SCENARIO 3

DYSPNEA
STEP 1
1. Dyspnea

: Difficulty in breathing,

often associated with lung or hearth disease

and resulting in shortness of breath.
2. Miksi
: urination
3. Ventricular hypertrophy : the thickening of the
ventricular walls (lower chambers) in the heart
4. Murmur
: is an extra or unusual
sound heard during a heartbeat
5. Ictus cordis
: a throb or pulsation, as of
the heart or of an artery. apex beat the beat
felt over the apex of the heart, normally in or
near the fifth left intercostal space.
6. Crisis hypertension
: clinical situation with
a very high blood pressure with target organ
abnormalities, systolic> = 180 diastolic> =
120
STEP 2

1.why the shortness of breath increase when the

patient do activity?
2.Why the shortness of breath can happen at
night while
sleeping?
3.What kind of dyspnea ?
4.why shortness of breath decreases during
sleep with 3 pillows?
5.what is the correlation of hypertention with
Ny.A disease?
6.what is the correlation of miksi reduse with
shortness of breath?
7. what is the sign and sympthom in this case?
8. What causes enlargement of heart to caudolateral?
9. What is the interpretation of physical examination?
10.
What is the Different diagnose?
11.
What is the diagnose from this case?
12.
Definition and classification?
13.
Etiologi and epidemiology?
14.
Clinical manifestation?
15.
Patophisiology?
16.
Pathogenesis?
17.
Treatment and tata laksana?
18.
Complication?
19.
Prognose?
20.
Interpretation of ECG?

STEP 3 & 4
1.why the shortness of breath increase when the
patient do activity?
Activity body need O2 heart cant inflate O2
in the whole body shortness ofbreath
increase
2.Why the shortness of breath can happen at
night while
sleeping?
a.

Influenced by the force of gravity

dyspnea less CO2 in the body then the

charging time left ventriclepumping
around the body one of which compensates
for kidney RAA binding, Na binding fluid and
a decrease in glomerular filtrate
b.

Due to shortness of breath too great

(paroxysmal nocturnal dyspnea) shortness of

breath subsides when waking uphigh cardiac
load
3.What kind of dyspnea ?
4.why shortness of breath decreases during
sleep with 3 pillows?

Increasing 20-30 degreesbody effort to fight

gravity diaphragm elevationexpiratory lung
vol >> alveoli with capillary gas exchange is
smooth
5.what is the correlation of hypertention with
Ny.A disease?
a. In compensating, the left ventricle work
harder myocardial hypertrophy ( cant
b.

return) over time becomes heart failure.

increased cardiac output blood is circulated

less
6.what is the correlation of miksi reduse with
shortness of breath?
Shortness of breath O2 Supply <
perfusion
Na

decrase

increase angiotention 2

compensation with blood vol >

retention

maintain

blood vol vol increased blood .

7. what is the sign and sympthom in this case?
Sign : bp 170/100 mmHg, rr 28 / mnt, percussion : the left
boundary is on SIC VI 2cm lateral to the linea mid
clavicularis sinistra, enlargement of heart to caudolateral, hr
88x / mnt.

Sympthom : no murmur, miksi reduce, ictus cordis doesnt

appear, palpation isnt strong enough to lift.
8. What causes enlargement of heart to caudolateral?
Jantung terjadi LVH ,axis sedikit berputar ke
kaudal..karena di arah lain ada organnya
9. What is the interpretation of physical examination?
Palpation abnormal, BR abnormal ( normal : 120/80) , RR
increase ( normal : 18-24x/ mnt), inspection normal,
percussion abnormal ( normal : SIC V), HR normal
10.
What is the Different diagnose?
Heart failure
Asma
ISPA
11.
What is the diagnose from this case?
Heart Failure
12.
Definition and classification?
13.
Etiologi and epidemiology?
14.
Clinical manifestation?
15.
Patophisiology?
16.
Pathogenesis?
17. Treatment and tata laksana?
18.
Complication?
19.
Prognose?
20.
Interpretation of ECG?
21. Why the shortness of breath can happen at
night while sleeping ?
22. Other examination ?