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NIM : 70 2010 005
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2 . K a r y a T u l i s i n i m u m i g a g a s a n , r u m u s a n , d a n p e n e l i t i a n S a y a s e n d i r i , t a n p a b a n t u a n p i h a k l a i n , k e c u a l i a r a h a n T i m P e m b i m b i n g .
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4 . P e m y a t a a n i n i S a y a b u a t d e n g a n s e s u n g g u h n y a d a n a p a b i l a d i k e m i i d i a n h a r i t e r d a p a t p e n y i m p a n g a n d a n k e t i d a k b e n a r a n d a l a m p e m y a t a a n i n i , m a k a Ssy^
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D e n g a n p e n y e r a h a n n a s k a h a r t i k e l d a n softcopy b c r j u d u l : G a m b a r a n Hyj tertensive Heart Disease pada L a n j u t U s i a y a n g D i r a w a t d i R S U D P a l e m b a n g B A R I P e r i o d e J a n u a r i
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d i a t a s . D e n g a n h a k t e r s e b u t , F K - U M P b e r h a k m e n y i m p a n , m e n g s l i h m e d i a l f o n n a ^ k a n , d a t a m b e n t u k p a n g k a l a n d a t a {database), m e n d i s t r i b u s i k a n , m e n a m p i t k ^ , m e m p u b l i k a s i k a n d i i n t e r n e t a t a u m e d i a l a i n u n t u k k e p e n t i n g a n a k a d e i n i s , t a n p a p e r i u m e m i n t a i z i n d a r i S a y a , s e l a m a t e t a p m e n c a n t u m k a n n a m a S a y a , d a n S a y a m e m b e r i k a n w e w e n a n g k e p d a p i h a k F K - U M P u n t u k m e n e n t u k a n s a l a h s a t u P e m b i m b i n g s e b a g a i P e n u l i s U t a m a d a l a m P u b l i k a s i . S e g a l a b e n t u k t u n t u t a n h u k u m y a n g t i m b u l a t a s p e l a n g g a r a n H a k C i p t a d a l a m K a r y a I l m i a h i n i m e n j a d i t a n g g u n g j a v y a b S a y a p r i f a a d i .
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G a m b a r a n Hypertensive Heart Disease p a d a L a n j u t U s i a y a n g D i r a w a t d i R S U D P a l c m b a n g B A R I P e r i o d e J a n u a r i - D e s e m b e r T a h u n 2 0 1 2
XV+ 7 0 h a l a m a n + 1 1 t a b c l + 1 1 g a m b a r + 7 l a m p i r a n A B S T R A K
M e n i n g k a t n y a a n g k a k e j a d i a n h i p e r t e n s i p a d a l a n j u t u s i a a k a n m e n g a k i b a t k a n t e r j a d i n y a p e n i n g k a t a n k e j a d i a n hypertensive heart disease. Hypertensive heart disease a d a l a h s u a t u i s t i l a h y a n g d i g u n a k a n s e c a r a u m u m u n t u k p e n y a k i t j a n t u n g s e p e r t i h i p c r t r o p i v e n t r i k e l k i r i , p c n y a k i t a r t e r i k o r o n e r , a r i t m i a j a n t u n g . d a n g a g a l j a n t u n g k o n g e s t i f y a n g d i s e b a b k a n o l e h e f e k p e n i n g g i a n t e k a n a n d a r a h k r o n i s . P e n e l i t i a n i n i b e r t u j u a n u n t u k m e n g e t a h u i g a m b a r a n hypertensive heart disease p a d a l a n j u t u s i a y a n g d i r a w a t d i R S U D P a l e m b a n g B a r i P e r i o d e J a n u a r i - D e s e m b e r ' f a h u n 2 0 1 2 . J e n i s p e n e l i t i a n i n i a d a l a h p e n e l i t i a n o b s c r v a s i o n a l d e s k r i p t i f p o t o n g l i n t a n g . P e n e l i t i a n i n i d i l a k u k a n d i B a g i a n R e k a m M e d i k R S U D P a l e m b a n g B a r i . P e n g a m b i l a n d a t a d i l a k u k a n s e c a r a total sampling d e n g a n j u m l a h s a m p e l s e b e s a r 1 0 6 p e n d e r i t a hypertensive heart disease. D a t a d i a m b i l d a r i R e k a m M e d i k R S U D P a l e m b a n g B a r i . K e m u d i a n d a t a d i o l a h d e n g a n m e n g g u n a k a n p e r a n g k a t l u n a k SPSS
1 6 . I l a s i l p e n e l i t i a n m e n u n j u k k a n r e n t a n g u s i a y a n g b a n y a k t e r j a d i p a d a u s i a 6 0 - 7 0 t a h u n a t a u k e l o m p o k e l d e r l y ( 5 8 . 5 % ) . J e n i s k e l a m i n y a n g b a n y a k t e r j a d i p a d a k e l a m i n p e r e m p u a n ( 5 7 . 5 % ) . K e l u h a n u t a m a y a n g p a l i n g b a n y a k a d a l a h s e s a k n a p a s ( 7 0 . 8 % ) . D e r a j a t h i p e r t e n s i t e r b a n y a k a d a l a h h i p e r t e n s i d e r a j a t 2 y a i t u 6 5 o r a n g ( 6 1 . 3 % ) . K a d a r k o l e s t e r o l t o t a l y a n g t i n g g i y a i t u 6 6 o r a n g ( 6 2 . 3 % ) . G a m b a r a n h i p e r t r o p i v e n t r i k e l k i r i b e r j u m l a h 6 5 o r a n g ( 6 1 , 3 % ) . G a m b a r a n c a r d i o m c g a l i b c r j u m l a h 8 1 o r a n g ( 7 6 , 4 % ) . O r a n g - o r a n g y a n g t c l a h m e m a s u k i u s i a d i a t a s 6 0 t a h u n h a r u s r a j i n m e m e r i k s a k a n k e s e h a t a n n y a t e r u t a m a b i l a s u d a h t e r d a p a t r i w a y a t p e n y a k i t j a n t u n g s e b e l u m n y a .
R c f e r e n s i : 2 9 ( 1 9 9 4 - 2 0 1 2 )
K a t a K u n c i : h i p e r t e n s i , hypertensive heart disease, L a n j u t u s i a .
U N I V E R S I T Y O F M U H A M M A D I Y A H P A L E M B A N G M E D I C A L F A C U L T Y
Thesis, February 2014 Miftahul Jauuah
The description of Hypertensive Heart Disease to the elderly who was nursed at R S U D Palembang Bari in period of January - December 2012 i
XV + 70 pages +11 tables + 1 1 pictures+ 7 enclosures
A B S T R A C T
The increase of numbers of hypertension to elderly will cause the increase of Hypertensive Heart Disease. Hypertensive Heart Disea.se was a term applied generally to heart disea.ses. .such as left ventricular hypertrophy, coronary artery disease, cardiac arrhythmias, and congestive heart failure, that are caused by the effects of elevated blood pre.s.sure. The purpose of this research to known the description of Hypertensive Heart Disease to the elderly who has been nursed at RSUD Palembang Bari in period of January December 2012. This research descriptived cro.ss - .sectional observational study. It was done at medical record of RSUD Palembang Bari. The collecting of data has done by using total sampling with 106 .sufferers of hypertensive heart disease then they were tested using .software of SPSS 16. The result showed that the disease most happened on the range of age between 60 -70 years old or elderly group ( 58.5 % ) . The gender of female has dominated for about ( 57.5 % ) . The most widely main complaint is asphyxiate ( 70.8 % ) . The highest degree of hypertension is the second degree of hypertens it }n is about 65 people ( 61,3 % ) . The highest total of level of cholesterol is 66 people ( 62,3 %) . The description of left ventrical hypertropy is 65 people ( 61,3% ) . The description of cardiomcgali is 81 people ( 76,4%}). People who will be over 60 years old must be regular and continuously check their health especially if they have got previous history of heart disease.
Reference : 29 ( 1994 - 2012 )
Key words : Hypertension, hypertensive heart disease, elderly.
