SKRIPSI AMELIA INDRI HAPSARI STUDI PENGGUNAAN BISOPROLOL PADA PASIEN GAGAL JANTUNG (Penelitian di Instalasi Rawat Inap RSUD Sidoarjo)
PROGRAM STUDI FARMASI FAKULTAS ILMU KESEHATAN UNIVERSITAS MUHAMMADIYAH MALANG 2016
DAFTAR SINGKATAN ACC ACEI AF AHA ARB AT1 AT2 ATP
: American College of Cardiology : Angiotensin Converting Enzyme Inhibitor : Atrial Fibrilation : America Heart Association : Angiotensin Receptor Bloker : Angiotensin Tipe 1 : Angiotensin Tipe 2 : Adenosin triphospat : Beta Blocker BNP : B-type natriuretic peptide BUN : Blood Urea Nitrogen CAD : Coronary Arthery Disease CIBIS : Ardiac Insufficiency Bisoprolol Study Cl : Klorida CO : Cardiac Output CVD : Cardiovascular CVDs : Cardiovascular Diseases Depkes: Departemen Kesehatan DM : Diabetes Melitus ECG : Electrocardiography ECHO: Echocardiography EDV : End Diastole Volume et al : Et Alii GD2P : Gula darah 2 jam Postprandial GDP : Gula Darah Puasa GDS : Gula Darah Sesaat GFR : Glomerular Filtration Rate Hb : Hemoglobin HERS : Heart dan Estrogen / Progestin Replacement Study HDL : High Density Lipoprotein HF : Heart Failure HHF : Hypertension Heart Disease HR : Hate Rate HT : Hipertensi ISDN : Isosorbid Dinitrat Iv : Intravena Ipm : Liter per menit LV : Left Atrium LVED : Left Ventricle End-Diastolic LVEF : Left Ventricle Ejection Fraction K+ : Kalium KRS : Keluar Rumah Sakit LPD : Lembar Pengumpulan Data mcg : microgram MmHg : Millimeter Hydragyrum MRS : Masuk Rumah Sakit
Na+ : Natrium NYHA : New York Heart Association O2 : Oksigen Po : Per Oral PJK : Penyakit Jantung Koroner RAA : Renin-Angiotensin-Aldosteron RAAS : Renin- Angiotensin-Aldosteron System RR : Respiratory Rate RV : Right Ventricle RMK : Rekam Medis Kesehatan RSUD : Rumah Sakit Umum Daerah SGPT : Serum Glutamic Pyruvic Transminase SGOT : Serum Glutamic Oxaloacetic Transminase WHO : Word health Organization
DAFTAR ISI Halaman HALAMAN JUDUL ...................................................................................... i LEMBAR PENGESAHAN ............................................................................. ii LEMBAR PENGUJIAN ................................................................................ iii KATA PENGANTAR .................................................................................... iv RINGKASAN ................................................................................................ vi ABSTRACT ................................................................................................... viii ABSTRAK .................................................................................................... ix DAFTAR ISI .................................................................................................. x DAFTAR TABEL .......................................................................................... xiii DAFTAR GAMBAR ...................................................................................... xiv DAFTAR LAMPIRAN ................................................................................... xv DAFTAR SINGKATAN ................................................................................ xvi
BAB I PENDAHULUAN .............................................................................. 1 1.1. Latar Belakang Masalah .................................................................. 1 1.2. Rumusan Masalah ........................................................................... 4 1.3. Tujuan Penelitian............................................................................. 4 1.4. Manfaat Penelitian ........................................................................... 4 BAB II TINJAUAN PUSTAKA ................................................................... 5 2.1. Tinjauan Tentang Definisi Gagal Jantung ....................................... 5 2.2. Tinjauan Epidemiologi Gagal Jantung ........................................... 5 2.3. Etiologi Gagal Jantung .................................................................. 6 2.3.1 Gangguan Primer Gagal Jantung ......................................... 7 2.3.1.1 Disfungsi Miokard ................................................... 7 2.3.1.2 Overload Volume .................................................... 7 2.3.1.3 Aterosklerosis.......................................................... 7 2.3.1.4 Aritmia ..................................................................... 7 2.3.1.5 Overload Tekanan ................................................... 8 2.3.1.6 Faktor Sistemik ........................................................ 8 2.4. Klasifikasi Gagal Jantung .............................................................. 8
2.5. Macam-Macam Gagal Jantung....................................................... 9 2.5.1 Gagal Jantung Akut- Kronik ............................................... 9 2.5.2 Gagal Jantung Kanan Kiri ................................................... 9 2.5.3 Gagal Jantung Sistolik Diastolik ......................................... 9 2.6
Faktor Resiko Gagal Jantung ........................................................ 9 2.6.1 Faktor yang tidak dapat dirubah .......................................... 10 2.6.2 Faktor yang dapat dirubah ................................................... 11
2.7.
Patofisiologi Gagal Jantung .......................................................... 12 2.7.1 Mekanisme Fisiologi Gagal Jantung.................................... 13 2.7.1.1 Preload (Beban awal) .............................................. 13 2.7.1.2 Kontraktilitas........................................................... 14 2.7.1.3 Afterload (beban akhir) ........................................... 14
2.8.
Mekanisme Kompensasi Pada Gagal Jantung ................................ 14 2.8.1 Peningkatan Aktivitas Adregenik Simpatik ......................... 15 2.8.2 Aktivasi System Renin-Angiontensin Aldosteron................ 16
2.9.
