Kasus pembelajaran klinik kardiovaskular (cv CODE 1)

1. R.P. is a 60-year-old woman with New York Heart Association (NYHA) class
IV heart failure (HF) admitted for increased shortness of breath and
dyspnea at rest. Her extremities appear well perfused, but she has 3+
pitting edema in her lower extremities. R.P.s vital signs include
blood pressure (BP) 125/70 mm Hg, heart rate (HR) 102 beats/minute, and
O2 saturation 89% on 100% facemask. After the initiation of an
intravenous diuretic, what the best intravenous drug to treat this
patient?

2. H.E. is a 53-year-old woman admitted to the hospital after the worst
headache she has ever experienced. Her medical history includes
exertional asthma, poorly controlled hypertension (HTN), and
hyperlipidemia. She is nonadherent to her medications, and she has not
taken her BP drugs, including clonidine, for 4 days. Vital signs include
BP 220/100 mm Hg and HR 65 beats/minute. She receives a diagnosis of a
cerebrovascular accident and hypertensive emergency. What the best
management option for this patients hypertensive emergency?

3. A.D. is a 52-year-old woman with a history of witnessed cardiac arrest
in a shopping mall; she was resuscitated with an automatic external
defibrillator device. On electrophysiologic study, she has inducible
ventricular tachycardia (VT). What the best for reducing the secondary
incidence of sudden cardiac death in patients such as A.D.?

4. S.V. is a 75-year-old woman with a history of NYHA class III HF (left
ventricular ejection fraction [LVEF] 25%) and several nonST-elevation
myocardial infarctions (MIs). She had an episode of sustained VT during
hospitalization for pneumonia. Her QTc interval was 380 milliseconds on
the telemetry monitor, and her serum potassium (K+) and magnesium (Mg)
were 4.6 mmol/L and 2.2 mg/dL, respectively. what the following is the
best treatment option for S.V.?

5. A.S. is a 56-year-old African American man with a long history of poorly
controlled HTN secondary to medication nonadherence and subsequent
dilated cardiomyopathy (LVEF 35%). He is assessed in a community health
clinic today and reports not having taken his medications for the past
week. A.S. is asymptomatic, and his examination is unremarkable except
for BP 180/120 mm Hg and HR 92 beats/minute. All laboratory values are
within normal limits except for a serum creatinine (SCr) of 1.4 mg/dL
and urinalysis with 2+ proteinuria. what therapeutic options would be
best to manage A.S.s condition in the clinic?

Kasus pembelajaran klinik kardiovaskular (cv CODE 1)

6. D.D. is a 72-year-old man admitted to the hospital for HF decompensation. D.D. notes
progressively increased dyspnea when walking (now 10 ft [3 m], previously 30 ft [6 m])
and orthopnea (now four pillows, previously two pillows), increased bilateral lower
extremity swelling (3+), 13-kg weight gain in the past 3 weeks, and dietary nonadherence.
He has a history of idiopathic dilated cardiomyopathy (LVEF 25%, NYHA class III),
paroxysmal atrial fibrillation (AF), and hyperlipidemia.
D.d. Adalah pria tua yang berumur 72 mengakui ke rumah sakit karena mengalami HF
decompensation (dekompensasi gagal jantung).
Catatan dyspnea D.d. semakin meningkat ketika berjalan (sekarang 10 kaki [3 m], sebelumnya 30
kaki [6 m]) dan orthopnea (empat bantal, sebelumnya dua bantal ), meningkatnya ekstremitas
pembengkakan bilateral (3 +), 3 minggu yang lalu BB 13 kg, dan tidak patuh makanan. Dia
memiliki sejarah idiopatik dilated cardiomyopathy ( LVEF 25 %, NYHA kelas III ), paroxysmal
fibrilasi atrium ( AF ), dan hyperlipidemia.

Pertinent laboratory values are as follows: B-type natriuretic peptide (BNP) 2300 pg/mL
(050 pg/mL), K+ 4.9 mEq/L, blood urea nitrogen (BUN) 32 mg/dL, SCr 2.0 mg/dL,
aspartate aminotransferase (AST) 40 IU/L, alanine aminotransferase (ALT) 42 IU/L,
international normalized ratio (INR) 1.3, activated partial thromboplastin time (aPTT) 42
seconds, BP 108/62 mm Hg, and HR 82 beats/minute.
Nilai laboratorium pasien meliputi : b-type natriuretic peptida (BNP) 2300 pg/mL (0 50 pg/mL),
K+ 4,9 mEq/L, nitrogen urea darah (BUN) 32 mg/dL, SCr 2.0 mg /dL, aspartate aminotransferase
(AST) 40 IU/L, alanina aminotransferase (ALT) 42 IU/L, dinormalisasi internasional rasio (INR) 1,3,
aktivitas thromboplastin (aPTT) 42 detik, BP 108/62 mmHg, dan HR 82 beats/menit.

Home drugs include carvedilol 12.5 mg 2 times/day, lisinopril 40 mg/day, furosemide 80
mg 2 times/day, spironolactone 25 mg/day, and digoxin 0.125 mg/day. What the best for
treating his ADHF?
Obat-obat yang diperoleh termasuk carvedilol 12,5 mg 2 kali per hari, lisinopril 40 mg per hari,
furosemide 80 mg 2 kali per hari, spironolactone, 25 mg per hari dan digoxin 0.125 mg per hari.
Apa yang terbaik untuk mengobati, adhf?
Jawaban :
1. Answer: C
This patient, who has ADHF, is receiving a -blocker. Although long-term -blockers can
improve HF symptoms and reduce mortality, -blockers can worsen symptoms in the short
Kasus pembelajaran klinik kardiovaskular (cv CODE 1)

term. It is recommended to keep the maintenance -blocker therapy at the same or a
slightly reduced dose compared with outpatient therapy in patients with ADHF; increasing
the -blocker dose before reaching euvolemia may acutely worsen his clinical picture. In
patients admitted with volume overload without substantial signs of reduced CO, it is
reasonable to try intravenous loop diuretics initially.
As gut edema increases, oral loop diuretics (notably furosemide) become less effective
because of decreased absorption. Nesiritide is a vasodilatory drug that can be initiated if
intravenous loop diuretic therapy fails, but because of its adverse effects and substantial
cost, it is not recommended before a trial of intravenous diuretics and other potential
therapies. Milrinone is an inotropic drug. Because of their adverse effects, inotropes are
recommended in cold and wet exacerbations only after vasodilatory medications have
failed.