K A T A P E N G A N T A R
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3 . 1 J e n i s P e n e l i t i a n 3 9 3 . 2 W a k t u d a n t e m p a t p e n e l i t i a n 3 9
3 . 3 P o p u l a s i d a n S a m p e l 3 9 3 . 3 . 1 P o p u l a s i 3 9 3 . 3 . 2 S a m p e l 4 0 3 . 3 . 3 K r i t e r i a I n k l u s i d a n E k s k l u s i 4 0
3 . 3 . 4 C a r a P e n g a m b i l a n S a m p e l 4 0
3 . 4 V a r i a b e l P e n e l i t i a n 4 1 3 . 5 D e f i n i s i O p e r a s i o n a l 4 1 3 . 6 C a r a p e n g u m p u l a n d a t a 4 5 3 . 7 M e t o d e T e k n i s A n a l i s i s D a t a 4 5
3 . 7 . 1 P e n g o l a h a n d a t a 4 5 3 . 7 . 2 A n a l i s i s d a t a 4 5 3 . 8 A l u r P e n e l i t i a n 4 6
B A B I V H A S I L D A N P E M B A H A S A N
H a s i l d a n P e m b a h a s a n 4 7 B A B V K E S I M P U L A N D A N S A R A N
5 . 1 K e s i m p u l a n 5 8 5 . 2 S a r a n 5 9 D A F T A R P U S T A K A , x i i i
L A M P I R A N 6 0 R I W A Y A I H I D U P 7 0
D A F T A R T A B E L
T a b e l 1 . K e a s l i a n P e n e l i t i a n 4 T a b e l 2 . K l a s i f i k a s i T e k a n a n D a r a h M c n u r u t J N C 7 7
T a b e l 3 . K l a s i f i k a s i F u n g s i o n a l G a g a l J a n t u n g N Y H A 2 3 T a b e l 4 . P a r a m e t e r e k h o k a r d i o g r a f i n o r m a l b e r d a s a r k a n j e n i s k e l a m i n 2 8
T a b e l 5 . G a m b a r a n b e r d a s a r k a n U s i a 4 7 T a b e l 6 . G a m b a r a n B e r d a s a r k a n J e n i s K e l a m i n 4 9
T a b e l 7 . G a m b a r a n B e r d a s a r k a n K e l u h a n U t a m a 5 1 T a b c l 8 . G a m b a r a n B c r d a s a r k a n D c r a j a t H i p e r t e n s i 5 2 T a b e l 9 . G a m b a r a n R e T d a s a r k a n K a d a r K o l e s t e r o l T o t a l 5 4 T a b e l 1 0 . G a m b a r a n B e r d a s a r k a n G a m b a r a n H K G 5 5 T a b e l 1 1 . G a m b a r a n B e r d a s a r k a n G a m b a r a n l o t o T o r a k s 5 6
D A F T A R G A M B A R
G a m b a r 2 . 1 . P e n g a r u h h i p e r t e n s i p a d a j a n t u n g 3 6
G a m b a r 2 . 2 K e r a n g k a T e o r i 3 7 G a m b a r 2 . 3 . K e r a n g k a K o n s e p 3 8 G a m b a r 3 . 1 . A l u r P e n e l i t i a n 4 6 G a m b a r 4 . 1 G a m b a r a n B e r d a s a r k a n U s i a 4 8
G a m b a r 4 . 2 G a m b a r a n B e r d a s a r k a n J e n i s K e l a m i n 4 9 G a m b a r 4 . 3 G a m b a r a n B e r d a s a r k a n K e l u h a n U t a m a 5 1 G a m b a r 4 . 4 G a m b a r a n B e r d a s a r k a n D e r a j a t I l i p e r t e n s i 5 3 G a m b a r 4 . 5 G a m b a r a n B e r d a s a r k a n K a d a r K o l e s t e r o l T o t a l 5 4 G a m b a r 4 . 6 G a m b a r a n B e r d a s a r k a n G a m b a r a n H K G 5 5 G a m b a r 4 . 7 G a m b a r a n B e r d a s a r k a n G a m b a r a n F o t o T o r a k s 5 6
D A F T A R L A M P I R A N
L a m p i r a n 1 . D a t a R e k a m M c d i k P a s i c n Hypertensive Heart Disease 6 0
L a m p i r a n 2 . P e n g o l a h a n D a t a d e n g a n S P S S 6 3
L a m p i r a n 3 . K a r t u B i m b i n g a n 6 5 L a m p i r a n 4 . S u r a t I z i n P e g g a m b i l a n D a t a A w a l 6 6
L a m p i r a n 5 . S u r a t T e l a h s e l e s a i P e n g a m b i l a n D a t a A w a l 6 7
L a m p i r a n 6 . S u r a t i z i n P e n e l i t i a n 6 8 L a m p i r a n 7 . S u r a t T e l a h s e l e s a i P e n e l i t i a n 6 9
B A B 1
P E N D A H U L U A N
L a t a r Belakang
B a n g s a I n d o n e s i a s e d a n g b e r k e m b a n g m e n u j u m a s y a r a k a t i n d u s t r i . P e r u b a h a n k e a r a h m a s y a r a k a t i n d u s t r i m e m b e r i a n d i l t e r h a d a p p e r u b a h a n p o l a g a y a h i d u p , s o s i a l e k o n o m i y a n g p a d a g i i i r a n n y a d a p a t m c m a c u m e n i n g k a t n y a p e n y a k i t t i d a k m e n u l a r . A d a n y a p e r u b a h a n d a l a m p o l a k e h i d u p a n l e r s e b u t m e n y e b a b k a n l e r j a d i n y a t r a n s i s i e p i d e m i o l o g i p e n y a k i t y a n g d i t u n j u k k a n d e n g a n a d a n y a k e c e n d e r u n g a n p e r u b a h a n p o l a k c s a k i t a n d a n p o l a p e n y a k i t u t a m a p e n y e b a b k e m a t i a n , d i m a n a t e r d a p a t p e n u r u n a n p r e v a l e n s i p e n y a k i t i n f c k s i , s e d a n g k a n p r e v a l e n s i p e n y a k i t n o n i n f e k s i a t a u d e g e n e r a l i f s e p e r t i h i p e r t e n s i , s t r o k e d a n k a n k e r j u s t r u s e m a k i n m e n i n g k a t . H a l i n i t e r j a d i s e i r i n g d e n g a n m e n i n g k a t n y a u s i a h a r a p a n h i d u p f K ' n d u d u k , s e h i n g g a d e w a s a i n i l e b i h s e r i n g d i j u m p a i p e n d u d u k b e r u s i a l a n j u t . P a d a t a h u n 2 0 0 0 j u m l a h p e n d u d u k l a n s i a ( > 6 0 t a h u n ) d i s e l u r u h d u n i a s e k i t a r 6 , 8 % d a r i t o t a l p o p u l a s i p e n d u d u k d u n i a d a n j u m l a h i n i d i p e r k i r a k a n a k a n t e r u s m e n i n g k a t m e n j a d i d u a k a l i l i p a t p a d a t a h u n 2 0 2 5 ( B u s t a n , 2 0 0 3 ) .
D a r i d a t a U S A - B e r e a u o f t h e C e n s u s , d i I n d o n e s i a d i p e r k i r a k a n a k a n m e n g a l a m i p e r t a m b a h a n w a r g a l a n s i a t e r b e s a r s e l u r u h d u n i a , a n t a r a t a h i m
1 9 9 0 - 2 0 2 5 y a i t u s e b e s a r 4 1 4 % ( D a r m o j o , 2 0 1 1 ) .
S a l a h s a t u p e n y a k i t d e g e n e r a l i f p a d a l a n j u t u s i a y a n g m e n j a d i m a s a l a h k e s e h a t a n a d a l a h p e n y a k i t h i p e r t e n s i . H i p e r t e n s i a d a l a h k e a d a a n p e n i n g k a t a n t e k a n a n d a r a h s e c a r a a b n o r m a l d a n b c r i a n g s u n g s e l a m a b e b e r a p a w a k t u y a n g d a p a t d i k e t a h u i m e l a l u i b e b e r a p a k a l i p e n g u k u r a n t e k a n a n d a r a h ( B u s t a n , 2 0 0 3 ) .
H i p e r t e n s i a d a l a h s u a t u k e a d a a n d i m a n a t e k a n a n d a r a h s e s e o r a n g a d a l a h > I 4 0 m m H g ( t e k a n a n s i s t o l i k ) d a n a t a u > 9 0 m m H g ( t e k a n a n d i a s t o l i k ) ( D e p a r t m e n t o f H e a l t h a n d H u m a n S e r v i c e s , 2 0 0 3 ) .
2
m e n u r u t l a p o r a n d a r i S u r v e i K e s e h a t a n R u m a h T a n g g a ( S K R T ) 2 0 0 4 p r e v a l e n s i h i p e r t e n s i p a d a d e w a s a 7 , 4 % t e r j a d i p a d a p r i a d a n 9 , 1 % t e r j a d i p a d a p e r e m p u a n ( Y a h y a , 2 0 0 5 ) .
B a i k t e k a n a n r e r a t a m a u p u n p r e v a l e n s i k e n a i k a n t e n s i a k a n n a i k d e n g a n b e r t a m b a h n y a u s i a . M a s t e r d k k d a l a m s t u d i p u s t a k a m e n e m u k a n p r e v a l e n s i h i p e r t e n s i 3 0 - 6 5 % p a d a o r a n g - o r a n g u s i a l a n j u t . N a t i o n a l H e a l t h
D o c u m e n t a t i o n d i U S A m e n e m u k a n p r e v a l e n s i 1 5 - 2 7 % p a d a o r a n g - o r a n g u s i a 6 5 t a h u n k e a t a s . D a r i s u r v e y h i p e r t e n s i y a n g t e l a h d i a d a k a n d i I n d o n e s i a s e l a m a i n i , p r e v a l e n s i h i p e r t e n s i p a d a o r a n g - o r a n g d i I n d o n e s i a l e b i h d a r i 2 0 % p a d a k e l o m p o k u m u r 5 0 t a h u n k e a t a s ( D a r m o j o , 2 0 1 1 ) .
