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NamaNama : Prof. Dr. H. Djanggan Sargowo: Prof. Dr. H. Djanggan Sargowo, dr.,, dr., SpPDSpPD..,, SpJP(K),SpJP(K),
FIHA, FACCFIHA, FACC,, FESC,FESC, FCAPC, FASCCFCAPC, FASCC
empa!"g# #a$%r empa!"g# #a$%r : Sragen, &1 Sep!em'er 1*: Sragen, &1 Sep!em'er 1*
A#ama!A#ama! : +%#% Inda$ E-1 /a#ang, e#p. 01-&0: +%#% Inda$ E-1 /a#ang, e#p. 01-&0Pend%d%2anPend%d%2an ::
1.1. 34#4 Do2!er dar% 56/, !a$4n 1*34#4 Do2!er dar% 56/, !a$4n 1*
&.&. 34#4 Card%o#og%! dar% 5n%7. Indone%a, !a$4n 18034#4 Card%o#og%! dar% 5n%7. Indone%a, !a$4n 180
0.0. 34#4 In!ern%! dar% 5n%7. A%r#angga, !a$4n 18934#4 In!ern%! dar% 5n%7. A%r#angga, !a$4n 189
.. 34#4 Do2!or, 5n%7. A%r#angga, !a$4n 1934#4 Do2!or, 5n%7. A%r#angga, !a$4n 19
.. Ad7aned Card%o#og; Co4re, 5n%7. Hong2ong, !a$4n 18Ad7aned Card%o#og; Co4re, 5n%7. Hong2ong, !a$4n 189.9. Sen%or a;a
0.0. Ke!4a PE>KI Ca'ang /a#ang >a;aKe!4a PE>KI Ca'ang /a#ang >a;a
.. Anggo!a Ko#eg%4m Kard%o7a24#er Indone%aAnggo!a Ko#eg%4m Kard%o7a24#er Indone%a
.. De2an Fa2. Kedo2!eran 5De2an Fa2. Kedo2!eran 5n%7.n%7. ++%ja;a%ja;a KK44ma S4ra'a;a44ma S4ra'a;a9.9. Ke!4a Dewan Pen awa >4ma$ Sa2%! Pend%d%2anKe!4a Dewan Pen awa >4ma$ Sa2%! Pend%d%2an
Curriculum VitaeCurriculum Vitae
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CAPITA SELECTA
FAKULTAS KEDOKTERAN UNIVERSITAS WIJAYA KUSUMA
FAKULTAS KEDOKTERAN UNIVERSITAS WIJAYA KUSUMA
Djanggan SargowoDjanggan Sargowo
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Doctor-Patient relationship:
Empa!$; : the ability to recognize and to some extent share the emotions and
states of mind of another and to understand the meaning and significance of
that person's behavior. Empathy is different from ;mpa!$; in that to be empathetic one
understands how the person feels rather than actually experiencing those
feelings, as in sympathy.
Patient: human being mimics
feelings
ppreciate or honor each other
honest may be positive ! "egative
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Doctor-Patient Relationship
Interaction
#y feelings#y feelings
affect myaffect my
behaviour behaviour
#y behaviours#y behaviours
affect patient$saffect patient$s
feelingsfeelings
Patient$s behaviourPatient$s behaviour
affect my feelingsaffect my feelings
Patient$s feelingsPatient$s feelingsaffect theiraffect their
diseasesdiseases
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Examination of patientExamination of patient the central pointthe central point needs scientific bac%groundneeds scientific bac%ground
Phase & :Phase & : namnesis namnesis
Physical notes Physical notes (ata recording (ata recording
"eeds patience, discipline, sensitive, curious"eeds patience, discipline, sensitive, curious
Phase && :Phase && : (ata analysis (ata analysis
&ntegrating data &ntegrating data
(iagnosis, Prognosis, Process, (iagnosis(iagnosis, Prognosis, Process, (iagnosis
Phase &&& :Phase &&& : # anagement# anagement
)reatment )reatment*onsideration, experience, advice*onsideration, experience, advice
++Primum "on "ocerePrimum "on "ocere
(o "o -arm /Pertama 0angan mela%u%an tinda%an yang merugi%an.(o "o -arm /Pertama 0angan mela%u%an tinda%an yang merugi%an.
