antung ) b u t a k ( r a l u v l a V g n u t n a J ti k a y n e P A Dsifung ikatupdikla isifka iskanmenjad iduaj ensi: a g g n i h e s t a p a r n a g n e d p u t u n e m t a p a d k a d it p u t a k n u a d = p u t a k i s n e is if u s n I . a h a l a d a a y n m i n o n is ( n a r o c o b e k i m a l a g n e m n a k a u a t a k il a b r il a g n e m t a p a d h a r a d ) p u t a k i s n e t e p m o k n i n a d p u t a k i s a ti g r u g e r u t a k g n a b u l = p u t a k s is o n e t S . b pmengalam ipenyemptians ehinggaalriandarah . g n a r u k r e b n a k a p u t a k i u a l e m h a r a d h a ri l a / n a t b m a h i m a l a g n e m g n u t n a j a s a k a m e m p u t a k i s n e is if u s n I . g n u t n a j a jr e k n a k a t a k g n i n e m n a k a p u t a k i s g n u f si D y h a r a d h a l m u j n a k it n a g g n e m k u t n u k a y n a b h i b e l h a r a d n a k a p m o m e m angmengalam i s is o n e t S . g n u t n a j a jr e k e m u l o v n a k t a k g n i n e m a g g n i h e s ,l i a b r il a g n e m /i s a ti g r u g e r i s n e t si s e r is a t a g n e m t p a a d r a g a a y n n a n a k e t n a k a t a k g n i n e m k u t n u g n u t n a j a s k a m e m . m u i d r a k a jr e k n a n a k e t n a k t a k g n i n e m n a k a a n e r a k , t a k g n i n e m g n a y n a ri l a a p a d a h r e t e R spon smiokardiumyangkha spadapeningkatanvolumedant ekanankejraberupa n a k a p u r e m i f o r t r e p i h n a d m u i d r a k o i m i s a t a li D . t o t o i f o r t r e p i h n a d g n a u r is a t a li d
g n u t n a j n a u p m a m e k n a k a t a k g n i n e m k u t n u n a u j u t r e b g n a y i s a s n e p m o k e m si n a k e m . h a r a d n a k a p m o m e m a l a d 1.STENOSISMITRAL i s i n if e D h a r a d n a ri l a k o l B n a k it r a i d t a p a d l a r ti m g n u t n a j ti k a y n e p a k a m i si n if e d a r a c e S r u t k u r t s n a h a b u r e P a y n a d a t a b i k a , l a r ti m p u t a k t a k g n it a d a p mtirall ealfet ,syang t a a s a d a p a n r u p m e s a r a c e s l a r ti m b u t a k a y n a k u b m e m k a d it n a k b a b e y n e m diastoilk . i g o l o i s if o t a P 4 r a ti k e s l a r ti m b u t a k n a a k u b m e p s a u l l a m r o n n a a d a e k m a l a D -6cm² .Apablia m h a d u s a k a m ) si s o n e t s d li m ( ² m c 2 i n i b u t a k n a a k u b m e p s a u l ula i itmbu lperubahan a n a m i d , k i m a n i d o m e h darahdar iat irumkri ihanyadapa tmasukkeventirke lkri,iapablia h e l o g n o r o d i d Presuregradien tyangabnorma.l l a r ti m s is o n e t s n a k a p u r e m i n i l a h a k a m m c 1 < l a r ti m b u t a k n a a k u b m e p a li b a p A a d r a g a g H m m 0 2 t n e i d a r g e r u s s e r p n a k u lr e p i d i n i k u t n U . t a r e b g n a y pa t t a a s a d a P . t a u k e d a p a t e t g n u t n a j h a r u c a g g n i h e s h a r a d n a ri l a n a k n a h a t r e p m e m t a h a ri t si Peninggian tekanan at irum kri i sudah tentu akan dtieruskan ke vena g n a y ,i g g n i n e m t u k i n a k a n a i d u m e k l a n o m l u p a n e v a d a