PPCM

1. Kardiomiopati peripartum adalah bentuk dari dilated cardiomyopathy dengan disfungsi sistolik ventrikel kiri, 2. merupakan penyakit gagal jantung yang berhubungan dengan kehamilan atau keadaan setelah melahirkan 3. Kardiomiopati peripartum biasanya terjadi pada satu bulan sebelum melahirkan atau dalam jangka waktu lima bulan setelah melahirkan pada wanita yang sebelumnya sehat. 4. Penyebab dari kardiomiopati peripartum ini belum diketahui secara pasti dan mungkin melibatkan banyak faktor. 5. kardiomiopati peripartum termasuk penyakit yang jarang dan seringkali dapat mengancam jiwa, 6. tingginya kematian akibat kardiomiopati peripartum seringkali berhubungan dengan keterlambatan atau kesalahan diagnosis, yang menimbulkan konsekuensi yang fatal bagi penderita kardiomiopati peripartum. 7. Meskipun kejadian kardiomiopati peripartum tidak terbatas pada usia, namun lebih sering terjadi pada wanita multipara dan hamil pada usia diatas 30 tahun. 8. Insiden kardiomiopati peripartum di dunia masih sangat sedikit diketahui, banyak penelitian yang dilakukan di USA, dan Afrika Selatan

Sympathectomy

Sympathectomy is a surgical procedure that destroys nerves in the sympathetic nervous system. The procedure is performed to increase blood flow and decrease long-term pain in certain diseases that cause narrowed blood vessels. It can also be used to decrease excessive sweating. This surgical procedure cuts or destroys the sympathetic ganglia, which are collections of nerve cell bodies in clusters along the thoracic or lumbar spinal cord. Purpose The autonomic nervous system controls such involuntary body functions as breathing, sweating, and blood pressure. It is subdivided into two components, the sympathetic and the parasympathetic nervous systems. The sympathetic nervous system speeds the heart rate, narrows (constricts) blood vessels, and raises blood pressure. Blood pressure is controlled by means of nerve cells that run through sheaths around the arteries. The sympathetic nervous system can be described as the "fight or flight" system because it allows humans to respond to danger by fighting off an attacker or running away. When danger threatens, the sympathetic nervous system increases heart and respiratory rates and blood flow to muscles, and decreases blood flow to such other areas as skin, digestive tract, and limb veins. The net effect is an increase in blood pressure. Sympathectomy is performed to relieve intermittent constricting of blood vessels (ischemia) when the fingers, toes, ears, or nose are exposed to cold (Raynaud's phenomenon). In Raynaud's phenomenon, the affected extremities turn white, then blue, and red as the blood supply is cut off. The color changes are accompanied by numbness, tingling, burning, and pain. Normal color and feeling are restored when heat is applied. The condition sometimes occurs without direct cause but is more often caused by an underlying medical condition, such as rheumatoid arthritis. Sympathectomy is usually less effective when Raynaud's syndrome is caused by an underlying medical condition. Narrowed blood vessels in the legs that cause painful cramping (claudication) are also treated with sympathectomy. Sympathectomy may be helpful in treating reflex sympathetic dystrophy (RSD), a condition that sometimes develops after injury. In RSD, the affected limb is painful (causalgia) and swollen. The color, temperature, and texture of the skin changes. These symptoms are related to prolonged and excessive sympathetic nervous system activity. Sympathectomy is also effective in treating excessive sweating (hyperhidrosis) of the palms, armpits, or face. Demographics Experts estimate that 10,000–20,0000 sympathectomy procedures are performed each year in the united States. Description Sympathectomy for hyperhidrosis is accomplished by making a small incision under the armpit and introducing air into the chest cavity. The surgeon inserts a fiberoptic tube (endoscope) that projects an image of the operation on a video screen. The ganglia are cut with fine scissors attached to the endoscope. Laser beams may also be used to destroy the ganglia. If only one arm or leg is affected, it may be treated with a percutaneous radiofrequency technique. In this technique, the surgeon locates the ganglia by a combination of x ray and electrical stimulation. The ganglia are destroyed by applying radio waves through electrodes on the skin. Diagnosis/Preparation A reversible block of the affected nerve cell (ganglion) determines if sympathectomy is needed. This procedure interrupts nerve impulses by injecting the ganglion with a steroid and anesthetic. If the block has a positive effect on pain and blood flow in the affected area, the sympathectomy will probably be helpful. The surgical procedure should be performed only if conservative treatment has not been effective. Conservative treatment includes avoiding exposure to stress and cold, and the use of physical therapy and medications. Sympathectomy is most likely to be effective in relieving reflex sympathetic dystrophy if it is performed soon after the injury occurs. The increased benefit of early surgery must be balanced against the time needed to promote spontaneous recovery and responses to more conservative treatments. Patients should discuss expected results and possible risks with their surgeons. They should inform their surgeons of all medications they are taking, and provide a complete medical history. Candidates for surgery should have good general health. To improve general health, a surgical candidate may be asked to lose weight, give up smoking or alcohol, and get the proper amount of sleep and exercise . Immediately before the surgery, patients will not be permitted to eat or drink, and the surgical site will be cleaned and scrubbed. Aftercare The surgeon informs the patient about specific aftercare needed for the technique used. Doppler ultrasonography, a test using sound waves to measure blood flow, can help to determine whether sympathectomy has had a positive result. The operative site must be kept clean until the incision closes. Risks Side effects of sympathectomy may include decreased blood pressure while standing, which may cause fainting. After sympathectomy in men, semen is sometimes ejaculated into the bladder, possibly impairing fertility. After a sympathectomy is performed by inserting an endoscope in the chest cavity, some persons may experience chest pain with deep breathing. This problem usually disappears within two weeks. They may also experience pneumothorax (air in the chest cavity). Normal results Studies show that sympathectomy relieves hyperhidrosis in more than 90% of cases and causalgia in up to 75% of cases. The less invasive procedures cause very little scarring. Most persons stay in the hospital for less than one day and return to work within a week. Morbidity and mortality rates In 30% of cases, surgery for hyperhidrosis may cause increased sweating on the chest. In 2% of cases, the surgery may cause increased sweating in other areas, including increased facial sweating while eating. Less frequent complications include Horner's syndrome, a condition of the nervous system that causes the pupil of the eye to close, the eyelid to droop, and sweating to decrease on one side of the face. Other rare complications are nasal blockage and pain to the nerves supplying the skin between the ribs. Mortality is extremely rare, and usually attributable to low blood pressure. Read more: Sympathectomy - procedure, recovery, test, blood, tube, pain, complications, time, operation, heart, cells, rate, Definition, Purpose, Demographics, Description, Diagnosis/Preparation http://www.surgeryencyclopedia.com/St-Wr/Sympathectomy.html#ixzz1jMUDtrcd