D a r i 2 0 % p e n d e r i t a h i p e r t e n s i d i I n d o n e s i a , h a n y a 4 % y a n g m e r u p a k a n h i p e r t e n s i t e r k o n t r o l . T i n g g i n y a p r e v a l e n s i h i p e r t e n s i y a n g t i d a k t e r k o n t r o l i n i a k a n m e n y e b a b k a n g a n g g u a n p a d a o r g a n - o r g a n l a i n y a n g b e r h u b u n g a n d e n g a n s i s t e m - s i s t e m t e r s e b u t s e p e r t i o t a k , g i n j a l , m a t a , j a n t u n g , a o r t a d a n p e m b u l u h d a r a h t e p i ( K a m r a n , 2 0 1 0 ) .
P e n y u l i t p a d a j a n t u n g d a n m a n i f e s t a s i k l i n i s n y a i n i d i n a m a k a n p e n y a k i t j a n t u n g h i p e r t e n s i a t a u hypertensive heart disease. Hypertensive heart disease m e r u p a k a n p e n y e b a b n o m o r s a t u k e m a t i a n a k i b a t h i p e r t e n s i .
W H O m e l a p o r k a n b a h w a d i I n d o n e s i a a n g k a k e m a t i a n a k i b a t h i p e r t e n s i h e a r t d i s e a s e m e n c a p a i 4 2 , 3 p e r 1 0 0 0 k e m a t i a n ( W H O , 2 0 0 8 ) .
B e r d a s a r k a n d a t a r e k a m m e d i k d i R u m a h S a k i t U m u m D a e r a h P a l e m b a n g B A R I ( 2 0 1 3 ) t e r j a d i p e n i n g k a t a n p r e v a l e n s i hypertensive heart disease. P a d a t a h u n 2 0 1 0 t e r d a p a t 1 0 9 p a s i e n s e d a n g k a n t a h u n 2 0 1 1 m e n j a d i 1 3 3 p a s i e n .
3
M e l i h a l k o n d i s i d a n d a t a - d a t a y a n g d i k e m u k a k a n d i a t a s y a i t u m e n i n g k a t n y a a n g k a k e j a d i a n h i p e r t e n s i y a n g a k a n m e n i n g k a t k a n k e j a d i a n
hypertensive heart disease, s c r t a b e l u m a d a n y a d a t a m c n g e n a i g a m b a r a n
hypertensive heart disease p a d a l a n j u t u s i a d i R S U D P a l e m b a n g B a r i , m a k a p e n e l i t i t c r t a r i k u n t u k m e l a k u k a n p e n e l i t i a n d e n g a n j u d u l g a m b a r a n
hypertensive heart disease p a d a l a n j u t u s i a y a n g d i r a w a t t l i R S U D P a l e m b a n g B a r i p e r i o d e j a n u a r i - d e s e m b e r t a h u n 2 0 1 2 .
1.2. Rumusan Masalah
B a g a i m a n a g a m b a r a n hypertensive heart disease p a d a l a n j u t u s i a y a n g d i r a w a t d i R S U D P a l e m b a n g B a r i P e r i o d e J a n u a r i - D e s e m b e r T a h u n 2 0 1 2 ?
1.3. T u j u a n Penelitian
1.3.1. T u j u a n Umum
U n t u k m e n g e t a h u i g a m b a r a n hypertensive heart disease p a d a l a n j u t u s i a y a n g d i r a w a t d i R S U D P a l e m b a n g B a r i P e r i o d e J a n u a r i -D e s e m b e r T a h u n 2 0 1 2 .
1.3.2. Tujuan Khusus
Y a n g m e n j a d i t u j u a n k h u s u s d a l a m p e n e l i t i a n i n i a d a l a h : 1 . M e n g e t a h u i g a m b a r a n hypertensive heart disease p a d a l a n j u t
u s i a b e r d a s a r k a n s o s i o d e m o g r a f i y a i t u u s i a d a n j e n i s k e l a m i n . 2 . M e n g e t a h u i g a m b a r a n hypertensive heart disease p a d a l a n j u t
u s i a b e r d a s a r k a n k e l u h a n u t a m a .
3 . M e n g e t a h u i g a m b a r a n hypertensive heart disease p a d a l a n j u t u s i a b e r d a s a r k a n d e r a j a t h i p e r t e n s i .
4 . M e n g e t a h u i g a m b a r a n hypertensive heart disease p a d a l a n j u t u s i a b e r d a s a r k a n k a d a r k o l e s t e r o l t o t a l .
5 . M e n g e t a h u i g a m b a r a n hypertensive heart disease p a d a l a n j u t u s i a b e r d a s a r k a n g a m b a r a n E K G .
4
1.4. Manfaat Penelitian
1.4.1. Manfaat Teoritis
M e m b e r i k a n i n f o r m a s i i l m i a h m c n g e n a i g a m b a r a n
hypertensive heart disease p a d a l a n j u t u s i a .
1.4.2. Manfaat Praktis
H a s i l p e n e l i t i a n i n i d i h a r a p k a n d a p a t m e n j a d i b a h a n m a s u k a n b a g i s e g e n a p p c n c n t u k e b i j a k a n d a n i n s l a n s i t e r k a i t u n t u k m e m p r i o r i t a s k a n p r o g r a m k e s e h a t a n k h u s u s n y a hypertensive heart disease p a d a l a n j u t u s i a .
1.5. Keaslian Penelitian
T a b e l 1 . K e a s l i a n P e n e l i t i a n
N a m a J u d u l P e n e l i t i a n D e s a i n P e n e l i t i a n
H a s i l
D a d a n g H u b u n g a n A n t a r a A n a l i t i k P e n d e r i t a
H e n d r a w a n . U m u r d a n J e n i s o b s c r v a s i o n a l hypertensive heart
A s m i k a , K e l a m i n d e n g a n disease d i d a p a t k a n
D a r w a l i k T e k a n a n D a r a h , h u b u n g a n y a n g I n d e k s m a s s a t u b u h s i g n i f i k a n a n t a r a ( I M T ) d a n K a d a r u m u r d e n g a n K o l e s t e r o l I o t a ! t e k a n a n d a r a h p a d a P e n d e r i t a ( s i s t o l i k , d i a s t o l i k )
Hypertensive Heart d a n i n d e k s m a s s a
5
D e s e m b e r 2 0 0 3 .
A n g g a H u b u n g a n U m u r , A h d i y a t J e n i s K e l a m i n , N u g r a h a , O b e s i t a s d e n g a n Z a i n a l K e j a d i a n
M u s t h a f a , Hypertensive Heart
L u h E k a Disease d i P o l i P u r w a n i J a n t u n g R S P A D
G a t o t S o e b r o t o P e r i o d e I J a n u a r i 2 0 1 1 - 2 8 F e b r u a r i 2 0 1 1 .
k o l e s t e r o l t o t a l ( P e a r s o n C < i r r e l a t i o n = 0 , 9 2 9 ) . D i d a p a t k a n p e r b e d a a n y a n g s i g n i f f k a n a n t a r a t e k a n a n d a r a h ( s i s t o l i k , d i a s t o l i k ) d a n i n d e k s m a s s a t u b u h (1MT» ( u j i t , P = 0 , 0 3 3 , P - 0 , 0 0 6 d a n P = 0 , 0 3 9 ) . T i d a k d i d a p a t k a n p e r b e d a a n y a n g s i g n i f i k a n a n t a r a k a d a r k o l e s t e r o l t o t a l ( u j i ( , P =^ 0 , 7 4 8 ) a n t a r a l a k i - l a k i d a n p e r e m p u a n .
D e s k r i p t i f T e r d a p a t h u b u n g a n a n a l i t i k b e r m a k n a a n t a r a d e n g a n u m u r d e n g a n p e n d e k a t a n k e j a d i a n
C r o s s hypertensive heart
s e c t i o n a l disease ( P < 0 , 0 5 ) . T i d a k t e r d a p a t h u b u n g a n t a n g b e r m a k a n a a n t a r a j e n i s k e l a m i s d e n g a n k e j a d i a n
6
T i d a k t e r d a p a t h u b u n g a n y a n g b e r m a k n a a n t a r a o b e s i t a s d e n g a n k e j a d i a n
hypertensive heart disease ( P > O , 0 5 ) .
BAB I I
TINJAUAN PUSTAKA
2.1. Landasan Teori 2.1.1 Hipertensi
A. Definisi
M e n u r u t The Seventh Report of The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure ( J N C V i l ) h i p e r t e n s i a d a l a h p e n i n g k a t a n t e k a n a n d a r a h s i s t o l i k > 1 2 0 m m H g d a n a t a u t e k a n a n d a r a h d i a s t o l i k > 8 0 m m H g d a n d i k l a s i f t k a s i k a n m e n j a d i k e l o m p o k n o r m a l , p r e h i p e r t e n s i , h i p e r t e n s i d e r a j a t s a t u , d a n d e r a j a t d u a . B e r i k u t i n i a d a l a h t a b e l k l a s i f i k a s i t e k a n a n d a r a h b c r d a s a r k a n J N C V I I ( D e p a r t m e n t o f H e a l t h a n d H u m a n S e r v i c e s , 2 0 0 3 ) .
