HEMODINAMIK DAN
SYOK
dr. Argoseto, SpAn
RSUD Temanggung
Konsep Dasar
SIRKULASI :
POMPA ( JANTUNG )
PIPA ( PEMBULUH DARAH )
ISI ( DARAH + PLASMA )
VENOUS RETURN CARDIAC OUTPUT
SVR
• CARDIAC OUTPUT
THE AMOUNT OF BLOOD THAT IS PUMPED INTO
THE AORTA EACH MINUTE
STROKE VOLUME X HEART RATE
BLOOD PRESSURE
CARDIAC OUTPUT SYSTEMIC VASCULAR RESISTANCE
STROKE VOLUME HEART RATE
PRELOAD CONTRACTILITY AFTERLOAD
Syok
Sindrom klinis mengancam nyawa akibat kegagalan perfusi
→ ketidak cukupan pasokan oksigen ke jaringan →
gangguan metabolisme sel & fungsi jaringan.
Jenis Syok :
Hipovolemik
Kardiogenik
Distributif → sepsis, anafilaktik
Obstruktif → pneumothorak, tamponade, ventilator
6
Cardiogenic Shock
• Menurunnya kontraktilitas.
• Meningkatnya filling pressures,
menurunnya LV stroke work,
menurunnya cardiac output.
• Kompensasi → Meningkatnya
resistensi pembuluh darah
sistemik.
Hypovolemic Shock
• Menurunnya cardiac output.
• Menurunnya filling pressures.
• Kompensasi → meningkatnya
systemic vascular resistance.
SHK 8
®
Distributive Shock
• Menurunnya systemic vascular
resistance.
• Low to normal filling pressures.
• Sepsis, anaphylaxis, neurogenic,
and acute adrenal insufficiency.
SHK 9
®
Obstructive Shock
• Menurunnya cardiac output.
• Meningkatnya systemic
vascular resistance.
• Variable filling pressures –
etiology dependent.
• Cardiac tamponade, tension
pneumothorax, massive
pulmonary embolus.
ALPHA 1 (A1):
A1 receptors : vascular smooth muscle & also in the
myocardium, which mediate inotropic (+) and
chronotropic (-) effects.
Stimulation of A1 receptors leads to vasoconstriction.
ALPHA 2 (A2):-
A2 receptors are located in large blood vessels.
Stimulation of A2 receptors mediates arterial and venous
vasoconstriction.
BETA 1 (B1):-
Beta 1 receptors increase heart rate / chronotrophic (+)
and myocardial contractility / inotrophic (+).
BETA 2 (B2):-
Beta 2 receptors enhance vasodilation; relax bronchial,
uterine and gastrointestinal smooth muscle
DOPAMINE
• Dopamine
A chemical precursor of epinephrine.
Possessing alpha and beta and dopaminergic receptor – simulating
actions.
The specific effects are related to the dose delivered.
– Low dose (2-3 g/kg/min) – mild inotrope
plus renal effect
– Intermediate dose (4-10 g/kg/min) –
inotropic effect
– High dose ( >10 g/kg/min) – vasoconstriction
– Chronotropic effect
SHK 13
®
DOBUTAMINE
• Dobutamine
– 5-20 g/kg/min
– Inotropic and variable chronotropic
effect
– Decrease in systemic vascular
resistance
SHK 14
®
DOBUTAMINE
• Mechanism of action:-
Chemically related to dopamine.
Increases myocardial contractility, stroke
volume and cardiac output.
Decreases preload and afterload
(Vasodilatation)
Produces mild chronotropic, hypotensive
and arrhythmogenic effects.
Increase renal and mesenteric blood flow
by increasing cardiac output.
Does not affect renal blood flow like
dopamine.
SHK 15
®
NOREPINEPHRINE
Mechanism of action: -
Potent alpha – receptor antagonist, leads to
arterial and venous constriction.
Minimal effect on beta 2 receptors.
Increases myocardial contractility due to its
beta 1 adrenergic effects.
Effective in septic shock and neuroginic
shock after adequate hydration.
Increases blood flow to the major organs
including the kidneys and helps in increases
urine output.
SHK 16
®
• Norepinephrine
– 0.05 g/kg/min and titrate
– Inotropic and vasopressor effects
– Potent vasopressor at high doses
SHK 17
®
Epinephrine
• Drug class: -
Catecholamine.
Endogenous catecholamine, produced,
stored, and released by the adrenal medulla.
Mainly eliminated via kidneys.
• Mechanism of action: -
Stimulation of alpha and beta-adrenergic receptors
causes vasoconstriction.
Increases heart contractility and rate.
Causes bronchodilation.
Antagonizes histamine effect.
SHK 18
®
Epinephrine
• 0.1 g/kg/min and titrate
• Increases myocardial O2
consumption
SHK 19
®
Terima Kasih