bubble echocardiogram

A bubble echocardiogram is a procedure which is designed to give a doctor an idea of how well someone's heart is functioning. This medical test may be ordered for a patient who appears to be experiencing problems related to the physical function of the heart, such as leaky valves or an oversized heart. Very few risks are associated with a bubble echocardiogram, and the procedure is virtually painless. A patient's doctor or cardiologist will usually discuss the procedure and its possible outcomes with a patient before the bubble echocardiogram is performed. In a traditional echocardiogram, the patient's heart is ultrasounded to create a picture of the heart, allowing medical professionals to assess the condition of the heart without the need for invasive surgery. The test is typically performed by an ultrasound technician, who may record the procedure or print out specific images which may be of interest to a physician. In a bubble echocardiogram, the echocardiogram is performed, and then a bubble of saline is injected into a vein in the arm. As the saline moves through the heart, the ultrasound technician follows it. The saline makes certain heart functions more visible, highlighting problems in the left ventricle, the major pumping area of the heart, along with issues with the valves. The saline ultimately dissipates harmlessly into the blood, and is eventually expressed by the body along with other waste materials. Sumber : http://www.wisegeek.com/what-is-a-bubble-echocardiogram.htm

BUERGER'S DISEASE / PENYAKIT BUERGER

Penyakit Buerger (Tromboangitis obliterans)

Adalah penyumbatan pada arteri dan vena yang berukuran kecil sampai sedang, akibat peradangan yang dipicu oleh merokok. Berdasarkan studi cohort, pria perokok sigaret berusia 20-40 tahun lebih banyak yang menderita penyakit Buerger dibandingkan dengan siapapun. Sekitar 5% penderita adalah wanita.

