View
226
Download
0
Category
Preview:
Citation preview
8/10/2019 Congestive Heart Failure Lapkas Kardio
1/27
Congestive Heart Failure
Ivan Virnanda Amu
Pendrik Tandean
8/10/2019 Congestive Heart Failure Lapkas Kardio
2/27
I N T R O D U C T I O N(1)
Clinical manifestations ofheart failure consists ofvarious hemodynamic
response, renal, neural, andhormonal abnormalities.
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.
Reflex of homeostasis/compensation
mechanism :
Neurohormonal changes
Ventricular dilatation
Frank-Starling mechanism.
8/10/2019 Congestive Heart Failure Lapkas Kardio
3/27
8/10/2019 Congestive Heart Failure Lapkas Kardio
4/27
Anamnesis
Date Here
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.
Occasionally cough, dry cough, no fever, there is no history of fever.
No chest pain, there is history of chest pain approximately 4 months ago, with pressed-
like sensation on centre of chest, radiated to left arm, with cold sweating, It felt more
than 1-2 minutes.
8/10/2019 Congestive Heart Failure Lapkas Kardio
5/27
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 (-)
8/10/2019 Congestive Heart Failure Lapkas Kardio
6/27
Physical Examination (1)
General Status Moderate ill/Well nourish/conscious.
Vital status : BP 140/80 mmHg, pulse 105 beats / min, regular, RR 28 /
min, temperature 36.7 C axiller, Weight 50 kg, Height 163 cm,BMI21.67
Head and Neck
Anemia (-), Icteric (-), cyanosis (-). No lymph nodes enlargement. Nodeviation of the trachea and Jugular Venous Pressure R +3 cmH20
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 onauscultation, Rales : both of lung bases.
Cardiac
Inspection ictus cordis does not appear and was not palpable, NormalImpression of heart border, Heart Sound I / II regular, Murmur (-)
8/10/2019 Congestive Heart Failure Lapkas Kardio
7/27
Physical Examination(2)
Abdominal
Insp : Ascites -/-
Palp : Liver and spleen : No enlargement.
Perc : Tympani.
Ausc : Peristaltic Normal.
Extremity
Edema -/-
Warm acral
8/10/2019 Congestive Heart Failure Lapkas Kardio
8/27
Laboratory ExamWBC 7,5 103/mm3
Eritrosit 5.15 106/mm3
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 167 mg/dl
LDL 27 mg/dl
HDL 140 mg/dl
TG 85 mg/dl
CK 121 U/L
CKMB 16 U/L
Troponin T < 0,002
Uric Acid 9,4 mg/dl
HbsAg ReaktifPT 12,7 control 10,0
INR 1,09
aPTT 34,9 control 23,7
GDS 112 mg/dl
Ureum 40 mg/dl
Creatinine 1,3 mg/dl
SGOT 21 U/L
SGPT 18 U/L
Natrium 145 mmol/l
Kalium 3,6 mmol/l
Chlorida 115 mmol/l
8/10/2019 Congestive Heart Failure Lapkas Kardio
9/27
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 V1-V4,
Conclussion : Sinus Tachycardia, RAD, OMI Anteroseptal
8/10/2019 Congestive Heart Failure Lapkas Kardio
10/27
Chest Radiology
Dilatation of hillus,parahillar, and suprahillarboth of lung
No spesific both of lung
Cor : CTI 0,57 aorta
dilatation Normal Sinus and
diaphragm
Intact bone
Conclussion :Cardiomegaly withpulmonary congestion.
Aorta dilatation
8/10/2019 Congestive Heart Failure Lapkas Kardio
11/27
Echocardiography
Conclussion :
Sistolic and Diastolicdysfunction LV, EF 29 %
Dilatation of LA and LV Anterior akinetic
anterior, anteroseptal.Hipokinetic in the othersegment
MR severe
AR trivial
8/10/2019 Congestive Heart Failure Lapkas Kardio
12/27
Working Diagnosis
CHF Nyha III ec CAD
Hyperuricemia
HBV
8/10/2019 Congestive Heart Failure Lapkas Kardio
13/27
Oxygen 2-3 Lpm via nasal canula
NaCl 0,9 % 500 cc/24 hours/IV
Lasix 40 mg/12 hours/IV
Aspillet 1x 80 mg
ISDN 3 x 10 mg
Captoril 2x12,5 mg
Simvastatin 1x20 mg
Allopurinol 1x300 mg
M
A
N
A
GE
M
E
NT
8/10/2019 Congestive Heart Failure Lapkas Kardio
14/27
DISCUSSION
ThemeGalleryis aDesign Digital Content &
Contents mall developed
by Guild Design Inc.