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$e Card%o7a4#ar Da!a =ae
1. Pa!%en! $%!or;
&. P$;%a# e?am%na!%on
0. E#e!roard%ogram
. C$e! @-ra;
. >o4!%ne '#ood e?am
9. Add%!%ona# e!:
1. wo-d%men%ona# e$oard%ograp$; w%!$ Dopp#er !4d%e
&. E?er%e !readm%# EC6 !e!0. Am'4#a!or; Ho#!er /on%!or%ng
. N4#ear %mag%ng
. Card%a a!$e!er%a!%on
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C#a%f%a!%on of Common Hear! D%eae
(aord%ng !o !$e a4e)
2 *ardiovascular malformations congenital heart
disease
3 &nvolving the valve, heart structure, and other large vessels,
etc.2 c4uired heart disease
3 rtery thrombosis disease : leading to ischemia or infarction,
such as coronary heart disease
3 5heumatic heart disease: heart inflammation, valvulardisease
2 -ypertension: primary, hypertensive heart disease
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C#a%f%a!%on of Common Hear! D%eae
(aord%ng !o !$e a4e)
2 AB4%red $ear! d%eae 3 p4#monar; and p4#monar;-7a4#ar $ear!
d%eae: p4#monar; $ear! d%eae, p4#monar;
$;per!en%on, p4#monar; em'o#%m, e!.
3 Infe!%on: 'a!er%a, 7%r4e %n7ade !$e $ear!
3 D%eae of o!$er ;!em %n7o#7e !$e
$ear!: $;per!$;ro%d%m, anem%a, ma#n4!r%!%on,
%mm4ne a'norma#%!%e, p$;%a# and $em%a#damage, men!a# fa!or, e!.
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C#a%f%a!%on of Common Hear! D%eae
(aord%ng !o pa!$o#og; )
2 Endoard%a# d%eae 3 Endoard%!%, 7a#74#ar d%eae, e!.
2 /;oard%a# d%eae
3 Inf#amma!%on, %$em%a or nero%, $;per!rop$;,f%'ro%, damage, e!.
2 6rea! 7a4#ar d%eae 3 A!$ero#ero%, d%e!%on, %nf#amma!%on, !$rom'o%,
ang%oma, em'o#%m, e!.
2 Per%ard%4m d%eae 3 Inf#amma!%on, p#o! (ga, wa!er, '#ood, p4, e!),
oar!a!%on, e!.
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C#a%f%a!%on of Common Hear! D%eae
(aord%ng !o pa!$op$;%o#og; )
2 Hear! Fa%#4re 3 3ef! $ear!, r%g$! $ear! a4!e, $ron% ;!o#%,
d%a!o#%
2 S$o22 D;f4n!%on of oronar; %r4#a!%on2 Pap%##ar; m4#e d;f4n!%on 2 Arr$;!$m%a
2 Card%a !amponade 2 !$er: $%g$ or #ow '#ood pre4re (of ;!em% or
p4#monar; 7a4#ar), $4n!, e!.
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Forma! of Hear! D%eae D%agno%
2 E!%o#og%a# d%agno% 3 S4$ a r$e4ma!% $ear! d%eae, oronar;
ar!er; d%eae
2 Pa!$o#og%a# or ana!om%a# d%agno% 3 S4$ a m%!ra# !eno%
2 Pa!$op$;%o#og; d%agno%
3 S4$ a $ear! fa%#4re, a!r%a# f%'r%##a!%on,p4#monar; $;per!en%on
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/e!$od of Card%o7a4#ar D%eae
D%agno%
2 Pa!%en! $%!or; 3 preen! $%!or;, pa! $%!or;, perona# $%!or;,
!$e $%!or; of 4rger;, 7a%na!%on $%!or;,marr%age and prorea!%on, fam%#; $%!or;, e!.
2 P$;%a# e?am%na!%on 3 S;mp!om and %gn
2 3a'ora!or; e?am%na!%on 3 =#ood, 4r%ne, faee, ero4 eff4%on (from
per%ard%a# eff4%on), p4!4m, '%op;, e!.
2 EB4%pmen! %npe!%on 3 @-ra;, 4#!rao4nd (e$oard%ograp$;),
e#e!roard%grap$;, rad%on4#%de, ang%ograp$;,e!.
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E7a#4a!%on of !$e /e!$od %n
Card%o7a4#ar D%eae D%agno%
2 H%!or; and p$;%a# e?am%na!%on
3 'a% 2%##, f%r!-$and %nforma!%on, man;
d%eae an 'e d%agnoed !$ro4g$ !$%
2 3a'ora!or; e?am%na!%on 3 /o! 4ppor!%7e, '4! ome an 'e 4ed !o ma2e
a def%n%!e d%agno%, 4$ a m;oard%a#
nero% mar2er, =NP, e!.
