Congestive Heart Failure Lapkas Kardio

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    Congestive Heart Failure

    Ivan Virnanda Amu

    Pendrik Tandean

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    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.

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    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.

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    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 (-)

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    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 (-)

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    Physical Examination(2)

    Abdominal

    Insp : Ascites -/-

    Palp : Liver and spleen : No enlargement.

    Perc : Tympani.

    Ausc : Peristaltic Normal.

    Extremity

    Edema -/-

    Warm acral

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    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

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    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

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    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

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    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

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    Working Diagnosis

    CHF Nyha III ec CAD

    Hyperuricemia

    HBV

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    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

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    DISCUSSION

    ThemeGalleryis aDesign Digital Content &

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    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 %.

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    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

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    PATHOPHYSIOLOGY

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    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

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    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

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    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

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    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.