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Lapsus + CHF CAD Abc
Lapsus + CHF CAD Abc
Case
Report
Faculty of Medicine
May 2015
Hasanuddin
University
Congestive
Heart Failure (CHF) NYHA III
By:
Miftah Farid Asmaun
Supervisor:
PATIENTS IDENTITY
Name
Sex
Date of Birth
Age
Occupation
Date of Admission
Medical Record No.
:
:
:
:
Mr.Y
Male
31-12-1939
75 years old
: Farmer
: 11th May 2015
: 71.14.90
HISTORY TAKING
CHIEF COMPLAINT
Shortness of breath
HISTORY TAKING
HISTORY TAKING
History of Previous Illness:
1. Previously treated in RS Toraja for 2 weeks with
complaint of chest pain and was diagnosed with
coronary heart disease before patient is referred to RS
Wahidin Sudirohusodo.
2. There is no history of hypertension.
3. History of diabetes mellitus is denied.
4. There is history of coronary artery disease.
5. There is history of smoking, 1 pack per day but had quit
smoking about 8 years ago.
6. There is no history of drinking alcohol.
7. History of heart disease in the family is denied.
HISTORY TAKING
Risk Factors:
PHYSICAL EXAMINATION
GENERAL STATE
Moderate illness/ well-nourished/ compos mentis
VITAL STATE
Blood Pressure
: 130/90 mmHg
Heart Rate
: 72 beats/minute
: 36,6OC
PHYSICAL EXAMINATION
REGIONAL STATE
Head :
Eye
Lip
: cyanosis (-)
Neck
Thorax :
Inspection
Palpation
PHYSICAL EXAMINATION
Heart :
Inspection
Palpation
Percussion
Auscultation
Abdomen :
Inspection
Auscultation
Palpation
Percussion
Extremities
pedis -/-
DIAGNOSTIC
EXAMINATION
Electrocardiography
(ECG)
DIAGNOSTIC
EXAMINATION
Interpretation:
Rhythm
: Sinus rhythm
Heart Rate
: 69 bpm
Axis : normoaxis
P wave
: 0,04s
PR interval
: 0,16s
T wave
: T-inverted V2-V4
Conclusion
DIAGNOSTIC
EXAMINATION
LABORATORIUM
WBC
7,14 x 10 3
/L
RBC
5, 92 x 10 6
/L
PLT
329, 000/L
HGB
18, 0 g/dl
HCT
57, 4%
INR
1, 21
PT
APTT
DIAGNOSTIC
EXAMINATION
LABORATORY TEST
Natrium
141 mmol/L
Kalium
5, 1 mmol/L
Chloride
100 mmol/L
Troponin T
<0, 02/negative
DIAGNOSTIC
EXAMINATION
DIAGNOSTIC
EXAMINATION
ECHOCARDIOGRAPHY
Normal left ventricle systolic
function
Concentric remodeling
Dilatation of RA and RV
RESUME
A 75 years old man admitted to the hospital with chief complaint dyspnea, suffered
since 3 months ago but worsened about a week before hospitalization. There are
dyspnea on effort (DOE), paroxysmal nocturnal dyspnea (PND), and orthopnea.
There is a history of chest pain occurring intermittently at rest with crushing and
tighten sensation.
History of previous illness:
Previously treated in RS Toraja for 2 weeks with complaint of chest pain and was
diagnosed with coronary heart disease before patient is referred to RS Wahidin
Sudirohusodo.
DIAGNOSIS
Congestive Heart Failure NYHA III et
causa Coronary Artery Disease
MANAGEMENT
O2 4 lpm via nasal canule
Connecta
Furosemid 40 mg/12 hours/intravena
Farsorbid 10 mg/8 hours/oral
Aspilet 80 mg/24 hours/oral
Captopril 6,25 mg/8 jam/oral
Omeprazole 40 mg/24 jam/oral
CONGESTIVE
HEART
FAILURE
INTRODUCTION
Along
DEFINITION
Heart failure is an inability of the heart to
pump sufficient amount of blood to fulfill the
needs of body metabolism (forward failure)
or that the ability to pump can only be
obtained with high pressure from the blood
entering the heart (backward failure), or
both.
PREVALENCE
About 1980; Framingham : age-adjusted:
male = female.
ETIOLOGY
Coronary Artery Disease (CAD)
Hypertension
Cardiomyopathy
(dilatated,
restricted and obliterated)
obstructed,
PATHOPHYSIOLOGY
Neurohormonal mech.
PATHOPHYSIOLOGY
ReninAngiotensinAldosterone system
mech.
PATHOPHYSIOLOGY
Sympathetic mech.
CLASSIFICATION
New York Heart Association (NYHA)
Functional Classification based on severity
and physical activity
DIAGNOSIS
Definitive diagnosis of congestive heart failure:
DIAGNOSIS
Major criteria:
1. paroxysmal nocturnal dyspnea (PND) or orthopnea;
2. Distended neck veins (in other than supine position);
3. rales;
4. Cardiomegaly seen in x-ray;
5. Acute pulmonary oedema seen in x-ray;
6. gallop ventricular S(3);
7. Increased vein pressure > 16 cm H20;
8. Hepatojugular reflux;
9. Pulmonal oedema, visceral congestion, cardiomegaly found in autopsion;
10. Decreases body mass in CHF.
DIAGNOSIS
Minor criteria:
1. Bilateral ankle oedema;
2. Night cough;
3. Dyspnea on regular activity;
4. Hepatomegaly;
5. Pleural effusion seen in x-ray;
6. Decrease of 1/3 vital capacity from the maximal record;
7. Tachycardia (120 bpm or more);
8. Engorgement pulmonal vascularization seen in x-ray.
EXAMINATIONS
1. Electrocardiography (ECG) :
Q wave, abnormality of T wave and ST segment,
LVH, bundle branch block, and atrial fibrillation.
2. Thorax X-ray : cardiomegaly, pulmonal
oedema.
3. Echocardiography : assess the heart structure
and function objectively.
4. Haematology and biochemistry
EXAMINATIONS
ECG
EXAMINATIONS
ECG
EXAMINATIONS
THORAX X-RAY
EXAMINATIONS
ECHOCARDIOGRAPHY
MANAGEMENT
NON-FARMACOLOGIC
-Education and counselling
-Diet
-Salt restriction
-Fluid restriction
-Avoid alcohol and cigar
-Perform regular activity which does not precipitate
the symptoms.
MANAGEMENT
FARMACOLOGIC
1. Decrease the preload:
diuretic, aldosterone receptors antagonist, nitrat
2. Increase heart contractility:
digitalis, ibopamin, -blocker gen.3
3. Decrease the afterload:
ACE-I, ARB, DRI, dihydropiridin CCB
4. Preventing miocard remodelling:
ACE-I, ARB
PROGNOSIS
Prognosis depends on:
- age
- etiology
- NYHA classification
- ejection fraction (EF)
- Comorbid conditions (renal dysfunction, diabetes, anemia,
hyperuricemia)
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