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E7a#4a!%on of !$e /e!$od %n
Card%o7a4#ar D%eae D%agno%
2 EB4%pmen! %npe!%on
3 /ajor me!$od for ard%o7a4#ar d%eae d%agno%,
D%7%ded %n!o %n7a%7e and non-%n7a%7e me!$od.
3 non-%n7a%7e me!$od an ea%#; 'e aep!ed '; pa!%en!,and % afe, $owe7er, !$e %nforma!%on ma; 'e #%m%!ed
(eg. EC6, e$oard%ograp$;)
3 In7a%7e me!$od: !$e oppo%!e !o non-%n7a%7e one (eg.
Card%a a!$e!er%a!%on) 3 Sem%-%n7a%7e e?am%na!%on, 4$ a !$oe 7%a !$e
eop$ag4 eg. )ransesophageal echocardiography
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Basic skillBasic skill
Inpe!%on: S2%n, m4oae, mo7emen! of
$e! wa##Pa#pa!%on : - Sen%!%7%!; of !$e $and"f%nger
- /4#e !one
- 4mor
Per4%on : Sonor, d4#ne, !%mpan%A44#!a!%on : So4nd"
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Problem Oriented Medical Record
P/> % or%en!ed !o pro'#em
1.=ae#%ne da!a
&.Pro'#em #%!0.Pro'#em or%en!ed med%a# reord
.S4mmar; of pro'#em
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Common symptoms and signs related toCardiovascular problem
! Chest pain"! Dyspnea#! Syncope$! Palpitations
%! Lo&er e'tremity edema(! )eart murmur*! )ypertension+! ,ever associated &ith cardiac symptoms and
signs
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C$e! Pa%n
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Dierential diagnosis o chest pain
S;!em %n7o#7ed Pa!$o#og;
Card%a /;oard%a# %nfar!%on
Ang%na pe!or%Per%ard%!%Pro#ape of !$e m%!ra# 7a#7eamponade
ep%ra!or; (a## !end !o g%7e r%e !op#e4r%!% pa%n)
P4#monar; em'o#4Pne4mon%aPne4mo!$ora?P4#monar; neop#am
6a!ro%n!e!%na# Eop$ag%!% d4e !o ga!r% ref#4?Eop$agea# !ear Pep!% 4#er =%#%ar; d%eaePanrea!%!%
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Dierential diagnosis o chest pain
S;!em %n7o#7ed Pa!$o#og;
/44#o2e#e!a# Cer7%a# ner7e roo! ompre%on ';
er7%a# d%Co!oandr%!%Fra!4red r%'
Ne4ro#og%a# Herpe o!er
>ep%ra!or; (a## !end !o g%7e r%e !op#e4r%!% pa%n)
P4#monar; em'o#4Pne4mon%aPne4mo!$ora?P4#monar; neop#am
P;$ogen% An?%e!;Pan% d%order Con7er%on d%order
/a#%nger%ng
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(yspnea(yspnea
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Dierential diagnosis o dyspnea:
S;!em %n7o#7ed Pa!$o#og;
Card%a Card%a fa%#4re
Coronar; ar!er; d%eae
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Dierential diagnosis o dyspnea:
S;!em %n7o#7ed Pa!$o#og;
!$er 'e%!; (#%m%!%ng $e! wa## mo7emen!or #eep apnea)
Anem%aP;$ogen% $;per7en!%#a!%on, pan%
a!!a2, an?%e!;.A%do% (eg ap%r%n o7erdoe,
d%a'e!% 2e!oa%do%)
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6yncope6yncope
Di i l di i
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Dierential diagnosis o syncope :
S;!em %n7o#7ed Pa!$o#og;
Card%a a$;arr$;$!m%a- 4pra7en!r%4#ar or 7en!r%4#ar =rad;arr$;!$m%a- %n4 'rad;ard%a, omp#e!e or
eond-degree $ear! '#o2, %n4 arre!S!o2e-Adam a!!a2- ;nope d4e !o !ran%en! a;!o#e3ef! 7en!r%4#ar o4!f#ow !ra! o'!r4!%on- aor!%
!eno%, HC/ ($;per!rop$% o'!r4!%7e
ard%om;pa!$;)P4#monar; $;per!en%on
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Dierential diagnosis o syncope :
S;!em %n7o#7ed Pa!o#og;
C%r4#a!or; Po!4ra# $;po!en%on 44a##; d4e !o an!%$;per!en%7edr4g or d%4re!% a#o a4ed '; a4!onom%ne4ropa!$; a %n d%a'e!e
P4#monar; em'o#4 ma; or ma; no! preeded ';$e! pa%n
Sep!% $o2 e7ere per%p$era# 7aod%#a!a!%on re4#!
