Beruflich Dokumente
Kultur Dokumente
Pendrik Tandean
I N T R O D U C T I O N(1)
Heart failure is the inability of the heart to maintain cardiac
output to support metabolic demands of the body.
The decrease in cardiac output resulting in reduced effective
blood volume.
Clinical manifestations of
heart failure consists of
various hemodynamic
response, renal, neural, and
hormonal abnormalities.
Reflex of homeostasis/compensation
mechanism :
Neurohormonal changes
Ventricular dilatation
Frank-Starling mechanism.
I N T R O D U C T I O N(2)
20 million people
The prevalence of heart failure in the
adult population in developed countries is
2%.
The prevalence of heart failure : increases
with age, and occurs in 6-10% of parents
at the age of 65 years.
Incidence of heart failure was lower in
women than in men
The overall prevalence of heart failure is
expected to increase
Anamnesis
Mr. M, Men, 61 y.o, admitted to ER (Januari 22nd, 2014) with chief complain
shothness of breath, since 1 week ago and worsening 1 day ago, intermittent,
DOE (+), PND (+). patients feel claustrophobic if the move where previously
activity is never compromised patients, patients slept with 2 pillows. During
the last month patient feel tired easily, always feel weak, and spent a longer
time to rest so that productivity decreases.
Date Here
Anamnesis (2)
Micturation and defecation normal, as usual.
There is history of Coronary Disease since 4 months ago,
but the patient did not take a medicine and go to the
doctor.
History of Hypertension since 3 years ago, but the patients
didnt take medicine regularly
History of Smoking, one pack daily.
History of DM (-)
Physical Examination
(1)
Thorax
Lung
Inspection : looks symmetrical, does not seem respiratory lag,
Palpation : No tumor mass, between the ribs is not widened, tactile
fremitus normal, resonant percussion. Vesicular breath sounds on
auscultation, Rales : both of lung bases.
Cardiac
Inspection ictus cordis does not appear and was not palpable, Normal
Impression of heart border, Heart Sound I / II regular, Murmur (-)
Physical Examination(2)
Abdominal
Insp : Ascites -/Palp : Liver and spleen : No enlargement.
Perc : Tympani.
Ausc : Peristaltic Normal.
Extremity
Edema -/Warm acral
Laboratory Exam
WBC
7,5 103/mm3
Eritrosit
Hb
16,0 g/dl
HCT
46,6 %
MCV
97 m3
MCH
31,1 pg
MCHC
32,2 g/dl
RDW
15,2 %
PLT
182 103/mm3
MPV
7,7 m3
NEU
61,4 %
LYM
26,4 %
MON
5,7 %
EOS
3,3 %
BAS
3,2 %
Total Cholesterol
LDL
HDL
TG
CK
CKMB
Troponin T
Uric Acid
HbsAg
PT
INR
aPTT
GDS
Ureum
Creatinine
SGOT
SGPT
Natrium
Kalium
Chlorida
167 mg/dl
27 mg/dl
140 mg/dl
85 mg/dl
121 U/L
16 U/L
< 0,002
9,4 mg/dl
Reaktif
12,7 control 10,0
1,09
34,9 control 23,7
112 mg/dl
40 mg/dl
1,3 mg/dl
21 U/L
18 U/L
145 mmol/l
3,6 mmol/l
115 mmol/l
ECG
Sinus Rhytm, HR 103x/m, Axis +170 , P wave 0,08 s, QRS complex 0,08 s, PR Interval 0,16 s, QS Configuration V1V4,
Conclussion : Sinus Tachycardia, RAD, OMI Anteroseptal
Chest Radiology
Dilatation of hillus,
parahillar, and suprahillar
both of lung
No spesific both of lung
Cor : CTI 0,57 aorta
dilatation
Normal Sinus and
diaphragm
Intact bone
Conclussion :
Cardiomegaly with
pulmonary congestion.
Aorta dilatation
Echocardiography
Conclussion :
Sistolic and Diastolic
dysfunction LV, EF 29 %
Dilatation of LA and LV
Anterior akinetic
anterior, anteroseptal.
Hipokinetic in the other
segment
MR severe
AR trivial
Working Diagnosis
CHF Nyha III ec CAD
Hyperuricemia
HBV
M
A
N
A
G
E
M
E
N
T
DISCUSSION
ThemeGallery
is a
Systolic heart
failure is the
Design
Digital
inability of the
heart
to Content
pump &
mall of
developed
so that the Contents
contraction
the
by Guild Design Inc.
heart
decreases
and
weakness,
fatigue,
and
decreased physical activity
abilities and other symptoms
of hypoperfusion.
ETIOLOGY
Myocardial disease
Pressure
overload,
such
as
hypertension, aortic stenosis, aortic
coartasio.
Volume Overloaded, such as aortic or
mitral insufficiency, congenital heart
disease (left to right shunt) or
excessive transfusion.
Barriers charging, such as constrictive
pericarditis or tamponade.
PATHOPHYSIOLOGY
SIGN AND
SYMPTOMS
FRAMINGHAMS CRITERIA
MAJOR
MINOR
Extremity edema
Nocturnal cough
Dyspnea d' effort
Hepatomegaly
Pleural effusion
Decrease in vital capacity 1/3 of the normal
Tachycardia ( > 120 beats / min)
Major or minorWeight loss 4.5 kg in 5 days of
treatment. Diagnosis of heart failure confirmed at
least 1 major criteria and 2 minor criteria
ACUTE CHF
Lab finding
increase RBC
decrease in PO2
Acidosis on blood gas analysis
ECG :
tachycardia ( except those already treated ).
ischemic
impaired ventricular conduction function,
left bundle - branch block ( LBBB ),
changes in the ST segment and T wave
Sign :
Typical symptoms of pulmonary edema : dyspnea,
orthopnea, tachypnea, cough with frothy sputum,
sometimes hemoptysis.
Output of symptoms : tachycardia, hypotension and
oliguria
Angina pectoris on myocardial infarction .
Impaired left ventricular function are severe , it can be
found pulsus alternans.
Cardiogenic shock
Chest X-Ray
Cardiomegaly, signs of lung dam
Pleural Effusion
MANAGEMENT
ACUTE
CHF
Decrease
ventricular filling
pressure