T a b e l 2 . K l a s i f i k a s i T e k a n a n D a r a h M e n u r u t J N C 7
Klasifikasi Tekanan Darah Tekanan Darah Tekanan Darah Sistolik (mmHg) Diastolik (mmHg)
N o r m a l < 1 2 0 d a n < 8 0 P r e h i p e r t e n s i 1 2 0 - 1 3 9 a t a u 8 0 - 8 9 H i p e r t e n s i D e r a j a t 1 1 4 0 - 1 5 9 a t a u 9 0 - 9 9 H i p e r t e n s i D e r a j a t 2 > i 6 0 a t a u > 1 0 0
Sumber: Department of Healt and I luman Services. 2()0j.
B. Etiologi
B e r d a s a r k a n e t i o l o g i n y a h i p e r t e n s i d i b a g i m e n j a d i d u a , y a i t u : 1 . H i p e r t e n s i p r i m e r
H i p e r t e n s i p r i m e r a d a l a h h i p e r t e n s i t a n p a k e l a i n a n d a s a r p a t o l o g i y a n g j e l a s . L e b i h d a r i 9 0 % k a s u s m e r u p a k a n h i p e r t e n s i e s e n s i a l . P e n y e b a b n y a m u l t i f a k t o r i a l m e l i p u t i f a k t o r g e n e t i k d a n l i n g k u n g a n . F a k t o r g e n e t i k m e m p e n g a r u h i k e p e k a a n t e r h a d a p n a t r i u m , k e p e k a a n t e r h a d a p s t r e s s , r e a k t i v a s i p e m b u l u h d a r a h t e r h a d a p v a s o k o n s t r i k t o r , r e s i s t e n s i i n s u l i n d a n I a i n - I a i n .
8
S e d a n g k a n y a n g t e r m a s u k f a k t o r l i n g k u n g a n a n t a r a l a i n y a i t u d i e t , k e b i a s a a n m e r o k o k d a n s t r e s s e m o s i ( Y o g i a n t o r o , 2 0 0 6 ) .
2 . H i p e r t e n s i s e k u n d e r
H i p e r t e n s i s e k u n d e r a d a l a h h i p e r t e n s i y a n g d i s e b a b k a n a t a u a k i b a t a d a n y a p e n y a k i t l a i n . H i p e r t e n s i i n i s e k i t a r 5 - 1 0 % d a r i s e m u a k a s u s h i p e r t e n s i . T e r m a s u k d a l a m k e l o m p o k i n i y a i t u h i p e r t e n s i a k i b a t p e n g g u n a a n e s t r o g e n , p e n y a k i t g i n j a l , h i p e r t e n s i v a s k u l a r r e n a l , h i p e r a l d o s t e r o n i s m e p r i m e r , d a n s i n d r o m c a s h i n g , f e o k r o m o s i t o m a , k o a r k t a s i o a o r t a , h i p e r t e n s i y a n g b e r h u b u n g a n d e n g a n k e h a m i l a n , d a n l a i n n y a . ( Y o g i a n t o r o , 2 0 0 6 ) .
C . P a t o f i s i o l o g i
M e k a n i s m e t e r j a d i n y a h i p e r t e n s i a d a l a h m e l a l u i t e r b e n t u k n y a a n g i o t e n s i n I I d a r i a n g i o t e n s i n I o l e h a n g i o t e n s i n c o n v e r t i n g e n z y m e ( A C E ) . A C E m e m e g a n g p c r a n f i s i o l o g i s p e n t i n g d a l a m m e n g a t u r t e k a n a n d a r a h . A n g i o t e n s i n o g e n y a n g d i h a s i l k a n o l e h h a t i d i u b a h o l e h h o r m o n r e n i n y a n g d i p r o d u k s i o l e h g i n j a l m e n j a d i a n g i o t e n s i n I . O l e h A C E y a n g t e r d a p a t d i p a r u - p a r u , a n g i o t e n s i n I d i u b a h m e n j a d i a n g i o t e n s i n I I . A n g i o t e n s i n I I i n i l a h y a n g m e m i l i k i p e r a n a n k u n c i d a l a m m e n a i k k a n t e k a n a n d a r a h m e l a l u i d u a a k s i u t a m a . A k s i p e r t a m a a d a l a h m e n i n g k a t k a n s e k r e s i h o r m o n a n t i d i u r e t i k ( A D H ) d a n r a s a h a u s . A D H d i p r o d u k s i d i h i p o t a l a m u s ( k e l e n j a r p i l u i t a r i ) d a n b e k e r j a p a d a g i n j a l u n t u k m e n g a t u r o s m o l a l i t a s d a n v o l u m e u r i n . d e n g a n m e n i n g k a t n y a A D H , s a n g a t s e d i k i t u r i n y a n g d i e k s k r e s i k a n k e l u a r t u b u h ( a n t i d i u r e s i s ) , s e h i n g g a m e n j a d i p e k a t d a n t i n g g i o s m o l a l i t a s n y a . U n t u k m e n g e n c c r k a n n y a , v o l u m e c a i r a n e k s t r a s e l u l e r a k a n d i t i n g k a t k a n d e n g a n c a r a m e n a r i k c a i r a n d a r i b a g i a n i n t r a s e l u l e r . A k i b a t n y a , v o l u m e d a r a h m e n i n g k a t y a n g p a d a a k h i m y a a k a n m e n i n g k a t k a n t e k a n a n d a r a h ( A n g g r e i n i A D , 2 0 0 9 ) .
9
m e m i l i k i p e r a n a n p e n t i n g p a d a g i n j a l . U n t u k m e n g a t u r v o l u m e c a i r a n e k s t r a s e l u l e r , a i d o s t e r o n a k a n m e n g u r a n g i c k s k r e s i N a C I ( g a r a m ) d e n g a n c a r a m e r e a b s o r p s i n y a d a r i t u b u l u s g i n j a l . N a i k n y a k o n s c n t r a s i N a C I a k a n d l c n c e r k a n k e m b a l i d e n g a n c a r a m e n i n g k a t k a n v o l u m e c a i r a n e k s t r a s e l u l e r y a n g p a d a g i i i r a n n y a a k a n m e n i n g k a t k a n v o l u m e d a n t e k a n a n d a r a h . P a t o g e n e s i s d a r i h i p e r t e n s i e s e n s i a l m e r u p a k a n m u l t i f a k t o r i a l d a n s a n g a t k o m p l e k . F a k t o r - f a k t o r t e r s e b u t m e r u b a h f u n g s i t e k a n a n d a r a h t e r h a d a p p e r f u s i j a r i n g a n y a n g a d e k u a t m e l i p u t i m e d i a t o r h o r m o n , a k t i v i t a s v a s k u l e r , v o l u m e s i r k u l a s i d a r a h , k a l i b e r v a s k u l e r . v i s k o s i t a s d a r a h , c u r a h j a n t u n g , e l a s l i s i t a s p e m b u l u h d a r a h d a n s t i m u l a s i n e u r a l . P a t o g e n e s i s h i p e r t e n s i e s e n s i a l d a p a t d i p i c u o l e h b e b e r a p a f a k t o r m e l i p u t i f a k t o r g e n e t i k , a s u p a n g a r a m d a l a m d i e t , t i n g k a t s t r e s s d a p a t b e r i n t e r a k s i u n t u k m c m u n c u i k a n g e j a i a h i p e r t e n s i . P e r j a l a n a n p e n y a k i t h i p e r t e n s i e s e n s i a l b e r k e m b a n g d a r i h i p e r t e n s i y a n g k a d a n g - k a d a n g m u n c u l m e n j a d i h i p e r t e n s i y a n g p e r s i s t e n . S e t e l a h p e r i o d e a s i m t o m a t i k y a n g l a m a , h i p e r t e n s i p e r s i s t e n b e r k e m b a n g m e n j a d i h i p e r t e n s i d e n g a n k o m p l i k a s i , d i m a n a k e r u s a k a n o r g a n t a r g e t d i a o r t a d a n a r t e r i k e c i l , j a n t u n g , g i n j a l , r e t i n a d a n s u s u n a n s a r a f p u s a t ( A n g g r e i n i A D , 2 0 0 9 ) .
D. Patofisiologi Hipertensi pada Lanjut Usia
10
P e n u r u n a n v o l u m e d a r a h d a n o u t p u t j a n t u n g d i s e r t a i k e k a k u a n a r t e r i b e s a r m e n y e b a b k a n p e n u r u n a n t e k a n a n d i a s t o l i k . L a n j u t u s i a d e n g a n h i p e r t e n s i s i s t o l i k d a n d i a s t o l i k o u t p u t j a n t u n g , v o l u m e i n t r a v a s k u l c r , a l i r a n d a r a h k e g i n j a l a k t i v i t a s p l a s m a r e n i n y a n g l e b i h r e n d a h d a n r e s i s t e n s i p e r i t c r ( l e m u I l m i a h G e r i a t r i S e m a r a n g , 2 0 0 8 ) .
P e r u b a h a n a k t i v i t a s s i s t e m s a r a f s i m p a t i k d e n g a n b e r t a m b a h n y a n o r e p l n c p h r i n m e n y e b a b k a n p e n u r u n a n t i n g k a t k e p e k a a n s i s t e m r e s e p t o r b e t a a d r e n e r g i k s e h i n g g a b e r a k i b a t p e n u r u n a n f u n g s i r e l a k s a s i o t o l p e m b u l u h d a r a h ( l e m u l l m i a h G e r i a t r i S e m a r a n g , 2 0 0 8 ) .
