congestive heart failure nyha iii and non st-elevation [autosaved]
DESCRIPTION
kardioTRANSCRIPT
Congestive Heart Failure NYHA III Post Acute Lung Oedem
and Non ST-segment Elevation Myocardial Infarction
By:
Anggun Setyawati
C111 10 117
Supervisor:
dr. Abdul Hakim Alkatiri, SpJP
Case ReportSeptember, 2015
Cardiovascular DepartmentFaculty of MedicineUniversitas Hasanuddin
Patient’s Identity
• Name : Mr. SD• Age : 77 years old• MR : 723072• Address : Mamasa• Admitted : August 21st, 2015
History Taking
• Chief complain: Breathless• Suffered since 4 years, worsen in 2 hours before admitted to
hospital• DOE (+)• PND (+)• Orthopnea (+)• Chest pain (+), since 2 days ago, blunt pain, radiation (-), provoked
by activity (-)• Cold sweat (+)• Cough (+), white sputum• Epigastric pain (+), nausea (-), vomit (-)
• Hypertension (+) since 10 years ago (consumes anti-hypertension irregularly)
• Diabetic mellitus(-)• Previous heart disease(+)• Family history of heart disease (-) • Smoking (+), alcoholic (-)
History Taking
• Modifiable: – Smoking, – Hypertension
• Non modifiable:– Age (77 y.o)– Gender (male)
Risk Factors
• General state: – moderate illness, poor-nourished, compos mentis
• BMI: 18,35 kg/m2 (overweight)• Vital signs:
– BP: 120/90 mmHg– HR: 72 bpm– RR: 22 x/minute– Axillary temperature: 36,5oC
Physical Examination
• Head : anemic (-) icteric (-)
• Neck : JVP R+3 cmH2O at 30o position
• Lung :– Inspection: symmetry left=right– Palpation : mass (-), no tenderness, normal vocal
fremity– Percussion: sonor– Auscultation : vesicular, ronchi (+), base of lung, wheezing (-)
Physical Examination
• Cor :– Inspection : ictus cordis visible– Palpation : ictus cordis palpable, thrill (-)– Percussion :
• Upper border 2nd ICS sinistra• Right border 4th ICS linea parasternalis dextra• Left border 5th ICS linea axillaris anterior sinistra
– Auscultation : heart sound I/II pure, regular, murmur (-)
Physical Examination
• Abdomen :– Inspection : flat, follows breath movement– Auscultation : peristaltic (+), normal– Palpation : liver and spleen not palpable– Percussion : tympani
• Extremities :– Edema (-)
Physical Examination
ECG
Laboratory Finding
August 21st, 2015
Laboratory Findings
Radiology Findings
• Chest X-Ray(August 22nd, 2015)
Cardiomegaly with dilatatio et elongatio aortae
Radiology Findings
• Abdominal USG(August 25th, 2015)– Prostate
hypertrophy– Right kidney cyst
Radiology Findings
-Left ventricle systolic and diastolic disfunction
-Segmental hypokinetic-Concentric left ventricle
hypertrophy-Mild aortic regurgitation
Echocardiography
• Congestive Heart Failure NYHA III Post Acute Lung Oedema
• Non-ST-Segment Elevation Myocardial Infarction
Assessments
1. Oxygen 6 lpm via simple mask2. IVFD NaCl 0,9% 500 cc/24 hours/IV3. Furosemide 200 mg/24 hours /syringe pump4. Aspilet 80 mg/24 hours oral5. Clopidogrel 75 mg/24 hours /oral6. Cedocard 1mg/hour/syringe pump7. Isosorbid dinitrate 5mg/sublingual if pain8. Arixtra 2,5mg/24 hours/subcutan
Management
DISCUSSION
1. Congestive Heart Failure2. NSTEMI
Definition
• Forward failure• Backward failure• Or both
CONGESTIVE HEART FAILURE
Causes
CONGESTIVE HEART FAILURE
• Myocard dysfunction:– CAD– Cardiomyopathy– Myocarditis and rheumatic heart disease– Infiltrative disease– Iatrogenic
• Mechanic dysturbance– Pressure overload– Volume overload– Filling defect
Causes
CONGESTIVE HEART FAILURE
Case:History Taking:- Shortness of breath- DOE (+)- PND (+)- Orthopnea - Cough
Physical Examination- JVP increasing- Rales
Radiology Findings- Chest X-ray: cardiomegaly followed by pulmonary edema sign- Abdominal USG: right pleural effusion
Pathophysiology
CONGESTIVE HEART FAILURE
Case:History Taking:- Shortness of breath- DOE (+)- PND (+)- Orthopnea - Cough
Physical Examination- JVP increasing- Rales
Radiology Findings- Chest X-ray: cardiomegaly followed by
pulmonary edema sign- Abdominal USG: right pleural effusion
New York Heart Association (NYHA)
Classification
CONGESTIVE HEART FAILURE
DIAGNOSIS
Major criteria:1. Paroxysmal Nocturnal Dyspnea (PND) or orthopnea;2. Distended neck veins (in other than supine position);3. Rales;4. Cardiomegaly seen in x-ray;5. Acute pulmonary edema seen in x-ray;6. Gallop ventricular S(3);7. Increased vein pressure > 16 cm H20;
8. Hepatojugular reflux;9. Pulmonary edema, visceral congestion, cardiomegaly found in autopsy; 10. Body mass decreasing
Diagnosis
CONGESTIVE HEART FAILURE
DIAGNOSIS
Minor criteria:1. Bilateral ankle edema;2. Night cough;3. Dyspnea on regular activity;4. Hepatomegaly;5. Pleural effusion seen in x-ray;6. Decrease of 1/3 vital capacity from the maximal record;7. Tachycardia (120 bpm or more);8. Engorgement pulmonary vascularization seen in x-ray.
Diagnosis
CONGESTIVE HEART FAILURE
At least 2 major criteriaOR
1 major criteria + 2 minor criteria concurrently
Definitive Diagnosis
CONGESTIVE HEART FAILURE
CaseHistory Taking:- Chest paint- Blunt- Suddenly- Provoked by activity (-)- Cold sweat
ECG:- ST-segment depression- Poor R-wave progression
Laboratory Findings:- Cardiac biomarkers/enzymes
increasing
Definition
NSTEMI
Pathophysiology
NSTEMI
Diagnosis
WHO criteriaAt least 2 points:- Typical chest pain- ECG record- Cardiac biomarkers/enzymes increasing
Diagnosis
NSTEMI
Therapy
Goal• Hemodynamic stabilization• Pain relief• Reperfusion• Prevent complications
Therapy
NSTEMI
Thank You