C A S E P R E S E N TAT I O N

Chf nyha iII ec.

ALCOHOLIC
CARDIOMYOPATHY
Present by
Hazmi Adly Harun Bin Harun
(C111 11 828)
Supervisor :

Prof dr Peter Kabo PhD SpFK SpJP(K) FIHA

FASCC

Department of Cardiology and Vascular Medicine

Medical Faculty of Hasanuddin University
Makassar 2015

PATIENT IDENTITY

Name
: Mr S
Age
: 56 years old
Gender
: Male
Admission date : 09-03-2016

HISTORY TAKING
Chief Complaint : Shortness of breath

Felt since approx. 2 weeks ago and worsen 2 days before being admitted to
the hospital. Experienced while doing minimal activity such as walking to the
bathroom and is relieved with rest.

At times patient get startled during the night due to sudden onset of
shortness of breath.

Patient usually sleeps using more than 1 pillow

No chest pain

Heartburn (-)

Cough (-).

Swelling extremities/ edemas (+)

Past Medical History

* History of hypertension (-)

* History of diabetes mellitus (-)
* History of family members with same illness
(-)
* History of smoking (+), approx. 2 boxes of
cigarette a day
* History of concumption of alcohol (+)
Family History

History of cardiovascular disease in

family (-)

RISK FACTORS

Non- Modified

Modified
Smoking
Alcohol
consumption

General Status
* Moderate illness/ Well nourished/ Conscious
* Nutritional Status: Normal
* Weight : 67 kg
* Height : 163 cm
: 25.21 kg/m2
* BMI

Vital Sign

* Blood Pressure
:
* Pulse Rate
* Respiratory Rate
* Temperature

: 90/60 mmHg
82 bpm
: 26 bpm
: 36.6 0C (axilla)

PHYSICAL EXAMINATION
Head and Neck Examinations
Eye
: Conjunctiva anemic (-/-), Sclera icteric
(-/-)
Lip
: Cyanosis (-)
Neck
: JVP R +3 cmHO

Chest Examination
Inspection : Symmetric between left and right
chest.
Palpation : No mass, no tenderness.
Percussion : Sonor between left and right chest,
lung-liver border is ICS IV right anterior.
Auscultation: Respiratory sound: Vesicular
Additional sound :Ronchi +/+
mediobasal,Wheezing -/-

Heart

Abdomen

Inspection
Palpation
Percussion
Auscultation

: Heart apex not visible

: Heart apex palpable
: Heart borders elongates
: S I/II regular, murmur pansystolic

Inspection
: Distended, follows breathing
movement
Auscultation
: Peristaltic sound (+), normal
Palpation
: No mass, no tenderness, liver palpable
4cm from arcus costa and spleen unpalpable
Percussion
: Tympani (+)

Pretibial edema +/+

Dorsal pedis edema +/+

Extremities

ECG
interpretation

* Rhythm : Sinus rhythm

* Heart rate : 88 bpm
* Regularity : reguler
: Normoaxis
* Axis
: 0,06 s
* P wave
* PR interval : 0,08 s
* QRS complex : duration 0,10s,
* ST Segment : 0,12 s
* Conclution :
Sinus rhythm, HR 88 bpm, regular, Normoaxis, LVH

Radiology findings

INTERPRETATION of CHEST X RAY

Cardiomegaly with signs of
pulmonary edema
INTERPRETATION OF ECHOCARDIOGRAPHY
Systolic function of the right and left
ventricle decreases due to DCM
Dilatation of all heart chambers
Excentric LVH
Global hypokinetic
Severe Mitral regurgitation, Low Tricuspid
regurgitation, Moderate Pulmonal
regurgitation,
Moderate Pulmonal hypertension
Left ventricular diastolic dysfunction grade
III

