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Congestive Heart Failure (CHF)NYHA II e.c Coronary Arterial
Disease
Supervisor:dr. Abdul Hakim Alkatiri, Sp.JP, FIHA
PRESENTED IN THE CONTEXT OF THE CLERKSHIP
CARDIOVASCULAR DEPARTMENT
MEDICAL FACULTY
HASANUDDIN UNIVERSITY2013
Presented by:
Eka Budi Prasetya C11108130
CASE REPORT CARDIOLOGY DEPARTMENT
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PATIENTS IDENTITY
Name : Mr. A
Age : 63 years old
Gender : Male
MR : 600089
Day of Admission : 20/3/2013
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HISTORY TAKING
CHIEF COMPLAINT: Breathing difficulty Anamnesis:
It was felt since 1 year ago and got worsen 2 weeks beforeadmitted to the hospital. It was experienced while doingminimal activity such as walking to the bathroom and relieved
with resting. There is complain of sudden shortness of breathduring night time that cause her to be awaken. The patientalso complains chest pain, felt on the left side of the chestwith the characteristics ofheavy feeling on the chest, durationof pain was < 30 minutes, did not radiate to the left arm andto the back. The pain exacerbates with exercise and lessen
with rest. Dyspnea on effort (+), Orthopnea (-), ParoxysmalNocturnal Dyspnea (+), Cough (+) intermittent since 1 yearago with sputum of white coloured. Fever (-) Nausea (-) Vomit(-) Palpitation (-), Cold sweats (+). Defecation and urination:normal.
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PAST MEDICAL HISTORY
History of diabetes (-)
History of hypertension (+) since 4 years ago
with controlled therapy.
History of dyslipidemia is denied.
History of hyperuricemia (+)
History of smoking (+) since 45 years ago but
stopped 1 month before admitted to thehospital. 1 box per day.
History of asthma (+)
History of cardiovascular disease in family (-)
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RISK FACTORS
Non-modified
Gender:Male
Age > 45years old
Modified
Cigarettesmoking
Hipertension
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PHYSICAL EXAMINATION
General Status:
Moderate illness/ Well nourished/ Conscious
Nutritional Status: Normal (BMI: kg/m)
Weight : 60 kg BMI: 23.4 kg/m2
Height : 160 cm
Vital Signs:
Blood Pressure : 130/60 mmHg
Pulse Rate : 80 bpm
Respiratory Rate : 25 bpm
Temperature : 36.7 0C
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Head and Neck Examinations:
Eye : Conjunctiva anemic (-/-), Sclera icteric (-/-)
Lip : Cyanosis (-)
Neck : JVP R +2 cmHO
Chest Examination
Inspection : Symmetric between left and right chest. Palpation : No mass, no tenderness.
Percussion : Sonor between left and right chest,lung-liver border in ICS IV right anterior.
Auscultation: Respiratory sound: Vesicular
Additional sound :Ronchi +/+,Wheezing /-
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Cardiac Examination
Inspection : Heart apex was not visible
Palpation : Heart apex was not palpable
Percussion : Right heart border in rightparasternal line, left heart
border in left midclavicularline ICS V.
Auscultation : Heart Sounds : S I/II regular,murmur (-) gallop(-)
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Abdominal Examination
Inspection : Flat, follows breathingmovement
Auscultation : Peristaltic sound (+), normal
Palpation : No mass, no tenderness, no
palpable liver or spleen. Percussion : Tympani (+)
Extremities Examination Pretibial edema -/-
Dorsal pedis edema -/-
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ECG Interpretation
Rhythm : Sinus rhythm
HR / QRS rate : 75 bpm
Axis : Normoaxis
Regularity : Regular
P wave : 0.08 s (N: 0.08-0.11 s)
PR interval : 0.12 s (N: 0.12-0.20 s)
QRS complex : 0.08 s (N: 0.06-0.11 s)
Q pathologies : II, III, AFV ST segment : Normal
T wave : T inverted V1-V3
Conclusion : Sinus rhythm, HR 75 bpm, OMI
inferior.