L a n j u t u s i a m e n g a l a m i k e r u s a k a n s t r u k t u r a l d a n f u n g s i o n a l p a d a a r t e r i b e s a r y a n g m e m b a w a d a r a h d a r i j a n t u n g m e n y e b a b k a n s e m a k i n p a r a h n y a p c n g c r a s a n p e m b u l u h d a r a h d a n t i n g g i n y a t e k a n a n d a r a h ( T e m u I l m i a h G e r i a t r i S e m a r a n g , 2 0 0 8 ) .
.2 Hypertensive Heart Disease
A. Definisi
Hypertensive heart disease a d a l a h s u a t u i s t i l a h y a n g d i g u n a k a n s e c a r a u m u m u n t u k p e n y a k i t j a n t u n g s e p e r t i h i p e r t r o p i v e n t r i k e l k i r i , p e n y a k i t a r t e r i k o r o n e r , a r i t m i a j a n t u n g , d a n g a g a l j a n t u n g k o n g e s t i f y a n g d i s e b a b k a n o l e h e f e k p e n i n g g i a n t e k a n a n d a r a h k r o n i s ( R i a z , 2 0 1 2 ) .
B. E t i o l o g i
n
C . Patofisiologi
P a l o t i s i o l o g i d a r i h y p e r t e n s i v e h e a r t d i s e a s e a d a l a h s a t u h a l k o m p l e k s y a n g m e l i b a t k a n b a n y a k F a k t o r y a n g s a l i n g m e m p e n g a r u h i , y a i t u h e m o d i n a m i k , s t r u k t u r a l , n c u r o c n d o k r i n , s e l u l e r . d a n f a k t o r m o l e k u l c r . D i s a t u s i s i , f a k t o r - f a k t o r i n i m e m e g a n g p e r a n a n d a l a m p e r k e m b a n g a n h i p e r t e n s i d a n k o m p l i k a s i n y a . d i s i s i l a i n p e n i n g k a t a n t e k a n a n d a r a h i t u s e n d i r i d a p a t m e m o d u l a s i f a k t o r - f a k t o r t e r s e b u t . P e n i n g k a t a n t e k a n a n d a r a h m e n y e b a b k a n p e r u b a h a n y a n g m e r u g i k a n p a d a s t r u k t u r d a n f u n g s i j a n t u n g m e l a l u i 2 c a r a y a i t u s e c a r a l a n g s u n g m e l a l u i p e n i n g k a t a n a f t e r l o a d d a n s e c a r a t i d a k l a n g s u n g m e l a l u i n u e r o h o r m o n a l t e r k a i t d a n p e r u b a h a n v a s k u l a r . L f e k h i p e r t e n s i t e r h a d a p j a n t u n g b e r b e d a - b c d a , p a d a j a n t u n g d a p a t t e r j a d i h i p c r t r o p i v e n t r i k e l k i r i , a b n o r m a l i t a s a t r i u m k i r i , p c n y a k i t k a t u p , g a g a l j a n t u n g , i s k e m i k m i o k a r d , d a n a r i t m i a k a r d i a . P a t o f i s i o l o g i b e r b a g a i e f e k h i p e r t e n s i t e r h a d a p j a n t u n g b e r b e d a - b e d a d a n a k a n d i j e l a s k a n p a d a b a g i a n i n i ( R i a z , 2 0 1 2 ) .
I . H i p e r t r o f i v e n t r i k e l k i r i
P a d a p a s i e n d e n g a n h i p e r t e n s i , 1 5 - 2 0 % m e n g a l a m i h i p c r t r o t i v e n t r i k e l k i r i ( H V K ) . R i s i k o H V K m e n i n g k a t d u a k a l i l i p a t p a d a p a s i e n o b e s i t a s . P r e v a l e n s i H V K b c r d a s a r k a n p e n e m u a n l e w a t R K G ( b u k a n m e r u p a k a n a l a t p e m e r i k s a a n y a n g s e n s i t i t ) p a d a s a a t m e n e g a k k a n d i a g n o s i s h i p e r t e n s i s a n g a t t a h b e r v a r i a s i . P e n e l i t i a n t e l a h m e n u n j u k k a n h u b u n g a n l a n g s u n g a n t a r a d c r a j a t d a n l a m a b e r l a n g s u n g n y a p e n i n g k a t a n t e k a n a n d a r a h d e n g a n H V K ( R i a z , 2 0 1 2 ) .
1 2
p e n i n g k a t a n a f t e r l o a d . R a n g s a n g a n m c k a n i k d a n n e u r o h o r m o n a l y a n g m e n y e r l a i h i p e r t e n s i d a p a t m e n y e b a b k a n a k t i v a s i p e r t u m b u h a n s e l - s e l o t o t j a n t u n g , e k s p r e s i g e n ( b e b e r a p a g e n d i b e r i e k s p r e s i s e c a r a p r i m e r d a l a m p e r k e m b a n g a n m i o s i t J a n i n ) , d a n H V K . S e b a g a i t a m b a h a n , a k t i v a s i s i s t e m r e n i n - a n g i o t e n s i n m e l a l u i a k s i a n g i o t e n s i n I I p a d a r e s e p t o r a n g i o t e n s i n I m e n d o r o n g p e r t u m b u h a n s e l - s e l i n t e r s t i s i a l d a n k o m p o n e n m a t r i k s e l . J a d i , p e r k e m b a n g a n H V K d i p e n g a r u h i o l e h h i p e r t r o f i m i o s i t d a n k e t i d a k s e i m b a n g a n a n t a r a m i o s i t d a n s t r u k t u r i n l e r s t i s l u m s k e l e t o n c o r d i s ( R i a z , 2 0 1 2 ) .
B e r b a g a i j e n i s p o l a H V K t e l a h d i j e l a s k a n , t e r m a s u k r e m o d e l i n g k o n s e n t r i k , H V K k o n s c n t r i k , d a n H V K e k s e n t r i k . H V K k o n s c n t r i k a d a l a h p e n i n g k a t a n p a d a k c t e b a l a n d a n m a s s a v e n t r i k e l k i r i d i s e r t a i p e n i n g k a t a n t e k a n a n d a n v o l u m e d i a s t o l i k v e n t r i k e l k i r i , u m u m n y a d i t e m u k a n p a d a p a s i e n d e n g a n h i p e r t e n s i . B a n d i n g k a n d e n g a n H V K e k s e n t r i k , d i m a n a p c n c b a l a n v c n t r i k e l k i r i t i d a k m e r a t a n a m u n h a n y a t c r j a d i p a d a s i s i t e r t e n t u , m i s a l n y a p a d a s e p t u m . L V H k o n s e n t r i k m e r u p a k a n p e r t a n d a p r o g n o s i s y a n g b u r u k p a d a k a s u s h i p e r e t e n s i . P a d a a w a l n y a p r o s e s H V K m e r u p a k a n k o m p e n s a s i p e r l i n d u n g a n s e b a g a i r e s p o n t e r h a d a p p e n i n g k a t a n t e k a n a n d i n d i n g v e n t r i k e l u n t u k m e m p e r t a h a n k a n c a r d i a c o u t p u t y a n g a d e k u a t , n a m u n H V K k e m u d i a n m e n d o r o n g t e r j a d i n y a d i s f u n g s i d i a s t o l i k o t o t j a n t u n g , d a n a k h i r n y a m e n y e b a b k a n d i s f u n g s i s i s t o l i k o t o t j a n t u n g ( R i a z , 2 0 1 2 ) .
2 . A b n o r m a l i t a s A t r i u m K i r i
13
p e n i n g k a t a n t e k a n a n a k h i r d i a s t o l i k v e n t r i k e l k i r i s e b a g a i t a m b a h a n u n t u k m e n i n g k a t k a n t e k a n a n d a r a h y a n g m e n y e b a b k a n g a n g g u a n p a d a f u n g s i a t r i u m k i r i d i t a m b a h p e n i n g k a t a n u k u r a n d a n p c n c b a l a n a t r i u m k i r i . P e n i n g k a t a n u k u r a n a t r i u m k i r i p a d a k a s u s h i p e r t e n s i y a n g t i d a k d i s e r t a i p e n y a k i t k a t u p j a n t u n g a t a u d i s f u n g s i s i s t o l i k m e n u n j u k k a n k r o n i s i t a s h i p e r t e n s i d a n m u n g k i n b e r h u b u n g a n d e n g a n b e r a t n y a d i s f u n g s i d i a s t o l i k v e n t r i k e l k i r i . S e b a g a i t a m b a h a n , p e r u b a h a n s t r u k t u r i n i m e n j a d i f a k t o r p r e d i s p o s i s i t e r j a d i n y a a t r i a l f i b r i l a s i p a d a p a s i e n - p a s i e n t e r s e b u t . A t r i a l f i b r i l a s i , d e n g a n h i l a n g n y a k o n t r i b u s i a t r i u m p a d a d i s f t i n g s i d i a s t o l i k , d a p a t m e m p e r c e p a t t e r j a d i n y a g a g a l j a n t u n g ( R i a z , 2 0 1 2 ) .
