L.TOBING SpA(K) PRESENTER: GOUTHAMI KATAN DCM is characterised by left ventricular systolic dysfunction, with an increase in mass and volume Develops at any age, in either sex and ethnic origin More common in men
More in black people CLASSIFICATION DCM PRIMARY FAMILIAL AND GENETIC SECONDARY TOXICITY RELATED SIGNS AND SYMPTOMS HEART FAILURE PERIPHERAL OEDEMA TACHYCARDIA MURMURS INVESTIGATIONS Generalised enlargement Dilation of the left ventricle with poor global contraction functions diffuse, non-specific ST segment & T wave changes , sinus tachycardia, arrhythmias ROLES OF TREATMENTS Relieve symptoms Retard disease progression Prevent complications CASE REPORT AAM,, 14 years Date of Admission: April 29 th 2014 HISTORY PREVIOUS ILLNESS Cardiomyopathy and minimal pulmonary embolus PREVIOUS MEDICATIONS Propranolol, Aldactone, Digoxin LABOR Normal delivery, cried as soon as baby was born, no cyanosis HISTORY GROWTH AND DEVELOPMENT Suitable with toddler in same age IMMUNIZATION Complete PRESENT STATUS Sensorium : Alert Temperature : 37,5C Heart Rate : 110 bpm, regular, murmur (-),soft heart sound Respiratory Rate : 72 x/minute, regular, rales (-) Blood Pressure : 80/50 mmHg Weight : 28 kg BW/A= 53% severe malnutrition Height : 146 cm BH/A = 90% normal Nutrition Status : BW/BH = 71% Severe malnutrion Dyspnea, cyanosis, icteric, anemic, and edema were not present LOCALIZED STATUS SKIN Pale HEAD Old man face EYES Light reflex (+/+), pupils was isochoric Pale conjungtiva palpebra inferior (+/+) E/N/T Normal in appearance NECK No enlargement of lymph nodes THORAX Symmetrical fusiform, retraction(+) epigastrial, distinct intercostal space. HR: 110 bpm, reglar,murmur (-), soft heart sound RR: 72rpm, regular, rales (-/-) ABDOMEN Soft, peritalsis (+) N, liver and spleen not palpable
EXTREMITIES Pulse 110 bpm, reglar, p/v was adequate , warm extremities , CRT < 3 GENITAL , normal in appearance. CHF ec dilated cardiomyopathy + moderate MR +mild TR +minimal PE + severe malnutrition Working diagnosis Total bed rest, semi fowler position, O2 , IVFD D5% , INJ.Lasix, Propranolol, Aldactone, Digoxin, Multivitamin tanpa Fe, Lacfolac syrup, Folic acid, Diet F75 + mineral mix, Balance cairan Management Laboratory finding on April 27 th 2014 Complete Blood Count (CBC) Hematology Unit Result Reference Hemoglobin (HGB) g% 11.6 12.0-14.4 Erythrocyte (RBC) 10 6 /mm 3
351 150-450 MCV fL 77.4 75-87 MCH Pg 25.7 25-31 MCHC g% 33.2 33-35 RDW % 18.0 11.6-14.8 MPV fL 6.14 7.0-10.2 Difftel Count Neutrofil % 61.17 37-80 Limfosit % 26.4 20-40 Monosit % 11.8 2-8 Eosinofil % 0.113 1-6 Basofil % 0.01 0-1 April 30 th - Mei 2 nd , 2014 S : shortness of breath (+), fever (+), cough (+), pale (+) O: Sens: alert, Temp: 37-37.6 o C. Body weight : 28 kg. Head Eyes: light reflex: (+/+), pupils were isochoric, no pale of conjunctiva palpebra inferior; Ear/nose/mouth: normal in appearance Neck Enlargement of lymph nodes (-) Thorax Symmetrical fusiform, no epigastrial retraction HR: 108 bpm, regular, murmur (+) soft heart sound RR: 60rpm, regular, rales (-/-) Abdomen Soft, peristaltic (+) normal, liver/spleen: not palpable Extremities Pulse 108 bpm, regular, p/v was adequate, warm extremities, CRT <3 BP: 90/70 mmHG, hypotrophy muscle (+),loss of subcutaneous fat (+), A : CHF ec dilated cadiomyopathy +moderate MR + mild TR + minimal PE + severe malnutrition P : Total bed rest + Semi fowler position IVFD D5%k O2 Inj.lasix Propranolol Aldactone Digoxin Multivitamin tanpa fe Vitamin A Lacfolac syrup F75 diet 250cc/ 3 h/ oral) + 5cc mineral mix
Mei 2 nd - Mei 6 th , 2014 S : shortness of breath (+), fever (-), cough (+), pale (+) O: Sens: alert, Temp: 37-37.1 o C. Body weight : 28 kg. Head Eyes: light reflex: (+/+), pupils were isochoric, no pale of conjunctiva palpebra inferior; Ear/nose/mouth: normal in appearance Neck Enlargement of lymph nodes (-) Thorax Symmetrical fusiform, no epigastrial retraction HR: 104 bpm, regular, murmur (+) soft heart sound RR: 62rpm, regular, rales (-/-) Abdomen Soft, peristaltic (+) normal, liver/spleen: not palpable Extremities Pulse 104 bpm, regular, p/v was adequate, warm extremities, CRT <3 BP: 90/70 mmHG, hypotrophy muscle (+),loss of subcutaneous fat (+), A : CHF ec dilated cadiomyopathy +moderate MR + mild TR + minimal PE + severe malnutrition P : Total bed rest + Semi fowler position IVFD D5%k O2 Inj.lasix Propranolol Aldactone Digoxin Multivitamin without fe Vitamin A Lacfolac syrup F75 diet 250cc/ 3 h/ oral) + 5cc mineral mix