2.8.3
Hipertrofi Ventrikel ........................................................... 18
2.8.4
Hukum Frank Starling ......................................................... 20
Manifestasi Klinis .......................................................................... 22
2.10 Diagnosa dan Pemeriksaan Fisik Gagal Jantung ........................... 22 2.10.1 Pemeriksaan Elektrodiagram(EKG) ........................... 23 2.10.2 Pemeriksaan Rontgen ................................................. 23 2.10.3 Pemeriksaan Echocardiography (ECHO) ................... 26 2.10.4 Pemeriksaan Laboratorium ........................................ 23 2.10.4.1 BNP atau NT-pro BNT............................................ 24 2.11. Penata Laksanaan Terapi ............................................................. 24 2.12 Terapi Gagal Jantung ..................................................................... 24 2.12.1 Dieuretik .......................................................................... 24 2.12.2 ACEI ............................................................................... 25 2.12.3 Angiotensin Reseptor Blocker (ARB) ............................. 26 2.12.4 Antagonis Aldosteron....................................................... 26 2.12.5 Calcium Chanel Blocker ................................................... 27 2.12.6 Beta Blocker ..................................................................... 27
2.12.6.1 Tinjauan Bisoprolol ............................................. 34 2.12.7 Glikosida Digitalis ............................................................ 30 2.12.8 Nitrat dan Hydralazine ..................................................... 34 BAB III
KERANGKA KONSEPTUAL ....................................................... 35
3.1. Kerangka Konseptual .................................................................... 35 3.2
Kerangka Operasional .................................................................. 36
BAB IV
METODE PENELITIAN ............................................................ 37
4.1. Rancangan Penelitian .................................................................... 37 4.2. Populasi Sampel ............................................................................ 37 4.3. Kriteria Data Inklusi .................................................................... 37 4.4. Kriteria Data Eksklusi.................................................................... 38 4.5. Bahan Penelitian ........................................................................... 38 4.6. Instrumen Penelitian ..................................................................... 38 4.7. Tempat dan Waktu ....................................................................... 38 4.8. Definisi Operasional ...................................................................... 38 4.9. Metode Pengumpulan Data ............................................................ 40 4.10. Analisis Data ................................................................................. 40 BAB V HASIL PENELITIAN ..................................................................... 5.1 Data Demografi Pasien .................................................................... 42 5.1.1 Jenis kelamin ................................................................................ 42 5.1.2 Usia Pasien ................................................................................... 42 5.2 Faktor Resiko Terdiagnosis Gagal Jantung ......................................... 43 5.3 Penggunaan Terapi pada pasien Gagal Jantung ................................... 43 5.3.1 Pola penggunaan Bisoprolol dan Kombinasi pada Gagal Jantung 44 5.4 Lama Perawatan Pasien ...................................................................... 48 5.6 Kondisi Keluar Rumah Sakit ............................................................. 48 BAB VI PEMBAHASAN ............................................................................. 49 BAB VII KESIMPULAN DAN SARAN ..................................................... 58 DAFTAR PUSTAKA ................................................................................... 59 LAMPIRAN ................................................................................................. 63
DAFTAR TABEL II.1 Penyebab gagal jantung ................................................................................... 6 II.2 Klasifikasi gagal jantung menurut fungsi NYH ............................................... 8 II.3 Penatalaksana terapi menurut kelas NYH ....................................................... 24 II.4 Dosis β-bloker yang digunakan pada terapi gagal jantung ................................ 32 II.5 Beta Bloker yang digunakan untuk Gagal Jantung ........................................... 32 II.6 Sediaan Bisoprolol di Indonesia....................................................................... 32 V.1 Faktor resiko terdiagnosis gagal jantung .......................................................... 36 V.2 Penggunaan terapi Bisoprolol pada pasien gagal jantung ................................. 36 V.3 Pola penggunaan Bisoprolol ............................................................................ 36
DAFTAR GAMBAR 2.1 Gagal jantung .................................................................................................. 5 2.2 Prevalensi Gagal Jantung di USA berdasarkan usia dan jenis kelamin ............. 10 2.3 Cardiak output ................................................................................................ 13 2.4 Mekanisme kompensasi ................................................................................. 15 2.5 Sistem Renin Angiotensin .............................................................................. 17 2.6 Hipertropi concentric dan eccentric ................................................................. 19 2.7 Konsep remodeling kardiak terkait disfungi jantung pada kasus gaga .............. 20 2.8 Patofisiologi Gagal Jantung ............................................................................. 21 2.9 Manifestasi Gagal Jantung ............................................................................... 22 3.1 Kerangka Konseptual Studi Penggunaan Obat pada Pasien Gagal Jantung ...... 35 3.2 Kerangka Operasional Pada Pasien Gagal Jantung……………………………. 36 5.1 Skema Kriteria Inklusi dan Eklusi penelitian gagal jantung .............................. 34 5.2 Jenis kelamin pasien gagal jantung dengan terapi Bisoprolol ............................ 35 5.3 Usia pasien gagal jantung dengan Terapi Bisoprolol......................................... 35 5.5 Lama perawatan pasien dengan terapi Bisoprolol ............................................. 41 5.6 Kondisi Keluar Rumah Sakit ............................................................................ 41
DAFTAR LAMPIRAN LAMPIRAN Halaman LAMPIRAN 1 Daftar Riwayat Hidup LAMPIRAN 2 Surat Pernyataan LAMPIRAN 3 Surat Ijin Penelitian LAMPIRAN 4 Lembar Pengumpulan Data LAMPIRAN5 Lembar Data induk
63 64 65 66 73
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