3 . P e n y a k i t K a t u p
H i p e r t e n s i y a n g k r o n i k d a n b e r a t d a p a t m e n y e b a b k a n d i l a t a s i c i n c i n k a t u p a o r t a , y a n g m e n y e b a b k a n t e r j a d i n y a i n s u t i s i e n s i a o r t a s i g n i f i k a n . B e b e r a p a d e r a j a t p e r u b a h a n p e r d a r a h a n s e c a r a s i g n i f i k a n a k i b a t i n s u f i s i e n s i a o r t a s e r i n g d i t e m u k a n p a d a p a s i e n d e n g a n h i p e r t e n s i y a n g t i d a k t e r k o n t r o l . P e n i n g k a t a n t e k a n a n d a r a h y a n g a k u t d a p a t m e n e n t u k a n d e r a j a t i n s u t i s i e n s i a o r t a , y a n g a k a n k e m b a t i k e d a s a r b i l a t e k a n a n d a r a h t e r k o n t r o l s e c a r a l e b i h b a i k . S e b a g a i t a m b a h a n , s e i a i n m e n y e b a b k a n r e g u r g i t a s i a o r t a , h i p e r t e n s i j u g a d i p e r k i r a k a n d a p a t m e m p e r c e p a t p r o s e s s k l e r o s i s a o r t a d a n m e n y e b a b k a n r e g u r g i t a s i m i t r a l ( R i a z , 2 0 1 2 ) .
4 . G a g a ! J a n t u n g
G a g a l j a n t u n g a d a l a h k o m p l i k a s i u m u m d a r i p e n i n g k a t a n t e k a n a n d a r a h y a n g k r o n i k . H i p e r t e n s i s e b a g a i p e n y e b a b g a g a l j a n t u n g k o n g e s t i f s e r i n g k a l i t i d a k d i k e t a h u i , s c b a g i a n k a r e n a
14
d i s f u n g s i t i d a k m a m p u m e n g h a s i l k a n t e k a n a n d a r a h y a n g t i n g g i , h a l i n i y a n g m e n j a d i p e n y e b a b g a g a l j a n t u n g t e r s e b u t . P r e v a l e n s i d i s f u n g s i d i a s t o l i k y a n g a s i m t o m a t i k p a d a p a s i e n d e n g a n h i p e r t e n s i d a n t a n p a H V K ( H i p e r t e n s i V e n t r i k e l K i r i ) a d a l a h s e k i t a r 3 3 % . P e n i n g k a t a n a f t e r l o a d y a n g k r o n i s d a n t e r j a d i n y a H V K d a p a t m e m b e r i p e n g a r u h b u r u k t e r h a d a p f a s e a w a l r e l a k s a s i d a n f a s e k o m p e n s a s i l a m b a t d a r i d i a s t o l i k v e n t r i k e l ( R i a z , 2 0 1 2 ) .
1 5
t e k a n a n d a r a h y a n g t i b a - t i b a d a p a t m e n y e b a b k a n e d e m a p a r u a k u t t a n p a p e r l u p e r u b a h a n p a d a f r a k s i e j e k s i v e n t r i k e l k i r i . S e c a r a u m u m , p e r k e m b a n g a n d i l a t a s i a t a u d i s f t i n g s i v e n t r i k e l k i r i y a n g a s i m t o m a t i k m a u p u n y a n g s i m t o m a t i k m e l a m b a n g k a n k c m u n d u r a n y a n g c e p a t p a d s t a t u s k l i n i s d a n m e n a n d a k a n p e n i n g k a t a n r i s i k o k e m a t i a n . S e b a g a i t a m b a h a n , s e i a i n d i s f u n g s i v c n t r i k e l k i r i , p c n c b a l a n d a n d i s f u n g s i d i a s t o l i k v e n t r i k e l k a n a n j u g a t e r j a d i s e b a g a i h a s i l d a r i p e n e b a l a n s e p t u m d a n d i s f u n g s i v e n t r i k e l k i r i ( R i a z , 2 0 1 2 ) .
5 . I s k e m i k M i o k a r d
P a s i e n d e n g a n a n g i n a m e m i l i k i p r e v a l e n s i y a n g t i n g g i t e r h a d a p h i p e r t e n s i . H i p e r t e n s i a d a l a h f a k t o r r i s i k o y a n g m e n e n t u k a n p e r k e m b a n g a n p e n y a k i t a r t e r i k o r o n e r , b a h k a n h a m p i r m e l i p a t g a n d a k a n r i s i k o . P e r k e m b a n g a n i s k e m i k p a d a p a s i e n d e n g a n h i p e r t e n s i b e r s i f a t m u l t i f a k t o r i a l ( R i a z , 2 0 1 2 ) .
H a l y a n g p e n t i n g p a d a p a s i c n d e n g a n h i p e r t e n s i , a n g i n a d a p a t t c r j a d i p a d a p a s i c n y a n g t i d a k m e n g a l a m i p e n y a k i t a r t e r i k o r o n e r c p i k a r d l u m . P e n i g k a t a n a f e r l o a d s e k u n d e r a k i b a t h i p e r t e n s i m e n y e b a b k a n p e n i n g k a t a n t e k a n a n d i n d i n g v e n t r i k e l k i r i d a n t e k a n a n t r a n s m u r a l , m e n e k a n a l i r a n d a r a h k o r o n e r s e l a m a d i a s t o l e . S e b a g a i t a m b a h a n , m i k r o v a s k u l a r , d i l u a r a r t e r i k o r o n e r e p i k a r d i u m , t e l a h t e r l l h a t m e n g a l a m i d i s f u n g s i p a d a p a s i e n d e n g a n h i p e r t e n s i d a n m u n g k i n t i d a k m a m p u m e n g k o m p e n s a s i p e n i n g k a t a n m c t a b o l i k d a n k c b u t u h a n o k s i g e n ( R i a z , 2 0 1 2 ) .
16
p e l e p a s a n n i t r i t o k s i d a y a n g m e r u p a k a n v a s o d i l a t o r p o t e n . P e n u r u n a n k a d a r n i t r i t o k s i d a m e n y e b a b k a n p e r k e m b a n g a n d a n m a k i n c e p a t n y a p e m b e n t u k a n a r t e r i o s k l e r o t i s d a n p l a k . G a m b a r a n m o r t o l o g i p l a k i d e n t i k d i b a n d i n g k a n d e n g a n p l a k y a n g d i t e m u k a n p a d a p a s i e n t a n p a h i p e r t e n s i ( R i a z , 2 0 1 2 ) .
6 . A r i t m i a k a r d i a
A r i t m i a k a r d i a u m u m n y a d i t e m u k a n p a d a p a s i c n d e n g a n h i p e r t e n s i y a n g m e n g a l a m i a r t e r i a l f i b r i l a s i k o n t r a k s i v e n t r i k e l y a n g p r e m a t u r d a n v e n t r i k u l e r t a k i k a r d i ( R i a z , 2 0 1 2 ) .
R e s i k o h e n l i j a n t u n g m e n d a d a k m e n i n g k a t . B e r b a g a i m e t a b o l i s m d i p c k i r a k a n m e m e g a n g p e r a n a n d a l a m p a t o g e n e s i s a r i t m i a t e r m a s u k p e r u b a h a n s t r u k t u r d a n m e t a b o l i s m e s e l , t i d a k h o m o g e n m i o k a r d , p e r f u s i y a n g b u r u k . f i b r o s i s m i o k a r d d a n t l u k t u a s i p a d a a f t e r l o a d . S e m u a f a k t o r t e r s e b u t d a p a t m e n y e b a b k a n p c n i n g k a t a n a n r e s i k o v c n t r i k e l t a k i a r i l m i a ( R i a z , 2 0 1 2 ) .
A r t r i a l f i b r i l a s i ( p a r o k s l s i m a l , k r o n i k r e k u r e n , a t a u k r o n i k p e r s i s t e n ) , s e r i n g d i t e m u k a n p a d a p a s i e n d e n g a n h i p e r t e n s i . F a k t a n y a , p e n i n g k a t a n t e k a n a n d a r a h m e r u p a k a n f a k t o r u m u m b a g i a r t r i a l f i b r i l a s i . P a d a s u a t u p e n e l i t i a n h a m p i r 5 0 % p a s i e n d e n g a n a r t r i a l t i b r i l a s i m e n g i d a p h i p e r t e n s i w a l a u p u n e t i o l o g i y a n g p a s t i t i d a k d i k e t a h u i , a b n o r m a l i t a s s t r u k t u r a t r i u m k i r i , p e n y a k i t a r t e r i k o r o n e r , d a n H V K t e l a h d i a n g g a p s e b a g i f a k t o r y a n g m u n g k i n b e r p e r a n . P e r k e m b a n g a n a r t r i a l f i b r i l a s i d a p a t m e n y e b a b k a n d i s f u n g s i s i s t o l i k d e k o m p e n s a t a . d a n y a n g l e b i h p e n t i n g , d i s f u n g s i d i a s t o l i k , m e n y e b a b k a n h i l a n g n y a k o n t r a k s i a t r i u m , d a n j u g a m e n i n g k a t k a n r e s i k o k o m p l i k a s i t r o m b o e m b o l i k , k h u s u s n y a s t r o k e ( R i a z . 2 0 1 2 ) .
