Chf Nyha II-III(Indah)

8/18/2019 Chf Nyha II-III(Indah)

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CHF NYHA II-III e.c. CAD

BY

INDAH NURMAWATI

C 111 03 134

Case presentation


2/31

PATIENT IDENTITYName : Mr. A

Media! Reord : 3"#1##

A$e : #4 %ears o!d

Address : Ba&'(a&


3/31

HISTORY TAKING C)ie* omp!aint : +)ortness o* (reat) Histor% ta,in$ :

' -atient *e!t s)ortness o* (reat) sine to ee,s

a$o (e*ore admitane. D%spnea e/aer(ated (%D%spnea e/aer(ated (%atiit% and not (% eat)er )an$eatiit% and not (% eat)er )an$e. Histor% o*s)ortness o* (reat) sine *o&r %ears a$o&nontin&o&s!%. He s!ept it) &se one pi!!o. -atiento*ten a,e &p in t)e ni$)t (ea&se d%spnea.

'+ometimes t)ere2s )est pain )en d%spnea. C)estpain as *e!t in t)e !e*t )est not penetrate to (a,and pain o&!d (e !oa!ied.


4/31

HISTORY TAKING…' +e!!in$ in t)e (ot) o* !e$ sine to ee,s

a$o.'

T)ere as no *eer )eada)e.' T)ere2s no o&$) na&sea and omit. He&s&a!!% *e!t pain at t)e &pper stoma).

' Histor% o* inreasin$ mit&ration in t)e ni$)t

sine to %ears a$o more o*ten t)irst% and)&n$r%.

' Urinate and de*eate as norma!.


5/31

PAST MEDICAL HISTORYT)e patient )ae $one to t)e dotor it)

t)e same omp!aint on 00# and )ae

)ad t)erap% (&t not re$&!ar!%.T)e patient denied )ae )%pertension

dia(etes me!!it&s.


6/31

RISK FACTORHe )ae smo,ed sine )e as %o&n$

15 pa,5da%.

He as not a!o)o!i.Man #4 %ears o!d


7/31

PHYSICAL EXAMINATION 6ita! +i$n :

7 B!ood press&re : 130580 mmH$7 -&!se : 94 /5min7 Inspirator% rate : 9 /5min

7 Bod% temperat&re : 3#oC Head ;/amination :

7 ;%es : t)ere as no anemis no %anosis no iter&s7 Ne, :


8/31

PHYSICAL EXAMINATIONHeart Examination :

7 Inspetion : it&s ordis as no isi(!e

7-a!pation : it&s ordis as no pa!pa(!e

7 -er&ssion : idenin$ o* )eart sie7 A&s&!tation : re$&!ar o* I5II Heart +o&nd no m&rm&r Stomach Examination :• Inspection : normal

• Palpation : no mass, tenderness on regioepigastrium• Percussion : tympani, mild acites (+)• Auscultation : peristaltic sound (+), normal

Extremity : there as oedema preti!ial and dorsum pedis


9/31

ADDITIONAL EXAMINATIONComp!ete (!oodComp!ete (!ood

WBC : 83 / 103 5mm3

H>B : 1 $5d!

RBC : 444 / 10 5mm3

-?T : 0 / 103 5mm3

HCT : 394 @

B!ood e!etro!%te

+odi&m+odi&m : 1# mmo!5!

-otassi&m-otassi&m : " mmo!5!

C)!orideC)!oride : 83 mmo!5!

Heart enim

C : #8

CMB : 33 U5!

Troponin'T : 01 n$5m!

B!ood )emistr%B!ood )emistr%Random (!ood s&$ar Random (!ood s&$ar : 4 m$5d!astin$ (!ood s&$ar : 131 m$5d!

+>T : 98 &5!

+>-T : 1" &5!

C)o!estero! tota! : 01 m$5d!C)o!estero! HD? : 10 m$5d!

C)o!estero! ?D? : "1 m$5d!

Tri$!%seride : 03 m$5d!

