Heart Failure Dimdim

8/13/2019 Heart Failure Dimdim

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Presented by:

Dian Megawati R. L. B

Supervisor :

Dr. dr. Idar Mappangara,

Sp.PD,

Sp.JP.FIHA.FINASIM

Department of Cardiology and Vascular Medicine

Medical Faculty of Hasanuddin University

Makassar

2013


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Medical Record : 64-24-44

Name : Mr. AH

Gender : Male

Age : 68 years old Admininistered date: December 18th, 2013


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Chief complaint : Shortness of breath

It was felt since 1 year before entering the hospital andgetting worse in 1 day before admission. It wasexperienced while doing minimal activity such as walkingto the bathroom and relieved with rest. Shortness ofbreath when sleep (+) patient used 2 pillows and oftenawakened because of that. Shortness of breath is alsoaccompanied by pain in the middle of the chest, duration> 30 minutes, characterized with being pressured throughthe back, and radiating to the left arm and neck, and got

lessen with rest. Palpitation (+), cold sweat (+), nausea (-), vomiting (-), heartburn (-), fever (-), cough (-).

Defecation : normal

Urinary : normal


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History of admission with the same complaint

(+) 1 year ago without regular treatment

History of hypertension (+) since 3 years ago

without regular treatment

History of diabetes mellitus ( - )

History of family with same disease ( - )


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Modifiable

- Cigarette Smoking

- Hypertension

Unmodifiable

- Gender :

Man

- Age : 68 y.o- Past heart disease


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Head and Neck Examinations: Eye : Conjunctiva anemic (-/-), Sclera icteric (-/-)

Lip : Cyanosis (-)

Neck : JVP R +2 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 in ICS IV right anterior .Auscultation :

Breath Sounds : Vesicular

Adventitious breath sound : Ronchi +-/+

-, wheezing -/-


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Heart Examination

o Inspection : IC was visible

oPalpation : IC was palpable

oPercussion : normal heart size

Upper border : left 2ndICS

Lower border : left 6thICS

Right border : right parasternalis line

Left border : left anterior axillaris lineoAuscultation : Regular of I/II heart sound, murmur (-)

Abdominal Examination

o Inspection : flat and following breath movement

oAuscultation : peristaltic sound (+) , normaloPalpation : liver and spleen unpalpable

oPercussion : tympani, ascites (-)

Extremities

o

Oedema : pretibial (+/+) minimal, dorsum pedis (-)


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HEMATOLOGY VALUE REFERENCE

VALUE

UNIT

WBC 15,76 4,00-10,0 (10/UI)

RBC 4,19 4,00-6,00 (106/UI)

HGB 12,4 12,0-16,0 (gr/dL)

HCT 34,6 37,0-48,0 (%)

PLT 241 150-400 (103/uL)

GDS 175 140 Mg/dL

Ureum 23 10-50 Mg/dL

Creatinin 0,9


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SGOT 22 65) Mg/dL

LDL Cholesterol 109


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Rhythm : Sinus

Heart rate : 88 bpm Regularity : Reguler

Axis : RAD

P wave : 0,05 s

PR interval : 0,16 s

QRS complex : 0,1 s

ST Segment : Normal, S wave widening in lead I

and V6

T wave :

Conclusion : Sinus rhythm, HR 88x/m, Right

axis deviation, incomplete RBBB


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Decreased of systolic LV function, EF

30%

Dimensional chambers of heart :

dilatation of LV & LA, SEC (-), thrombus

(-)

LVH (+)

Global hypokinetic

Good RV systolic function, TAPSE 2,0

cm

Heart valves : - Aorta : 3 cuspis,

calcification- Tricuspid : good

function

and movement

- Pulmonal : good

functionand movement

Conclusion :

LV systolic and diastolic disfunction, EF

30%

Dilatation of LV & LA

Global hypokinetic


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CONGESTIVEHEART FAILURE


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Heart is no longer able to pump

an adequate supply of blood inrelation to the venous return and in

relation to the metabolic needs ofthe body tissues at the particular

moment

Heart Failure

The state in which abnormalcirculatory congestion occurs as

the result of heart failure.

CongestiveHeart Failure


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Other Causes

Arrhythmias

Valvular heart disease

Congenital heart diseasePericardial disease

Hyperdynamic

circulation

Alcohol and

drugs(chemotherapy)

Main Causes

Ischemic heart disease(35%-40%)

Cardiomyopathy(dilated)(30-40%)

Hypertension ( 15-20%)

Etiology ofHeart Failure


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CAD

ACS

UAP NSTEMI STEMI

StableAnginaPectoris


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WHO Diagnostic Criteria:

Clinical history of ischemic type chestpain lasting >20 minutes.

Changes in serial ECG tracings.

Rise and fall of serum cardiac biomarkerssuch as creatinine kinase-MB fraction andtroponin.


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Substernal chest pain / chest discomfort radiated to the left arm,shoulder, neck, jaw. Penetrated to the back.

The chest discomfort may also be described as a dull pain,pressure, squeezing or crushing sensation or burning sensation

Duration more than 20 minutes. More intense and persistent.

Not fully relieved by rest or nitroglycerine

Often accompanied by systemic symptoms: nausea, vomiting,palpitation, fatigue, cold sweat, light headness


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Heart Failure Dimdim

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