17
d e n g a n H V K d a r i p a d a p a s i e n t a n p a H V K . P e n y e b a b a r i m i t m i a t e r s e b u t d i a n g g a p t e r j a d i b e r s a m a - s a m a d e n g a n p e n y a k i t a r t e r i k o r o n e r d a n f i b r o s i s m i o k a r d ( R i a z , 2 0 1 2 ) .
D. Faktor Resiko
F a k t o r r e s i k o p e n y a k i t p e n y a k i t k a r d i o v a s k u l e r p a d a h i p e r t e n s i a d a l a h s e b a g a i b e r i k u t :
I . U s i a
P r e v a l e n s i h i p e r t e n s i m e n i n g k a t s e i r i n g d e n g a n p e r u b a h a n u s i a . L e b i h d a r i 5 0 % p a d a o r a n g b e r u s i a 6 0 - 6 9 t a h u n d a n l e b i h d a r i 7 0 % p a d a u s i a 7 0 t a h u n a t a u l e b i h m e n d e r i t a h i p e r t e n s i . P r e v a l e n s i hypertensive heart disease j u g a m e n g i k u t i p o l a i n i y a n g j u g a a k a n d i p e n g a r u h i o l e h b e r a t n y a h i p e r t e n s i i t u s e n d i r i . P a d a p e n e l i t i a n R a m a C h a n d r a n S . V a s s a n , d k k p a d a
Framingham heart study d i t e m u k a n b a h w a s e s e o r a n g y a n g m e m i l i k i t e k a n a n d a r a h n o r m a l d a n t i n g g i ( t e k a n a n d a r a h s i s t o l i k 1 3 0 - 1 3 9 m m H g a t a u d i a s t o l i k 8 5 - 8 9 m m H g ) , m a k a p a d a u s i a 3 5 - 6 4 t a h u n s e t e l a h 1 0 t a h u n , i n s i d e n m e n d e r i t a p e n y a k i t k a r d i o v a s k u l e r s e k i t a r 4 % p a d a w a n i t a d a n 8 % p a d a p r i a , s e d a n g k a n p a d a s u b j e k y a n g b e r u s i a 6 5 - 9 0 t a h u n i n s i d e n p e n y a k i t k a r d i o v a s k u l e r i n i a k a n m e n i n g k a t p a d a k e d u a j e n i s k e l a m i n y a i t u 2 5 % p a d a w a n i t a d a n 1 8 % p a d a p r i a ( P a n g g a b e a n , 2 0 0 6 ) .
1 8
b e b e r a p a p e r u b a h a n f i s i o l o g i s s e p e r t i p e n i n g k a t a n r e s i s t e n s i p e r i f e r d a n a k t i v a s i a k t i v i t a s s i m p a t i k , p e n u r u n a n s e n s i t i v i t a s r e f l e k b a r o r e s e p t o r d a n p e r a n g i n j a l k a r e n a p e n u r u n a n a l i r a n d a r a h d a n l a j u t i l t r a s i g l o m e r u l u s p a d a g i n j a l ( P a n g g a b c a n , 2 0 0 6 ) .
2 . J e n i s k e l a m i n
D i b a w a h u s i a 5 5 t a h u n , p r e v a l e n s i h i p e r t e n s i l e b i h t i n g g i p a d a p r i a d a r i p a d a w a n i t a d a n a k a n l e b i h t i n g g i l a g i p a d a w a n i t a s e t e l a h u s i a 5 5 t a h u n . P e r e m p u a n r e i a l i f k e b a l t e r h a d a p h i p e r t e n s i s a m p a i u s i a s e t e l a h m e n o p a u s e d i l i n d u n g i o l e h h o r m o n e s t e r o g e n y a n g b e r p e r a n d a l a m m e n i n g k a t k a n k a d a r
Highl Density Lipoprotein ( H D L ) . K a d a r k o l e s t e r o l H D L y a n g t i n g g i m e r u p a k a n f a k t o r p c l i n d u n g d a l a m m e n c c g a h t e r j a d i n y a p r o s e s a t e r o s k l e r o s i s . L f c k p e r l i n d u n g a n e s t e r o g e n d i a n g g a p s e b a g a i p e n j e l a s a n a d a n y a i m u n i t a s w a n i t a p a d a u s i a p r e m e n o p a u s e ( P a n g g a b c a n . 2 0 0 6 ) .
3 . R i w a y a t k e l u a r g a
R i w a y a t k e l u a r g a d e n g a n p e n y a k i t j a n t u n g k a r d i o v a s k u l e r p r e m a t u r ( l a k i - l a k i k u r a n g d a r i 5 5 t a h u n , p e r e m p u a n k u r a n g d a r i 6 5 t a h u n ( P a n g g a b c a n , 2 0 0 6 ) .
4 . D e r a j a t H i p e r t e n s i
19
m e n g a l a m i p e n y a k i t k a r d i o v a s k u l e r d i b a n d i n g k a n d e n g a n s e s e o r a n g y a n g m e m i l i k i t e k a n a n d a r a h n o r m a l ( t e k a n a n d a r a h s i s t o l i k 1 2 0 - 1 2 9 m m H g a t a u t e k a n a n d a r a h d i a s t o l i 8 0 - 8 4 m m H g ) y a n g h a n y a m e m i l i k i r i s i k o m e n d e r i t a p e n y a k i t k a r d i o v a s k u l e r s e b e s a r 1,5 l i p a t p a d a w a n i t a d a n 1,3 k a l i l i p a t p a d a p r i a ( P a n g g a b e a n , 2 0 0 6 ) .
5 . M e r o k o k
M e r o k o k m e n y e b a b k a n p e n i n g g i a n t e k a n a n d a r a h . P e r o k o k b e r a t d a p a t d i h u b u n g k a n d e n g a n i n s i d e n h i p e r t e n s i m a l i g n a y a n g a k a n b e r l a n j u t m e n j a d i hypertensive heart disease.
M e r o k o k d a p a t m e r a n g s a n g p r o s e s a t e r o s k e l e r o s i s k a r e n a e f e k l a n g s u n g t e r h a d a p d i n d i n g a r t e r i . K a r b o n m o n o k s i d a d a p a t m e n y e b a b k a n h i p o k s i a j a r i n g a n a r t e r i , n i k o t i n m e n y e b a b k a n m o b i l i s a s i k a t c k o l a m i n y a n g d a p a t m c n a m b a h r e a k s i t r o m b o s i t d a n m e n y e b a b k a n k e r u s a k a n p a d a d i n d i n g a r t e r i . P a d a p e n e l i t i a n Framingham heart study t a h u n 2 0 0 8 d i t e m u k a n b a h w a l a k i - l a k i p e r o k o k m e m i l i k i r e s i k o p e n y a k i t k a r d i o v a s k u l e r s e b e s a r 3 , 3 % d a n p a d a w a n i t a p e r o k o k s e b e s a r 2 , 0 % ( V a s a n , 2 0 0 1 ) .
6 . D i s l i p i d e m i a
2 0
A t e r o s k e l e r o s i s a d a l a h p e n y a k i t k a r d i o v a s k u l e r y a n g p a l i n g e r a t k a i t a n n y a d e n g a n d i s l i p i d e m i a y a n g m e l i p u t i p r o s e s p a t o l o g i y a n g m e n y e b a b k a n d i s f u n g s i e n d o t h e l i a l a k i b a t r e t e n s i , a k u m u l a s i d a n o k s i d a s i l i p o p r o t e i n d i d i n d i n g a r t e r i . D i s i s i l a i n , p e n i n g k a t a n afterload a k i b a t h i p e r t e n s i m e n y e b a b k a n p e n i n g k a t a n t e k a n a n d i n d i n g d i n d i n g v e n t r i k e l k i r i d a n t e k a n a n t r a n s m u r a l . M e n e k a n a l i r a n d a r a h k o r o n e r s e l a m a d i a s t o l i k . S e b a g a i t a m b a h a n , m i k r o v a s k u l e r d i l u a r a r t e r i k o r o n e r e p i k a r d i u m . T e l a h t e r l i h a t m e n g a l a m i d i s f u n g s i p a d a p a s i e n d e n g a n h i p e r t e n s i d a n m u n g k i n t i d a k m a m p u m e n g k o m p e n s a s i p e n i n g k a t a n m e t a b o l i k d a n k e b u t u h a n o k s i g e n . K o m b i n a s i d a r i k e a d a a n d i a t a s a k a n m e m p e r c e p a t t e r j a d i n y a i s k e m i k a t a u i n f a r k m i o k a r d p a d a p e n d e r i t a h i p e r t e n s i y a n g b e r s a m a a n d e n g a n d i s l i p i d e m i a ( V a s a n , 2 0 0 1 ) .
