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CONGESTIVE HEART FAILURE (CHF)

NYHA IV e.c post Partum

Cardiomyopathy (PPCM)

Supervisor :

By :

Marhawa

C 111 07007

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Patient Identity

Name : Ms. K

Gender : Female

Age : 33 years old Medical Record : 601710

Date of Admission : 30 Maret 2013

Address :Jl. Dg Tata , Mks

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Anamnesis (1)

Chief Complaint : Shortness of breath

Pasien MRS dengan rujukan dari RSUD Pangkep dengan D/ Post partum 8

hari+ efusi pleura+ Anemia.

Ibu mengeluh sesak nafas sejak 1 minggu yang lalu ( 2 hari post

partum)makin lama makin memberat, sesak dirasakan setiap saat, tidak

dipengaruhi aktivitas. batuk (+), lendir (+) berwarna putih, darah (-), demam(+)

Riwayat perdarahan dari jalan lahir (-)

Riwayat diraawat di ICU Pangkep diberikan drips furosemid q amp dan inj.

Widecillin

Riwayat melahirkan normal di RS KDIA ST. Fatimah tanggal 14 Maret 2013dengan BB lahir bayi 2800 gram

Riw HT (-), DM (-), asma (-), alergi (-)

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Pemeriksaan fisis

KU : sesak. Anemis

T 140/100 mmHg

N : 140x/ menit

P : 40x/menit

S : 38,3 C

Status lokalis

Mammae : engorgement

Thorax : VBS kanan menurunRhonki -/- ??? wheezing -/-TFU : 2 jari atas SOP

Fluxus (-)

PDV : tidak dilakukan

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Past Medical History

There is history of being admitted to thehospital 2 times with the same complaint ofshortness of breath.

There is history of hypertension since 10 yearsago but she doesnt take the drugs regularly.

She never smoking and consumption alcohol.

There is no history of fever, congenital heartdisease, thyroid disease, and diabetesmellitus.

There is also no family history with

cardiovascular disease and thyroid disease.

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Risk Factors

Cigarette smoking (-)

Alcohol consumption(-)

Hypertension(+) Diabetes Mellitus(-)

Cardiovascular disease (+)

Thyroid disease (-) History of cardiovascular disease andthyroid disease in family (-)

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Physical Examination

General Status:

Severe ill

Nutritional Status: Good

Consciousness: Conscious

Vital Signs:

Blood Pressure : 120/70 mmHg

Pulse Rate : 92 bpm, regular

Respiratory Rate : 28 bpm

Temperature : 36.7 C

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Head and Neck Examinations: Eye : Conjunctiva anemic (-/-), sclera icteric (-/-)

Lip : cyanosis (-)

Neck : No mass, no tenderness, JVP : R + 3 cmH2O

Chest Examination Inspection : Symmetric left=right

Palpation : No mass, no tenderness, vocal fremitusleft=right

Percussion : Sonor left = right, lung-liver border in ICSVI right anterior

Auscultation: Breath sound : vesicular

Additional sound : Ronchi - -Wheezing -/- - -

+ +


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Cardiac Examination

Inspection : Ictus cordis was not visible

Palpation : Ictus cordis was not palpable Percussion :Right heart border in rightparasternal line, left heart border two fingersfrom left midclavicular line ICS VI.

Auscultation :

Heart sound : S I/II regular, no gallop, noadditional sound


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Abdominal Examination

Inspection : flat, following breath movement

Auscultation : Peristaltic sound (+), normal

Palpation : No mass, no tenderness, no palpable

liver and spleen

Percussion : Tympani (+), ascites (-)

Extremities Examination

Pretibial edema -/-

Dorsum pedis edema -/-


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Electrocardiography(ECG)

Interpretation:Rhythm:No sinusHR/QRSrate:75x/minutesRegularity: regularP wave & PRinterval: 0,08s and

0,16 sQRS Complex: 2small squares(0.08s),Q pathologies inV1,V2, V3. VES (+)Axis: Normal

ST segment: NormalT wave: Normal

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Conclusion of ECG

Sinus rhythm.

HR 75x/minutes.

Normoaxis.

P wave normal.