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Conclusion:
-Cardiomegaly
(CTI= >0.5)
-Dilatatio et Elongatioaortae
CHEST X-RAYS 20/3/2013
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LABORATORY FINDINGS
WBC 11.35 x 10/uL GOT 110 U/L
RBC 4.41 x 10/uL GPT 43 U/L
HB 12.8 g/dL Electrolytes (Na, K, Cl) 137, 4.0, 137 mmol
HCT 40.4 % Total Cholesterol 186 mg/dL
PLT 309 x 10/uL LDL Cholesterol 131.6 mg/dL
GDS 73 mg/dL Triglyceride 72 mg/dL
Ur 31 mg/dL HDL Cholesterol 40 mg/dL
Cr 1,2 mg/dL Uric Acid 9.1 mg/dL
Troponin T 1722
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ECHOCARDIOGRAM 27/2/2013
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MANAGEMENT
O2 5 lpm
IVFD NaCl 0.9%
10 dpm
Inj. Furosemide 40
mg/12 jm/ IV
Fasorbid 10 mg 1-
1-1
Aspilet 80 mg 0-1-
0
Captopril 12,5 mg1-1-1
Alprazolam 0.5 mg
0-0-1
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DISCUSSION
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DEFINITION
Heart is no longer able to
pump an adequate supply ofblood in relation to the venous
return and in relation to the
metabolic needs of the body
tissues at the particular moment
Heart Failure
The state in which abnormal
circulatory congestion occurs as
the result of heart failure.
CongestiveHeart Failure
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Other Causes
Arrhythmias
Valvular heart disease
Congenital heart disease
Pericardial diseaseHyperdynamic circulation
Alcohol and
drugs(chemotherapy)
Main Causes
Ischemic heart disease(35%-40%)
Cardiomyopathy(dilated)
(30-40%)Hypertension ( 15-20%)
Etiology of
Heart Failure
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Major Criteria Minor Criteria
Paroxysmal Nocturnal Dyspnea
Cardiomegaly
Gallop S3
Hepatojugular reflux
Increased of JVP
Rales or ronchi
Acute pulmonary edema
Prolonged circulation time(> 25 sec)
Weigh loss 4,5 kg in 5 days in
response to treatment of CHF
Extremity edema
Nocturnal cough
Decreased vital pulmonary
capacity (1/3 of maximal)
Hepatomegaly
Pleural effusion
Tachycardia ( 120bpm)
Dyspnea deffort
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Classification of CHF
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Pathophysiology of CHF
Plaque incoronary artery
Blood flow toheart muscle isreduced. Heart
muscle lacking of
oxygen
Ischemia of heartmuscle can lead to
myocardialinfarction
The heart musclecant pumpadequately
Pulmonary edemaAbnormal Heart
rhythm
SymptomaticCongestive Heart
Failure
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Treatment of CHF
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CAD
CAD
ACS
UAP NSTEMI STEMI
StableAnginaPectoris
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Definition
Acute myocardial infarction (AMI) is an
irreversible necrosis of heart muscle due to
prolonged ischemia, which is suddenly
happened.
Imbalance in oxygen supply and demand, which
is most often caused by plaque rupture with
thrombus formation in a coronary vessel,
resulting in an acute reduction of blood supply toa portion of the myocardium.
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DIAGNOSIS
WHO Diagnostic Criteria:
Clinical history of ischemic type chestpain lasting >20 minutes.
Changes in serial ECG tracings.
Rise and fall of serum cardiac biomarkerssuch as creatinine kinase-MB fraction andtroponin.
Oxford Handbook of Clinical Medicine 6thEdition
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CLINICAL MANIFESTATIONS
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MANAGEMENT
Coronary Heart Disease in Clinical Practice
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THANK YOU