7 . O b e s i t a s
O b e s i t a s s a n g a t b e r h u b u n g a n d e n g a n h i p e r t e n s i . S e k i t a r 6 0 -7 0 % p e n d e r i t a h i p e r t e n s i j u g a m e n g a l a m i o b e s i t a s . B e b e r a p a s t u d i t e l a h m e n g e v a l u a s i b a h w a i n d e k s m a s s a t u b u h m e r u p a k a n s a l a h s a t u f a k t o r r i s i k o t e r j d i n y a remodeling
v e n t r i k e l k i r i d a n g a g a l j a n t u n g . P e n e l i t i a n y a n g d i l a k u k a n S a t i s h K e n c a h i a h , d k k p a d a t a h u n 2 0 0 2 d i p e r o l e h h a s i l b a h w a r i s i k o t e r j a d i n y a g a g a l j a n t u n g a k a n m e n i n g k a t 5 % p a d a l a k i
2 1
8 . D i a b e t e s M e l i t u s
S e k i t a r 5 0 % p e n d e r i t a h i p e r t e n s i e s e n s i a l j u g a m e n g a l a m i r e t e n s i i n s u l i n . D i k e t a h u i i n s u l i n sensitisizer s e p e r t i agonist of perioxisome proliferutur activator receptor gamma d a p a t m c n u r u n k a n l e k a n a n d a r a h . S e l a n j u t n y a h i p e r i n s u l i n e m i a m e r u p a k a n p r e d i k t o r p e n t i n g d a l a m m e n i n g k a t k a n k c t e b a l a n t u n i k a i n t i m a d a n m e d i a p a d a p a s i e n d e n g a n h i p e r t e n s i y a n g m e n y e b a b k a n p e n y a k i t j a n t u n g k o r o n e r s e h i n g g a m e n g i n d i k a s i k a n p e n i n g k a t a n r i s i k o p e n y a k i t k a r d i o v a s k u l a r p a d a p e n d e r i t a . I l a s i l Framingham heart study p a d a t a h u n 2 0 0 8 d i t e m u k a n b a h w a p e n y a k i t d i a b e t e s p a d a l a k i - l a k i a k a n m e m i l i k i r i s i k o s e b e s a r 2 , 8 % d a n p a d a w a n i t a s e b e s a r 2 , 4 % u n t u k t e r j a d i n y a p c n y a k i t k a r d i o v a s k u l e r ( V a s a n , 2 0 0 1 ) .
9 . K u r a n g n y a a k t i v i t a s f i s i k
S t u d i e p i d e m i o l o g i y a n g d i l a k u k a n o l e h S h a r i S . B a s s u k i d a n J o A n n E . M a n s o n d i U S A m c n u n j u k k a n b a h w a a t i v i l a s t i s i k m i n i m a l 3 0 m e n i t p e r h a r i d a p a t m c n u r u n k a n r i s i k o p e n y a k i t j a n t u n g k o r o n e r s e b e s a r 3 0 - 5 0 % . M e k a n i s m e p r o t e k t i f d a r i a k t i v i t a s t l s i k i n i m e l i p u t i p e n u r u n a n b e r a t b a d a n , m c n u r u n k a n r e s i s t e n s i i n s u l i n , h i p e r t e n s i , d i s l i p i d e m i a a t e r o g e n i k , i n f l a m a s i . d a n m e n i n g k a t k a n s e n s i t i v i t a s i n s u l i n , k o n t r o l g l i k e m i k d a n f u n g s i f i b r i n o l i t i k d a n e n d o t h e l i a l ( P a n g g a b e a n , 2 0 0 6 ) .
Diagnosis
I . G e j a i a d a n l a n d a - T a n d a K l i n i k
G e j a i a d a n t a n d a - t a n d a f i s i k hypertensive heart disease
t e r g a n t u n g d a r i d u r a s i . t i n g k a t k c p a r a h a n d a n t i p e d a r i p e n y a k i l n y a s e n d i r i . S e b e l u m m e n e g a k k a n d i a g n o s i s
2 2
h i p e r t e n s i s e k u n d e r . B e r i k u t i n i a k a n d i t u l i s k a n g e j a i a d a n t a n d a t l s i k p a d a hypertensive heart disease.
a. G a g a l j a n t u n g
D i a g n o s i s g a g a l j a n t u n g k o n g e s t i f d a p a t d i t e g a k k a n b e r d a s a r k a n k r i t e r i a F r a m i g h a m s e p e r t i b e r i k u t :
K r i t e r i a m a y o r
1 ) P a r o k s i m a l n o k t u r a l d i p s n e a 2 ) D i s t e n s i v e n a l e h e r
3 ) R o n k i p a r u 4 ) K a r d i o m c g a l i 5 ) E d e m a p a r u a k u t 6 ) G a l l o p S 3
7 ) P e n i n g g i a n t e k a n a n v e n a j u g u l a r i s 8 ) R c f l u k s h c p a t o j u g u l a r
K r i t e r i a m i n o r
1 ) E d e m a c k s t r e m i t a s 2 ) B a t u k m a l a m h a r i 3 ) D i s p n e a d ' e t T o r t 4 ) H e p a t o m e g a l i 5 ) E f u s i p l e u r a
6 ) P e n u r u n a n k a p a s i t a s v i t a l p a r u 1/3 d a r i n o r m a l 7 ) r a k i k a r d i a ( > 1 2 0 / m e n i t )
M a y o r a t a u m i n o r
P e n u r u n a n b e r a t b a d a n > 4 , 5 k g d a l a m 5 h a r i p e n g o b a t a n .
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K l a s i f i k a s i f u n g s i o n a l d a r i The New York Heart Association ( N Y H A ) b i a s a n y a d i g u n a k a n u n t u k m e n y a t a k a n
h u b u n g a n a n t a r a a w i t a n g e j a i a d a n d e r a j a t l a t i h a n fisik. ( P a n g g a b e a n , 2 0 0 6 )
T a b e l 3 . K l a s i f i k a s i F u n g s i o n a l G a g a l J a n t u n g N Y H A
Kelas Gejaia
K e l a s 1 T i d a k a d a b a t a s a n a k t i v i t a s fisik K e l a s 11 S e d i k i t b a t a s a n p a d a a k t i v i t a s ( r a s a
l e l a h , d i s p n e a )
K e l a s I I I B a t a s a n a k t i v i t a s b e r m a k n a ( n y a m a n s a a t i s t i r a h a t n a m u n s e d i k i t a k t i v i t a s m e n y e b a b k a n g e j a i a )
K e l a s I V G e j a i a s a a t i s t i r a h a t
Sumber: Panggabcan, 2006
b . I s k e m i a M i o k a r d
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k o r o n e r a k u t s e p e r t i m i o k a r d i n f a r k d e n g a n S T e l e v a s i a t a u m i o k a r d i n f a r k t a n p a S T c i c v a s i ( P r i n s a n t , 2 0 0 5 ) .
c. A r i t m i a
A r i t m i a j a n t u n g d a p a t m e n y e b a b k a n b e r b a g a i g e j a i a s e p e r t i p a l p i t a s i , s i n k o p . fibrilasi a t r i u m , v e n t r i k u l a r t a k i k a r d i d a n s u d d e n c a r d i a c d e a t h ( P r i n s a n t , 2 0 0 5 ) .
2 . T e s L a b o r a t o r i u m
B e r d a s a r k a n r e k o m e n d a s i J N C V I I . p e m e r i k s a a n l a b o r a t o r i u m y a n g p e r l u d i l a k u k a n s e b e l u m m e m u l a i p e n g o b a l a n h i p e r t e n s i m e l i p u t i u r i n a l i s i s , g l u k o s a d a r a h d a n h e m a t o k r i t , p o t a s s i u m s e r u m , k r e a t i n i n , k a l s i u m d a n p r o f i l l i p i d ( s e t e l a h 9 - 1 2 j a m p u a s a ) m e l i p u t i k a d a r k o l e s t e r o l t o t a l , L D L , H D L , d a n t r i g l i s c r i d a . T e s l a b o r a t o r i u m y a n g l e b i h e k s t e n s i f d a p a t d i l a k u k a n b a g i p a s i e n d e n g a n h i p e r t e n s i r e s i s t a n . P e n g o b a t a n y a n g n y a t a a t a u k e t i k a e v a l u a s i k l i n i s m c n u n j u k k a n b e n t u k h i p e r t e n s i s e k u n d e r . S e i a i n p e m e r i k s a a n l a b o r a t o r i u m u n t u k h i p e r t e n s i , j u g a p e r l u d i l a k u k a n p e m e r i k s a a n k i m i a d a r a h u n t u k p c n y a k i t j a n t u n g s e p e r t i C K M B , C K , L D H , S C O T , S G P T ( B a s h a , 1 9 9 8 ) .
3. R a d i o l o g i
P o t o t o r a k s A P s a n g a t p e n t i n g d i l a k u k a n p a d a p e n d e r i t a
hypertensive heart disease u n t u k m e i i h a t p e r u b a h a n - p e r u b a h a n p a d a j a n t u n g a k i b a t h i p e r t e n s i y a n g t i d a k t e r k o n t r o l .
T a n d a - t a n d a r a d i o l o g i s hypertensive heart disease s e b a g a i b e r i k u t :
2 5
b . P a d a k e a d a a n l a n j u t , a p e k s j a n t u n g m e m p e r b e s a r k e k i r i d a n k e b a w a h .
c. A o r t i c k n o b m e m p e r b e s a r d a n m e n o n j o l d i s e r t a i k a l s i f i k a s i . d . A o r t a a s c e n d e n d a n d e s c e n d e n m e l e b a r d a n b e r k e l o k y a n g
d i s e b u t p e m a n j a n g a n a o r t a .
e. T a n d a - t a n d a b e n d u n g a n p e m b u l u h p a r u p a d a s t a d i u m p a y a h