Mei 7th Mei 8th , 2014 S : shortness of breath (+), fever (-), cough (+), pale (+) O: Sens: alert, Temp: 37-37.1 o C. Body weight : 28 kg. Head Eyes: light reflex: (+/+), pupils were isochoric, no pale of conjunctiva palpebra inferior; Ear/nose/mouth: normal in appearance Neck Enlargement of lymph nodes (-) Thorax Symmetrical fusiform, no epigastrial retraction HR: 104 bpm, regular, murmur (+) soft heart sound RR: 62rpm, regular, rales (-/-) Abdomen Soft, peristaltic (+) normal, liver/spleen: not palpable Extremities Pulse 104 bpm, regular, p/v was adequate, warm extremities, CRT <3 BP: 90/70 mmHG, hypotrophy muscle (+),loss of subcutaneous fat (+), A : CHF ec dilated cadiomyopathy +moderate MR + mild TR + minimal PE + severe malnutrition P : Total bed rest + Semi fowler position IVFD D5%k O2 Inj.lasix Propranolol Aldactone Digoxin Multivitamin without fe Folic Acid Lacfolac syrup F100 diet 200cc/ 3 h/ oral) + 4cc mineral mix
Mei 9th Mei 10th , 2014 S : shortness of breath (), fever (-), cough (+), pale (+) O: Sens: alert, Temp: 36.9-37 o C. Body weight : 28 kg. Head Eyes: light reflex: (+/+), pupils were isochoric, no pale of conjunctiva palpebra inferior; Ear/nose/mouth: normal in appearance Neck Enlargement of lymph nodes (-) Thorax Symmetrical fusiform, no epigastrial retraction HR: 98 bpm, regular, murmur (+) soft heart sound RR: 30rpm, regular, rales (-/-) Abdomen Soft, peristaltic (+) normal, liver/spleen: not palpable Extremities Pulse 98 bpm, regular, p/v was adequate, warm extremities, CRT <3 BP: 90/70 mmHG, hypotrophy muscle (+),loss of subcutaneous fat (+), A : CHF ec dilated cadiomyopathy +moderate MR + mild TR + minimal PE + severe malnutrition P : Total bed rest + Semi fowler position IVFD D5%k O2 Inj.lasix Propranolol Aldactone Digoxin Cotrimoxazole Multivitamin without fe Folic Acid Lacfolac syrup F100 diet 200cc/ 3 h/ oral) + 4cc mineral mix
DISCUSSION DCM is a disease that develops at any age, sex or ethnics. In this case, the patient is a 14 years old Indonesian girl. DISCUSSION DCM is a disease that develops at any age, sex or ethnics. In this case, the patient is a 14 years old Indonesian girl. DISCUSSION Diagnosis of DCM is primarily on echocardiography to evaluate the heart looking for dilated chambers and pump function. In this case, the patients Echo showed that there is a chamber enlargement and minimal pulmonary embolus . DISCUSSION Diagnosis of DCM is primarily on echocardiography to evaluate the heart looking for dilated chambers and pump function. In this case, the patients Echo showed that there is a chamber enlargement and minimal pulmonary embolus . DISCUSSION Patients with DCM usually have sign symptoms of heart failure. Common types of medication used to treat CHF is diuretics, inotropic agens and beta blockers In this case, the patient are diagnosed with CHF caused by DCM and taking diuretics, inotropic agents and beta blockers. NUTRITIONAL STATUS Severe malnutrition. The calories target for this patient, female, 14 years with body weight 28 kg, body height 146cm, and height age 11 years is 2220 kkal (RDA based on height age X ideal body weight) Managed by giving F75 and gradually changed to F100 until switched to reguler diet to achieved her calorie targets
PROGNOSIS Although DCM can be reversed with proper treatment but many progresses to heart failure. Higher mortality rate is associated with age, sex and severity In this case, the patient have a bad prognosis due to severity of her heart failure.
The patient was discharged from hospital on 12 th of Mei due to some personal reasons. SUMMARY This paper reports a case of dilated cardiomyopathy of a 14 year old female. Diagnosis is made by patient history, clinical features and echocardiography. This patient is treated with diuretics, beta blockers and inotropic agents It is important for her to have good health practices to improve her quality of life PERTANYAAN FLASHBACK? SESAK CARDIO /NON CARDIO HARUS DISINGKIRKAN KELAINAN PARU DCM X ADA MURMUR, SESAK BERAT, PALING SERING INFEKSI VIRUS BISA SUDDEN DEATH!!!!!!!! MEDIKAMENTOSA PENTING!!!