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

HYPERTENSION
HEART DISEASE
Presented by :
Wan Hani Nadiah Binti Wan Jusof C11112850
Ummi Asyiqin Binti Kamil C11112851
Nur Izzati Binti Adli C11112854
Nurul Nabilah Azra Binti Nor Azlan C11112863

Supervisor :
Prof. Dr. Peter Kabo, PhD, SpFK, SpJP(K), FIHA, FAsCC

Department of Cardiology and Vascular Medicine

Medical Faculty of Hasanuddin University
Makassar 2017
 PATIENT IDENTITY

Name : Mrs.N
Age : 56 years old (22/12/1960)
Gender : Male
MR : 264798
Day of Admission : 12th January 2017
 HISTORY TAKING
Chief Complaint : Shortness of breath

Patient was admitted into the hospital with chief complaint shortness
of breath . He has been experiencing this since 10 years ago and
worsened in the past 1 week before admitted into the hospital .
Before this patient faces difficulty breathing in the middle of night
and during activity. It has been 1 year since he left his workplace
and only do the minimal activites.
History of chest pain (+)
History of fever, coughing (-)
History of smoking (+), 5 years ago
 Past
Past Medical
Medical
History
History
History of hypertension (+), >20 years, routinely
consume Amlodipine 5 mg/day.
History of heart disease (+) since 2007. Had
been diagnosed with Coronary Artery Disease
and Congestive Heart Failure on May 2016.
History of same complain (+). 2 times (2007 and
2016)
History of DM (-)
History of dislipidemia (+)
History of hyperuricemia (+)
History of stroke (-)
Family History

History of hypertension in family (+)

History of heart disease in family (+)
General Status
Moderate illness/ Underweight / Conscious
Nutritional Status: Underweight
Weight : 37 kg
Height : 158 cm
BMI : 14.8 kg/m2

Vital Sign

Blood Pressure : 130/80 mmHg

Pulse Rate : 100 bpm
Respiratory Rate : 42 tpm
Temperature : 36.5 0C (axilla)
 PHYSICAL
PHYSICAL EXAMINATION
EXAMINATION

Head
Head and
and Neck
Neck Examinations
Examinations
Eye
Eye ::Conjunctiva
Conjunctivaanemic
anemic(-/-),
(-/-),Sclera
Scleraicteric
icteric
(-/-)
(-/-)
Lip
Lip ::Cyanosis
Cyanosis(-)
(-)
30
Neck Chest
::JVP Examination
Neck ChestJVPRR+3
+3cmHO
cmHOposition
Examination position30
Inspection
Inspection ::Symmetric
Symmetric between
betweenleft
leftand
andright
right
chest.
chest.
Palpation
Palpation ::NoNomass,
mass,no
notenderness.
tenderness.
Percussion
Percussion ::Sonor
Sonorbetween
betweenleft
leftand
andright
right
chest,
chest, lung-
lung-
liver
liverborder
borderininICS
ICSIV
IVright
right
anterior.
anterior.
Auscultation:
Auscultation:Respiratory
Respiratorysound
soundVesicular
Vesicular

Additional
Additionalsound
sound::Ronchi
Ronchi+/+
+/+(basal),
(basal),
Wheezing
Wheezing-/--/-
 Inspection : Thrill was visible
Palpation : Thrill was palpable
Percussion :Right heart border in right
parasternal line, Left heart
border
in left midclavicular line
ICS V.
Heart Auscultation : Heart Sounds : S I/II regular,
systolic murmur 4/6 at apex

Inspection : Flat
Auscultation : Peristaltic sound (+), normal
Palpation : No mass, no tenderness, liver
& spleen
unpalpable
Percussion : Tympani(+)
Abdomen

Pretibial edema -/-

Extremiti
Dorsal pedis edema -/-

es
ECG
ECG INTERPRETATION
INTERPRETATION
 RADIOLOGY FINDINGS

-Cardiomegaly with the sign of

pulmonary edema
-Dilatation and atherosclerosis of aorta
 LABORATORIUM
HEMATOLOGY RESULT NORMAL VALUE UNIT

WBC 12.27 4,00-10,0 (10/UI)

RBC 4.83 4,00-6,00 (106/UI)

HGB 11.6 12,0-16,0 (gr/dL)

HCT 35.6 37,0-48,0 (%)

PLT 388 150-400 (103/uL)

GDS 89 140-200 mg/dL

Ureum 86 10-50 mg/Dl

Creatinin 2.46 <1,3 mg/dL

URIC ACID 5,3 3,4-7,0 mg/dL
SGOT 25 <41 mmol/L

SGPT 23 <38 mg/dL

PT 11.0 10-14 detik

APTT 28.5 22-30 detik

CK 31.0 <190 U/L

CK-MB 13.5 <25 U/L

Troponin I 0.03 <0.01 ng/ml

Sodium 127 136-145 mmol/L

Potasium 4.0 3.5-5.1 mmol/L

Chloride 96 97-111 mmol/L

ECHOCARDIOGRAPHY
Date : 16/1/2017
-Systolic function of left ventricle
decrease
-Ejection fraction : 52%
-Dilatation of left atrium and left
ventricle
-Eccentric left ventricle
hypertrophy
-Hypokinetic segmental
-Severe mitral
regurgitation,prolaps AML
-Moderate aorta regurgitation
-Left ventricle diastolic dysfunction
grade III
-Mild pulmonal hypertension
 Working
Diagnosis