LABORATORY FINDINGS
PEMERIKSAAN

NILAI

NILAI RUJUKAN

UNIT

WBC

7.8

4.00-10.00

103/ul

RBC

5.25

4.00-6.00

106/ul

Hb

16.1

12.0-16.0

gr/dl

Plt

112

150-400

103/ul

PT

22.7

10-14

Detik

APTT

30.6

22.0-33.0

Detik

INR

1.98

--

GDS

90

140

mg/dl

Ureum

113

10-50

mg/dl

Creatinin

1.28

L(<1.3) P(<1.1)

mg/dl

SGOT

578

<38

U/L

SGPT

492

<41

U/L

963.00

L(<190), P (<167)

U/L

CKMB

49.0

<25

U/L

Troponin I

0.65

<0.01

ng/ml

Natrium

129

136-145

mmol/l

Kalium

4.8

3.5-5.1

mmol/l

Klorida

100

97-111

mmol/l

CK

Blood Gas Analysis

pH

7.539

7.35-7.45

pCO2

32.0

mmHg

SO2

96.8

PO2

77.9

80.0-100.0

mmHg

HCO3

27.6

22-26

mmol/l

ctO2

23.4

Vol%

ctCO2

28.5

mmol/l

BE

4.8

-2 sd +2

mmol/l

Working
DIAGNOSIS
Chf nyha iII ec.
MODERATE
ALCOHOLIC
CARDIOMYOPATHY

MANAGEMENT
Bed rest
Oxygen 3-4 lpm via nasal canule
IVFD NaCl 0.9% 500 cc/24 hr
Diuretic
Furosemid 2 amp/8 hr/iv

ACE Inhibitor
Captopril 12.5mg/8hr/oral

Expectorant
Ambroxol 20mg/8hr/oral

DISCUSSION
HEART FAILURE

DEFINITION
rt
a
e
H
ure
l
i
a
F
Heart is no longer able to pump an
adequate supply of blood in relation
to the venous return and in relation
to the metabolic needs of the body
tissues at the particular moment
ve
i
t
s
ge
Con art
He e
ur
F ai l

The state in which

abnormal circulatory
congestion occurs as the
result of heart failure.

ETIOLOGY OF
HEARTFAILURE
Myocard
Disease
CAD
Cardiomyopathy
Iatrogenic

Miocarditis

Myocard Mechanical
Dysfunction

Pressure overloaded
(Stenosis Aortae, Hypertension,
Coartatio Aortae)
Volume Overloaded
(Mitral/Aortae Regurgitation,
Congenital Heart Disease,
Hipertransfusion)

Miocard Filling Inhibitating

(Cardiac Tamponade, Pericarditis)

The Framingham criteria for CHF

CHF considered present if 2 major or 1 major &
2 minor Minor Criteria
Major Criteria
Paroxysmal Nocturnal

Extremity edema

Dyspnea

Nocturnal cough

Cardiomegaly

Decreased vital pulmonary

Gallop S3

Hepatojugular reflux

Hepatomegaly

Increased of JVP

Pleural effusion

Rales or ronchi

Tachycardia ( 120bpm)

Acute pulmonary edema

Dyspnea deffort

Prolonged circulation time(>

25 sec)

Weigh loss 4,5 kg in 5 days

in
response to treatment of CHF

capacity (1/3 of maximal)

*Signs of CHF

clASSIFICATION OF
CHF

*PATHOPHYSIOLOGY OF CHF

CHF MANAGEMENT
Optimalized
Oxigenation

NonFarmakologi

Reduce Physical
Activity
Low salt, enough
calories and proteins
detary
Fluid restriction

CHF MANAGEMENT
Farmakologi

Managing preload

Managing afterload

Managing
contractility

Neurohormonal
modulation
Diuretics
Venodilator

Inotropic agents :
Cardiac glycosides
B- adrenergic

ACE inhibitors
ARB
blockers
CCB

blockers
ACE
inhibitors
ARB

Medical Therapy
*ACE-Inhibitor
*Digitalis
*Diuretic
*Anti-arrhytmia
*Digoxin
*Anti-coagulant
*Antibiotic

Surgical intervention

Symptomatic with severe MR

Asymptomatic with severe MR and preserved LV
function
Asymptomatic with severe MR and Left ventricle end
systolic diameter (LVESD)

Thank You