Penyebab Penyebabnya tidak diketahui, tetapi berdasarkan penelitian, beberapa studi melaporkan bahwa korelasi penyakit Buerger lebih banyak menyerang perokok dan keadaan ini akan semakin memburuk jika penderita tidak berhenti merokok. Penyakit ini hanya terjadi pada sejumlah kecil perokok yang lebih peka. Mengapa dan bagaimana merokok sigaret menyebabkan terjadinya penyakit ini, tidak diketahui. Gejala Gejala karena berkurangnya pasokan darah ke lengan atau tungkai terjadi secara perlahan, dimulai pada ujung-ujung jari tangan atau jari kaki dan menyebar ke lengan dan tungkai, sehingga akhirnya menyebabkan gangrene (kematian jaringan). * Sekitar 40 penderita juga mengalami peradangan vena (terutama vena permukaan) dan arteri dari kaki atau tungkai * Penderita merasakan kedinginan, mati rasa, kesemutan atau rasa terbakar. * Penderita seringkali mengalami fenomena Raynaud dan kram otot, biasanya di telapak kaki atau tungkai. * Pada penyumbatan yang lebih berat, nyerinya lebih berat dan berlangsung lebih lama. * Pada awal penyakit timbul luka terbuka, gangrene atau keduanya. * Tangan atau kaki terasa dingin, berkeringat banyak dan warnanya kebiruan,kemungkinan karena persarafannya bereaksi terhadap nyeri hebat yang menetap. Diagnosa Pada lebih dari 50 penderita, denyut nadi pada satu atau beberapa arteri di kaki maupun pergelangan tangan, menjadi lemah bahkan sama sekali tak teraba. Tangan , kaki, jari tangan atau jari kaki yang terkena seringkali tampak pucat jika diangkat ke atas jantung dan menjadi merah jika diturunkan. Mungkin ditemukan ulkus (luka terbuka, borok) di kulit dan gangren, biasanya pada satu atau lebih jari tangan atau jari kaki. Pemeriksaan USG menunjukkan penurunan yang hebat dari tekanan darah dan aliran darah di kaki, jari kaki, tangan dan jari tangan yang terkena. Angiogram bisa menggambarkan arteri yang tersumbat dan kelainan sirkulasi lainya, terutama di tangan dan kaki. Pengobatan Penderita harus berhenti merokok atau penyakitnya akan menjadi lebih buruk, sehingga akhirnya memerlukan tindakan amputasi. Penderita juga harus menghindari : * pemaparan terhadap dingin * cedera karena panas, dingin atau bahan (seperti iodine atau asam) yang digunakan untuk mengobati kutil dan kapalan * cedera karena sepatu yang longgar/sempit atau pembedahan minor * infeksi jamur * obat-obat yang dapat mempersempit pembuluh darah. Berjalan selama 15-30 menit 2 kali/hari sangat baik Penderita dengan gangrene, luka-luka atau nyeri ketika beristirahat, perlu menjalani tirah baring. Penderita harus melindungi kakinya dengan pembalut yang memiliki bantalan tumit atau dengan sepatu boot yang terbuat dari karet. Bagian kepala dari tempat tidur dapat ditinggikan 15-20 cm diatas balok, sehingga gaya gravitasi membantu mengalirkan darah menuju arteri-arteri. Pentoxifylline, antagonis kalsium atau penghambat platelet (misalnya aspirin) diberikan terutama jika penyumbatan disebabkan oleh kejang. Penderita yang berhenti merokok tetapi masih mengalami penyumbatan arteri, mungkin perlu menjalani pembedahan untuk memperbaiki aliran darah, dengan memotong saraf terdekat untuk mencegah kejang. Jarang dilakukkan pencangkokan bypaas karena arteri yang terkena terlalu kecil. (Dr Iman Firmansyah)