Hypertension Heart
Disease
Congestive Heart
Failure NYHA III
Mitral Regurgitation
 MANAGEMENT
Bed rest
Oxygen 3 lpm via nasal canule
Cardiac diet
IVFD NaCI 0.9%
500 cc/24 hrs/iv
Diuretic :
Furosemide 20mg/24hr/iv
Angiotensin-receptor blocker : Anti-angina :

Valsartan 80mg/24hr/oral Isosorbid dinitrate

5mg/if
needed/sublingual
Lansoprazole

30mg/24 hrs/iv
Fluid restriction
DISCUSSION
 Epidemiology
The Health Examination Survey (HES) found an
estimated 17.0 million adults in the United States
to have definite hypertension and 10.5 million
adults to have definite hypertensive heart
disease (HHD), in addition to those persons with
borderline or suspect forms of these diseases .
At United States in 2005 was 35.3 million for men
and 38.3 million for women
Systolic BP increases with age;
Man >> woman until reach menopause, when
their BP rises more sharply and reaches levels
higher than in men
 HYPERTENSION
Definition: the blood pressure
elevation to a level that places
the patient at an increased risk
for heart failure, stroke, kidney
failure and retinal damage.
The excessive pressure on
artery walls caused by high
blood pressure can damage
blood vessels, as well as
organs in your body.
The higher your blood pressure
and the longer it goes
uncontrolled, the greater the
damage.
 Cardiovascular and
Hypertension
Uncontrolled and prolonged elevation
of blood pressure can lead to a
variety of changes in the myocardial
structure ,coronary vasculature, and
conduction system of the heart.
 These changes in turn can lead to:
Development of left ventricular hypertrophy
Coronary Artery Disease
Various conduction system diseases
Systolic and diastolic dysfunction of the
myocardium
Complications that can manifest clinically as
angina or myocardial infarction ,cardiac
arrhythmias and congestive heart failure.
Hypertension Heart Disease

Hypertension Heart Disease is a

constellation of abnormalities
including coronary artery
disease, left ventricular
hypertrophy (LVH), systolic and
diastolic dysfunction, and their
clinical manifestations including
arrhythmias, conduction
abnormalities and symptomatic
heart failure, that are caused by
the direct or indirect effects of
elevated BP.
Hypertension Heart Disease

Include:
Left Ventricular

hypertrophy
Left Ventricular dysfunction

: Diastolic and systolic

Heart Failure

Arrhythmia , conduction

abnormalities
CHD
 Etiology
The aetiology of HHD is a very complex interplay of
various hemodynamic, structural, neuroendocrine ,
cellular, and molecular factor.
These factors play integral roles in the development
of hypertension and its complications; elevated BP
itself can modulate these factors.
Obesity has been linked to hypertension and LDH
in various epidemiologic studies.
50% of obese patients are having some degree of
hypertension ; 60-70% of patients with
hypertension being obese.
Hypertension that progressive to
Heart Failure
 Patient History
Symptoms of hypertensive heart disease
depend on the duration, severity, and type of
disease.
Patient may or may not be aware of the
presence of hypertension, which is why
hypertension has been named "the silent killer.
LVH - totally asymptomatic
Heart Failure exertional/non-
exertional,orthopnea,PND,fatigue,ankle edema
Myocardial Ischemia angina pectoris
Cardiac Arrhythmias palpitation ,syncope, sudden
cardiac death
 Physical
Examination
Pulses if the patients in af, pulse vol decreased in ptn with LV
dysfunction.
Blood Pressure - Systolic and/or diastolic BP is elevated
(>140/90mm Hg). Mean BP and pulse pressure are also elevated
generally.
Veins Jugular Veins may be distended ( Heart failure)
Heart s2, s4 heart sound can be heard.
Lungs sign of pulmonary congestion ( rales, decreases breath
sounds)
Abdomen - may reveal a renal artery bruit ( secondary
hypertension )
Extremities ankle edema ( advanced heart failure)
Staging of Hypertension
 Laboratory
Studies
Urinalysis
Blood Glucose and haematocrit levels
Serum potassium, creatinine and calcium
measurements
Lipid profile after a 9-12 hour
HDL/LDL/Triglycerides
Additional Test
Chest Radiographs
Electrocardiogra
phy
Echocardiography
 Managements
1) Blood Pressure Goals :
 Lifestyle
Modification
Smoking Cessation
Control blood glucose and lipids
Diet
Eat healthy (i.e., DASH diet)
Moderate alcohol consumption
Reduce sodium intake to no more than 2,400 mg/day
Physical activity
Moderate-to-vigorous activity 3-4 days a week
averaging 40 min per session.
Pharmacotherap

hy
The treatment of hypertension and hypertensive
heart disease can involve the following classes
of antihypertensive medications:
Thiazide diuretics
Beta blockers and combined alpha and beta
blockers
Calcium channel blockers
Angiotensin-converting enzyme (ACE) inhibitors
Angiotensin-receptor blockers (ARBs)
Direct vasodilators - Such as hydralazine
 Prevention of HHD
Monitoring and preventing your blood
pressure from getting too high
Eating a healthy diet and monitoring
stress levels
Maintaning a healthy weight, getting
adequate sleep
Exercising Regularly