%n $;po!en%on
Cere'ra7a4#ar ran%en! %$em% a!!a2
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PalpitationsPalpitations
l i i
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Palpitations :
Palpitations may be caused by any disordercausing a change in cardiac rhythm or rateand any disorder causing increased stro.e
volume
l i i
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Palpitations :
/apid Palpitations:!/egular palpitations may be a sign o:
! Sinus tachycardia"! Atrial lutter#! Atrial tachycardia$! Supraventricular re-entry tachycardia
"!Irregularly irregular palpitations may indicate:! Atrial ibrillation"! 0ultiple atrial or ventricular ectopic beats#! 0ultiocal atrial tachycardia 10AT2: usually ound in
patients &ith lung pathology
P l i i
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Palpitations:
Slo& palpitations: patients oten describe these as missedbeats or orceul beats 1ater a pause the ne't beat is otenmore orceul due to a long illing time and thereore ahigher stro.e volume2!
Causes o slo& palpitations:
!Sic. sinus syndrome"!Atrioventricular bloc.#!3ccasional ectopics &ith compensatory pauses
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Page 01
"ormal E*7
2 5ate 898 bpm
2 5egularity regular
2 P waves normal
2 P5 interval 9.1; s
2
Normal Sinus Rhythm
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Page 0&
6inus )achycardia
2 Etiology: 6 node is depolarizing faster
than normal, impulse is conducted
normally.
2 5emember: sinus tachycardia is a
response to physical or psychological
stress, not a primary arrhythmia.
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Page 00
trial ?ibrillation
2 (eviation from "65
3 "o organized atrial depolarization, so no
normal P waves impulses are not
originating from the sinus node.
3 trial activity is chaotic resulting in an
irregularly irregular rate. 3 *ommon, affects ;@A, up to 19A if B
=9 years old
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trial ?lutter
2(eviation from "65 3 "o P waves. &nstead flutter waves
note +sawtooth pattern are formed ata rate of ;9 C9 bpm.
3 Dnly some impulses conduct throughthe node usually every otherimpulse.
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Fower Extremity EdemFower Extremity Edemaa
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D%fferen!%a# d%agno% of #ower
e?!rem%!; edema
Pa!$o#og; Ca4e
Conge!%7e $ear!fa%#4re
/;oard%a# %nfar!%on, re4rren! !a$;arr$;!$m%a(par!%4#ar#; a!r%a# f%'r%##a!%on), $;per!en%7e$ear! d%eae, m;oard%!%, ard%om;opa!$; d4e!o dr4g and !o?%n, m%!ra#, aor!% or p4#monar;
7a#7e d%eae
>%g$! $ear! fa%#4reeondar; !op4#monar;$;per!en%on (orp4#mona#e)
C$ron% #4ng d%eae, pr%mar; p4#monar;$;per!en%on
H;poa#'4m%nem%a E?e%7e pro!e%n #o (d4e !o nep$r%!%;ndrome, e?!en%7e '4rn, pro!e%n #o%ngen!eropa!$;), red4ed pro!e%n prod4!%on (d4e!o #%7er fa%#4re), or %nadeB4a!e pro!e%n %n!a2e (d4e!o pro!e%n-energ; ma#n4!r%!%on)
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D%fferen!%a# d%agno% of #ower
e?!rem%!; edema
Pa!$o#og; Ca4e
>ena# d%eae An; a4e of rena# %mpa%rmen! ( e.g. $;per!en%on,d%a'e!e me##%!4, a4!o%mm4ne d%eae, %nfe!%on)
3%7er %rr$o% A#o$o#, $epa!%!% A, =, C, e!, a4!o%mm4ne$ron% a!%7e $epa!%!%, '%#%ar; %rr$o%, +%#ond%eae, $emo$roma!o%, dr4g
Id%opa!$% Premen!r4a# edema
Ar!er%o#ar d%#a!a!%on(e?po%ng !$eap%##ar%e !o $%g$
pre4re, !$4%nrea%ng%n!ra7a4#ar$;dro!a!% pre4re)
D%$;drop;r%d%ne a#%4m $anne# '#o2er ( e.g.n%fed%p%ne, am#od%p%ne)
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D%fferen!%a# d%agno% of #ower
e?!rem%!; edema
Pa!$o#og; Ca4e
Sod%4m re!en!%o C4$%ng d%eae re4#!%ng %n e?e%7em%nera#oor!%o%d a!%7%!;, or!%o!ero%d
3oa# a4e Ce##4#%!%, 7eno4 !$rom'o%, #;mp$edema
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-eart #urmur -eart #urmur
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D%fferen!%a# D%agno% of Hear! /4rm4r P$aeof
ard%a;#e
Na!4re ofm4rm4r
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D%fferen!%a# D%agno% of Hear! /4rm4r P$aeof
ard%a;#e
Na!4re ofm4rm4r
)
F4n!%ona# /> d4e !od%#a!a!%on of m%!ra# 7a#7eann4#4
: r$e4ma!%
fe7er, %nfe!%7eendoard%!%, m%!ra# 7a#7epro#ape, $orda# r4p!4re,pap%##ar; m4#e %nfar!