Systolic heart failure is the
inability of the heart to pump
so that the contraction of the
heart decreases and
weakness, fatigue, and
decreased physical activity
abilities and other symptoms
of hypoperfusion.
Diastolic heart failure is a
disorder of impaired relaxation
and ventricular filling. Diastolic
heart failure is defined as heart
failure with an ejection fractionof more than 50 %.
8/10/2019 Congestive Heart Failure Lapkas Kardio
15/27
Myocardial disease
Coronary heart disease (ischemic heart
disease)
Cardiomyopathy
Myocarditis and rheumatic heartdisease
Infiltrative disease
Iatrogenic due to drugs or as a result of
radiation
Mechanical disturbance in myocardialinfarction alone so there is actually no
abnormalities.
Pressure overload, such as
hypertension, aortic stenosis, aortic
coartasio.
Volume Overloaded, such as aortic ormitral insufficiency, congenital heart
disease (left to right shunt) or
excessive transfusion.
Barriers charging, such as constrictive
pericarditis or tamponade.
TIOLOGY
8/10/2019 Congestive Heart Failure Lapkas Kardio
16/27
PATHOPHYSIOLOGY
8/10/2019 Congestive Heart Failure Lapkas Kardio
17/27
Pulmonary symptoms include: dyspnoea,
paroxysmal nocturnal dyspnea and orthopneu.
Additionally nonproductive cough that arise at
the time of lay
SIGN AND
SYMPTOMS
Systemic signs and symptoms such as weakness,
rapid fatigue, oliguria, nausea, vomiting, increased
central venous insistence, tachycardia, narrow
pulse pressure, ascites, hepatomegaly, and
peripheral edema
Nervous system symptoms such as : insomnia,
headaches, nightmares until delirium
8/10/2019 Congestive Heart Failure Lapkas Kardio
18/27
FRAMINGHAMS CRITERIA
MAJOR K 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
Paroxysmal nocturnal dyspnea
Neck vein distention
Pulmonary Crackles
Cardiomegaly
Acute pulmonary edema S3 Gallop
Elevation of jugular venous
Hepatojuguler Reflex
8/10/2019 Congestive Heart Failure Lapkas Kardio
19/27
ACUTE CHF
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
Third heart sound (diastolic gallop).
Murmur sound in case of ventricular
dilatation.
Crackles wet
Lab findingincrease 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
Chest X-Ray
Cardiomegaly, signs of lung dam
Pleural Effusion
8/10/2019 Congestive Heart Failure Lapkas Kardio
20/27
8/10/2019 Congestive Heart Failure Lapkas Kardio
21/27
A
B
C
Patients at risk of suffering from heart failure but no signs of heart failure, for
example patients with CHD, diabetes, cardiomyopathy and hypertension.
Patients suffering from Structural Heart Disease and
symptoms of heart failure
D Refractory heart failure despite maximal therapy. In this groupit is necessary for specific intervention such as a heart
transplant, permanent mechanical support.
Patients suffering from structural heart disease. But there is no sign
of heart failure eg myocardial infarction, LVH or valvular heart
disease
American College of Cardiology / American HeartAssociation 2005 Guidelines Update (4 levels severity)
8/10/2019 Congestive Heart Failure Lapkas Kardio
22/27
MANAGEMENT
Increasing the
cardiac output
Decrease
ventricular fillingpressure
Overcome heart failure
syndrome
ACUTE
CHF
8/10/2019 Congestive Heart Failure Lapkas Kardio
23/27
8/10/2019 Congestive Heart Failure Lapkas Kardio
24/27
MANAGEMENT CHRONIC CHF
Click to add Title
Click to add Title
Click to add Title
Click to add Title
4. Prevent myocardial remodeling and inhibit theprogression of heart failure (ACE Inhibitor, ARB)
5. Fixing myocardial energy metabolism withcarnitine, Co - enzyme Q10, D - ribose, magnesium
and vitamins.
6. Nonpharmacologic interventions aimed specifically for stage D of heart
failure patients who have not responded to medication. The specific
interventions can be Implantable Defibrillators Caardioverter (ICD),
Boventricular Pacing Theraphy, revascularization by PTCA or CABG 's, heart
transplantation, and ventricular reduction cardioplasti .
8/10/2019 Congestive Heart Failure Lapkas Kardio
25/27
HEART FAILURE with Normal Systolic
Function
Increased in parallel with age
Mainly found in women
Symptoms : decrease in exercise capacity,
neurohormonal activation and decreasedquality of life.
Specific treatment against heart failure with
normal systolic function does not exist. D-ribose, L-carnitine and Co-enzyme Q10
reported to improve output
8/10/2019 Congestive Heart Failure Lapkas Kardio
26/27
8/10/2019 Congestive Heart Failure Lapkas Kardio
27/27
Recommended