p n a n a k e t a g g n i h e s, l a n o m l u p n e m t a p a d a y n s u r e t e s yebabkan Oedemaparu. e k n a k s u r e ti d n a k a a g u j fi s a p a r a c e s r e li p a k n a d l a n o m l u p a n e v a d a p n a n a k e t n a i g g n i n e P i f o r t r e p i h , l a n o m l u p i s n e t r e p i h n a k l u b m i n e m t a p a d g n a y , l a n o m l u p i r e t r a m e t si s . n a n a k l e k ir t n e v i s a t a li d n a d n a n a k l e k ir t n e v s i n il k i s a t s e fi n a M e K luhan-keluhandapa tberupa: x Sesaknapas( dsipneu) ,merupakankeluhanyangpailngmenonjo l ,keluhani n i . u r a P m a l a d i d a n e v i t s e g n o k a y n a d a n a g n e d n a g n u b u h r e b x Peninggiankongesit fparut ejrad iakiba tadanyaperubahanvolum s a v a r t n i u a t a n a d r a l u k s a v a r t s k E kula rapabliapendertiadalamPossi iitdu r u e n p o h t r o n a h u l e k n a k l u b m i n e m k u t n u g n u r e d n e c i n i n a a d a e k Atauparoxysma l .t a r e b u a t a g n a d e s l a r ti m s is o n e t S a ti r e d n e p a d a p a m a t u r e t , u e n p s y d l a n r u t c o n x Hemopit is sdapatj ugat ejrad ipadas teno is smtiral ,yang itmbu lakibatr elfeks i .l a i k n o r b a n e v m a l a d e k l a n o m l u p a n e v i s n e t r e p i h x Palptias ibiasanyamuncu lapablias teno is smtiralt ersebuts udahdsierta iadanya .l a ir t a i s a li r b if
x Saki tdada( ches tpain)j ugas eirngdikeluhkan olehpendertia Steno is s k g n u m .l a r ti m inakiba tsikemikmiokard ventirke lkananakiba thipertens i .t a r e b g n a y l a n o m l u p x Suaraparau( hoarseness )dapatj ugat ejrad iakiba tkompres ipadanervu s r a s e b m e m g n a y l a n o m l u p i r e t r e h e l o i ri k s n e r u c e r L A R T I M I S N E I S I F U S N I . 2 i s i n if e D l a r ti m i s n e is if u s n I adalahkeadaandimanat erdapatr elfuk sdarahDar ivent irke l a r a c e s p u t u n e m k a d it l a r ti m b u t a k t a b i k a , k il o t si s t a a s a d a p i ri k m u ir t a m a l a d e k i ri k . k it a m e r g n u t n a j ti k a y n e p h a l a d a i n i n a n i a l e k a m a t u b a b e y n e P . a n r u p m e s i g o l o it E a j ti k a y n e p i g o l o it e g n i p m a si D ntungr ema itk,ma ishadai nsuif isens iMtira lata s : n i a l i g o l o it e r a s a d : a d a p r u t k u r t s n a h a b u r e P -- daunkatub -- chordaet endinea -- muskulu spapliarsi --Perubahananatomi a k a m , a n r u p m e s n a g n e d p u t u n e m l a r ti m b u t a k a y n t a p a d k a d it n a g n e D akan is a ti g r u g e r a y n l u b m it n a k t a b i k a g n e m i g o l o i s if o t a P a g u j , a t r o A e k k u s a m h a r a d g n i p m a si d a k a m , l e k ir t n e v k il o t si s t a a s a d a P s u r a h a t r o a e k i ri k l e k ir t n e v t u p t u O n a i k i m e d n u p u a l a W .i ri k m u ir t a e k i l a b m e k n a i g a b e s n a k e m n a g n e d l a m it p o a r a c e s n a k n a h a t r e p i d simekompensas.iventirke lkri iberkontraks i .i s a s n e p m o k e d l u b m it i a p m a s t a u k h i b e l k a y n a b g n a y h a r a d m u l o v t a b i k a i a g a b e s a g u j is a t a li d r e b n a k a i ri k l e k ir t n e v a y n ri h k A i a t r e si d u l a l e s k a d it i ri k m u ir t a i s a t a li d . k il o t si s t a a s a d a p i ri k m u ir t a i r a d k u s a m n e p inggiant ekananpadaatirumkiir .Konsekuen isl aindliatas iat irumkri iadalah . k a y n a b n i k a m e s is a ti g r u g e r
