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 Report September, 2015 Cardiovascular Department Faculty of Medicine Universitas Hasanuddin
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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
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.