Q pathologies in V1, V2, and V3 (OMIAnteroseptal).

VES (+). T wave normal

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Chest X-rays

Conclusion :Cardiomegaly (CTI (8+10)/32= 0.56) , pulmonaryedema with dilatationand elongation aortae

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Laboratory Finding

Test Result Normal valueWBC 7.9/ul 4.0 10.0 x 103

RBC 3.96/l 4.0 6.0 x 106

HGB 11.6 gr/dl 12 16

HCT 36.0% 37 48

PLT 221 000/l 150 400 x 103

Complete Blood Count

Electrolyte

Test Result Normal value

Na 149 mmol/l 136-145

K 4.1 mmol/l 3.5-5.1

Cl 117 mmol/l 97-111

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Laboratory Finding

Test Result Normal valueGDS 131 mg/dl

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Diagnosis

CHF NYHA III e.c CAD (OMI

anteroseptal)

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Management

O2 5 lpm

IVFD NaCl 0.9% 10

dpmInj. Furosemide 40

mg/12 jm/ IV

Fasorbid 10 mg 1-1-1

Aspilet 80 mg 0-1-0

Captopril 12,5 mg

1-1-1Alprazolam 0.5 mg

0-0-1

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Planning

ECG control

Echocardiography

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DISCUSSION

Congestive Heart Failure (CHF)

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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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Coronary Artery Disease

Coronary artery disease is a narrowing of the smallblood vessels that supply blood and oxygen to theheart.

(CAD) occurs when the arteries that supply blood tothe heart muscle (the coronary arteries) becomehardened and narrowed due to buildup of a materialcalled plaque (plaque) on their inner walls. This isknown as atherosclerosis

Eventually, blood flow to the heart muscle is reduced,

and, because blood carries much-needed oxygen, theheart muscle is not able to receive the amount ofoxygen it needs.

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Causes Coronary Artery Disease

Coronary artery disease (CAD) is caused byatherosclerosis (the thickening and hardening ofthe inside walls of arteries). Some hardening ofthe arteries occurs normally as a person grows

older. In atherosclerosis, plaque deposits build up in thearteries. Plaque is made up of fat, cholesterol,calcium, and other substances from the blood.

Plaque buildup in the arteries often begins inchildhood.

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Plaque in the arteries can be:

Hard and stable. Hard plaque causes the arterywalls to thicken and harden. This condition isassociated more with angina than with a heartattack, but heart attacks frequently occur withhard plaque.

Soft and unstable. Soft plaque is more likely tobreak open or to break off from the artery

walls and cause blood clots. This can lead to aheart attack.

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Risk factors

Risk Factors That Cannot Be Modified:

Age and gender. As get older, risk forCAD increases.

Men, risk increases after age 45.

Women, risk increases after age 55(or menopause).

Family history of early heart disease.

Heart disease diagnosed before age55 in father or brother.

Heart disease diagnosed beforeage 65 in mother or sister.

Risk Factors That Can BeModified:

High blood cholesterol(hyperlipidemia)

High blood pressure(hypertension)

Cigarette smoking

Diabetes

Overweight or obesity

Lack of physical activity

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INVESTIGATION

Electrocardiogram (ECG)

Treadmill Test

Echocardiography

Coronary Angiography

Multi-Slice Computed Tomography Scan(MSCT)

Cardiac Magnetic Resonance Imaging (CardiacMRI)

Radionuclear Medicine

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TREATMENT (1)

Lifestyle Changes

Eat a healthy diet

Quit smoking, if you

smoke

Exercise

Lose weight, if you

are overweight orobese

Reduce stress

Medicines Cholesterol-loweringmedicines

Anticoagulants Aspirin ACE inhibitors Beta blockers

Calcium channelblockers Nitroglycerin Long-acting nitrates

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TREATMENT (2)

Special Procedures

Angioplasty (PTCA)

Coronary artery bypass surgery

Enhanced External Counterpulsation (EECP)Cardiac Rehabilitation

Exercise training

Education, counseling, and training

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THANK YOU

Terima Kasih.

Danke.

Matur Nuwun.

S k

Gracias..

AriGato.

awa CHF

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