. 3 INSUFISIENS ITRIKUSPID i g o l o it E i s n e is if u s n I. k i n a g r o u a t a l a n o is g n u f r a s a d s a t a i d a jr e t t a p a d d i p s u k ir t is n e is if u s n I n u f r a s a d s a t a d i p s u k ir t g isona l dsiebabkan karena dliatas i vent irke l kanan , yang . d i p s u k ir t is n e is if u s n i n a k b a b e y n e m a y n ri h k a n a d d i p s u k ir t is a t a li d n a k b a b e y n e m g n u t n a j i s a s n e p m o k e d a y n a d a t a b i k a i a g a b e s l u b m it l a n o is g n u f d i p s u k ir t i s n e is if u s n I n e d i a t r e si d a li b a m a t u r e t, . n a n a k gan ifbrlias iat ira.l Insuifisens it irkuspid ata sdasa r g n ir e s g n il a p g n a y k i n a g r o adalahpenyaktij antungr ema itk. k i m a n i d o m e H i r a d n a n a k m u ir t a e k i l a b m e k g n a y h a r a d a y n a d a n a k n i k g n u m e m d i p s u k ir t i s n e is if u s n I . k il o t si s t a a s a d a p n a n a k l e k ir t n e v Sebailknya pada saa tdiastoilk ,volum darah yang n a d n a n a k m u ir t a a y n t a b i k a h a b m a t r e b t a g n a s n a n a k l e k ir t n e v n a d m u ir t a e k i a p m a s .i f o r t r e p i h n a d i s a t a li d i m a l a g n e m n a n a k l e k ir t n e v I T A P O Y M O I D R A C i s i n if e D a d a p t i k a y n e p i a g a b e s n a k is i n if e d i d i t a p o i m o i d r a K ototj antungyangbukan , l a ti n e g n o k g n u t n a j ti k a y n e p n u p u a m , is n e t r e p i h , r e n o r o k t i k a y n e p h e l o n a k b a b e si d , o s o t n a S r a w n A n a d o n o y r a M H u n a b r a H ( .l a i d r a k ir e p a d a p t i k a y n e p n u p u a t a p u t a k ) 7 0 0 2 ir p a r a e s m u i d r a k o i m i a n e g n e m g n a y t i k a y n e p h a l a d a i t a p o i m o i d r a K me rdan n a d l a ir e t r a , r e n o r o k , b u t a k , l a ti n e g n o k n a n i a l e k , is n e t r e p i h i r a d t a b i k a i a g a b e s n a k u b .) 9 4 2 l a h , 1 0 0 2 , k k d , o n o t n a li R i t r a i d u m I il i L ( l a i d r a k ir e p a y n i g o l o it E n a d i s a k if is a l K it u p il e m i t a p o i m o i d r a k i g a b m e m O H W a y n i g o l o is if n a d i m o t a n a n a k r a s a d r e B : l e k ir t n e v a u d e k u a t a u t a s h a l a s is a t a li d h e l o i a d n a ti d ( is a t a li d y h a p o i m o i d r a K dsierta idsifung iss sitoilkataudiastoilk.) Eitolog i :peirpartum ,diabetes ,sikemia,i nfeks ivriu sdanbakter,ii nsuif isens ivi t B1,s sitemik i/munologsi ,itdakdiketahu.i i u h a t e k i d a p n a t l a i d r a k o i m i p o r t r e p i h n a g n e d i a d n a ti d ( i p o r t r e p i h i t a p o i m o i d r a K e itologinya.)
