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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

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