-rotein tota! : #

A!(&min : #

>!o(&!in : 9Ure&m : 34

Creatinin : 0

Uri aid : 9.0


10/31

;C> :;C> : '+in&s r)%tme'+in&s r)%tme

'?atera! a!! is)emia'?atera! a!! is)emia

'?AD'?AD


11/31

ADDITIONAL EXAMINATION C)est /'ra% :

Cardiome$a!% it)

si$n o* p&!mona!edema


12/31

ADDITIONAL EXAMINATION

;)oardio$rap)% :' CH'CAD

' -H


13/31

SUGGESTION ADDITIONAL

EXAMINATIONCoronar% an$io$rap)%


14/31

DIAGNOSISCH NYHA III'I6 e. CAD

DM t%pe


15/31

MANAGEMENT /%$en : 3'4 ?5m I6D NaC! 08 @I6D NaC! 08 @ ?oop di&retis : &rosemide amp51 )o&rs5I6?oop di&retis : &rosemide amp51 )o&rs5I6

to red&e preload Aspi!ets 90 m$ 0'1'0

to preent a$$re$ate p!ate!et -!ai/ "# m$ 0'1'0

to preent prod&tion o* trom(o/ane A sop!ate!et not a$$re$ate

AC;I : Captopri! 1# m$ /1 AC;I : Captopri! 1# m$ /1 arteridi!ator and enodi!ator to red&e a*ter!oad

== sparin$ di&retis : +pirono!a,tone # m$ 1'0'0sparin$ di&retis : +pirono!a,tone # m$ 1'0'0

spesi*is anta$onist o* a!dosteronespesi*is anta$onist o* a!dosterone


16/31

MANAGEMENT... Nitrat : arsor(id 10 m$ 3/1Nitrat : arsor(id 10 m$ 3/1

6enodi!ator 6enodi!ator : to red&e: to red&e filling pressurefilling pressure

+imastatin 10 m$ 0'0'1

Atrapid ''


17/31

DISCUSSION


18/31

ORONARY ARTERY DISEASE

Coronar% arter% disease ECADF o&rs

)en t)e arteries t)at s&pp!% (!ood to

t)e )eart m&s!e Et)e oronar% arteriesF(eome )ardened and narroed.T)e

arteries )arden and narro d&e to

(&i!d&p o* a materia! a!!ed p!aG&e Ep!a,F

on t)eir inner a!!s. T)e (&i!d &p o*

p!aG&e is ,non as at)eros!erosis


19/31

-at)o$enesis: M%oardia! s&pp!%

Narro esse! (ea&se*!aG&e

ormin$ o* trom(&s (ea&se

trom(osite a$re$ation

+pasme oronaria arter%

M%oardia! reG&irements

Atiit% inrease


20/31

RISK FACTORSRISK FACTORS

Risk Factors That Cannot Be Modified:Risk Factors That Cannot Be Modified:

7 Age.Age. As %o& $et o!der %o&r ris, *or CAD inreases. As %o& $et o!der %o&r ris, *or CAD inreases.Men ris, inreases a*ter a$e 4#.Men ris, inreases a*ter a$e 4#.

Women ris, inreases a*ter a$e ##.Women ris, inreases a*ter a$e ##.

7 Family history of early heart disease.Family history of early heart disease. Heart disease dia$nosed (e*ore a$e ## in *at)er orHeart disease dia$nosed (e*ore a$e ## in *at)er or

(rot)er.(rot)er.

Heart disease dia$nosed (e*ore a$e # in mot)er orHeart disease dia$nosed (e*ore a$e # in mot)er or

sister.sister.


21/31

RISK FACTORS…RISK FACTORS…

Risk Factors That Can Be Modified:Risk Factors That Can Be Modified:

Hi$) (!ood )o!estero!Hi$) (!ood )o!estero!

Hi$) (!ood press&reHi$) (!ood press&reCi$arette smo,in$Ci$arette smo,in$

Dia(etesDia(etes

erei$)t or o(esit%erei$)t or o(esit%

?a, o* p)%sia! atiit%?a, o* p)%sia! atiit%


22/31

C?INIC +YNDRM CAD :

An$ina -etoris

In*ar, Mio,ard7 Non' ae7 ae


23/31

CONGESTIVE HEART FAILURE

(CHF)

Con$estie )eart *ai!&re ECHF is anCon$estie )eart *ai!&re ECHF is an

im(a!ane in p&mp *&ntion in )i) t)eim(a!ane in p&mp *&ntion in )i) t)e

)eart *ai!s to maintain t)e ir&!ation o*)eart *ai!s to maintain t)e ir&!ation o*(!ood adeG&ate!%.(!ood adeG&ate!%.