r%4p%d
reg4rg%!a!%on(>)
F4n!%ona# >
: r$e4ma!%fe7er, %nfe!%7eendoard%!%
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D%fferen!%a# D%agno% of Hear! /4rm4r P$aeof
ard%a;#e
Na!4re ofm4rm4r
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Page 0
D%fferen!%a# D%agno% of Hear! /4rm4r P$ae ofard%a
;#e
Na!4re ofm4rm4r
$e4ma!% fe7er, ongen%!a#
r%4p%d!eno% (S)
>$e4ma!% fe7er
3ef! and r%g$!a!r%a# m;?oma
4mor o'!r4!%on of 7a#7eor%f%e %n d%a!o#e
Con!%n4o4 PDAAr!er%o7eno4f%!4#aCer7%a# 7eno4
$4m
Congen%!a#
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H;per!en%onH;per!en%on
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(ifferential diagnosis of
hypertension2 6ystemic hypertension may be classified
as:
3 Primary essential hypertension, for which
there is no identified cause. )his accounts for8A of cases.
3 6econdary hypertension, for which there is a
clear cause
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Glood Pressure *lassification
Normal 100
BP Classification SBP mmHg DBP mmHg
H"* &&
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Ca4e of eondar; $;per!en%on
/e$an%m Pa!$o#og;
>ena# >ena# paren$;ma# d%eae (e.g.$ron% a!rop$% p;e#onep$r%!%,$ron% g#omer4#onep$r%!%), rena#ar!er; !eno%, ren%n-prod4%ng!4mor, pr%mar; od%4m re!en!%on
Endor%ne Aromega#;, $;po- and$;per!$;ro%d%m, $;pera#em%a,adrena# or!e? d%order (e.gC4$%ng d%eae, Conn;ndrome, ongen%!a# adrena#$;perp#a%a), adrena# med4##a
d%order (e.g p$eo$romo;!oma)
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Ca4e of eondar; $;per!en%on
/e$an%m Pa!$o#og;
Inreaed %n!ra7a4#ar 7o#4me Po#;;!$em%a (pr%mar; oreondar;)
Dr4g A#o$o#, ora# on!raep!%7e,monoam%ne o?%dae %n$%'%!or,g#4oor!%o%d
P;$ogen% S!re
Ne4ro#og%a# Inreaed %n!raran%a# pre4re
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Fe7er ao%a!ed w%!$ aFe7er ao%a!ed w%!$ a
ard%a ;mp!om or %gnard%a ;mp!om or %gn
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(ifferential diagnosis of fever
2 &nfective endocarditis bacterial or fungal infection
within the heart
2 #yocarditis involvement of the myocardum in an
inflammatory proess, which is usually viral
2 Pericarditis inflammation of the pericardium whichmay be infective, postmyocardial infarction or
autoimmune
2 Dther rare conditions such as cardiac myxoma
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Page 1
6ummary
1. *linical diagnosis for patient with
cardiovascular disease needs
comprehensive approach.
;. *ardiovascular data base includes
patient history, physical examination,
electrocardiogram, chest Iray, 5outine
blood exams and additional tests
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Page &
6ummary
C. *omponents of a complete cardiac
diagnosis include etiologic diagnosis,
pathologic or anatomical diagnosis, and
pathophysiologic diagnosis.
@. #any of symptoms and signs may lead to
differential diagnosis.
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