24/31

W)en ardia o&tp&t (eame

inadeG&ate to *&!! *i!! t)e reG&irement o*

meta(o!ism )eart o&!d ma,eme)anism o* ompensation. B&t )en

t)e me)anism )ae (een &se

ma/ima!!% and ardia o&tp&t sti!!inadeG&ate t)en s%mptoms o* )eart

*ai!&re o&!d (e arise.


25/31

NYHA la!"!ca#!$% $" Hea

YHA la!"!ca#!$% $" Hea

Fa!l'&e

a!l'&e

II No s%mptoms and no !imitation in ordinar%No s%mptoms and no !imitation in ordinar%p)%sia! atiit%.p)%sia! atiit%.

IIII Mi!d s%mptoms and s!i$)t !imitation d&rin$Mi!d s%mptoms and s!i$)t !imitation d&rin$ordinar% atiit%. Com*orta(!e at rest.ordinar% atiit%. Com*orta(!e at rest.

IIIIII Mar,ed !imitation in atiit% d&e toMar,ed !imitation in atiit% d&e tos%mptoms een d&rin$ !ess't)an'ordinar%s%mptoms een d&rin$ !ess't)an'ordinar%atiit%. Com*orta(!e on!% at rest.atiit%. Com*orta(!e on!% at rest.

I6I6 +eere !imitations. ;/perienes s%mptoms+eere !imitations. ;/perienes s%mptomseen )i!e at rest.een )i!e at rest.


26/31

T(e F&a)!%*(a) c&!#e&!a "$& HF

(e F&a)!%*(a) c&!#e&!a "$& HF

CHF considered present if two major or one major pls two minor criteriaCHF considered present if two major or one major pls two minor criteria

are flfilledare flfilled

Major CriteriaMajor Criteria

!aro"ysmal noctrnal dyspnoea!aro"ysmal noctrnal dyspnoea #eck $ein distension#eck $ein distension

RalesRales

Radiographic cardiomegalyRadiographic cardiomegaly Acte plmonary oedemaActe plmonary oedema %& gallop%& gallop Hepatojglar refl"Hepatojglar refl" Circlation time ' () secondsCirclation time ' () seconds

*eight loss*eight loss +.) kg in ) days in response to treatment of CHF+.) kg in ) days in response to treatment of CHF !lm.oedema, $isc. congestion or cardiomegaly at atopsy!lm.oedema, $isc. congestion or cardiomegaly at atopsy


27/31

T(e F&a)!%*(a) c&!#e&!a "$& HF

(e F&a)!%*(a) c&!#e&!a "$& HF

Minor riteria Bi!atera! an,!e oedema

Not&rna! o&$) D%spnoea on e/ertion

Hepatome$a!%

-!e&ra! e**&sion

Heart rate ≥ 10 (pm


28/31

Ma%!"e#a#!$% $" LHFMa%!"e#a#!$% $" LHF

BrainBrain

restlessness,restlessness,

anxiety, generalizedanxiety, generalizedfatigue.fatigue. Kidney Kidney

low urine output withlow urine output withsubsequent fluidsubsequent fluidretention, highretention, highafterload due to RAAafterload due to RAA

cascade activation,cascade activation,kidney failure.kidney failure.

yspneuyspneu coughcough

!orward effects!orward effects Backward effectsBackward effects


29/31

Ma%!"e#a#!$% $" RHFMa%!"e#a#!$% $" RHF

"eripheral subcutaneous tissue"eripheral subcutaneous tissue

#iver #iver

"ortal syste$"ortal syste$

%pleen%pleen

!orward effects!orward effects Backward effectsBackward effects

"eripheral tissue hypoxia"eripheral tissue hypoxia

ue to low cardiac outputue to low cardiac outputcaused by failure to delivercaused by failure to deliver

enough blood to left atriu$enough blood to left atriu$


30/31

TREATMENTS…

MANA>IN> CNTRACTI?ITY

MANA>IN> -R;?AD MANA>IN> AT;R?AD

N;URHRMNA?

MDU?ATIN


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Documents

Chf Nyha II-III(Indah)