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 to hospital : August 21st, 2015
History Taking
• Chief complain: Shortness of breath• Suffered since 4 years ago, get worse in 2 hours before admitted to
hospital• DOE (+)• PND (+)• Orthopnea (+)• Chest pain (+), since 2 days ago, blunt pain, radiation (-), provoked by
ECGInterpretationBasic rhytm : sinus Heart rate : 79 bpmRegularity : regularAxis : normoaxisMorphology P Wave : 0,08 second, biphasic on V1PR interval : 0,20 secondKompleks QRS : 0,08 second, R wave on I, II, III,aVF, V6; QS on V1-2; Rs on V3-V5ST segment : depression on V5-V6, I, aVLT wave : inverted on V3-V4
• The heart is unable to pump blood forward at a sufficient rate to meet the metabolic demands of the body (forward failure), or is able to do so if only the cardiac filling pressure are abnormally high (backward failure), or both.
CONGESTIVE HEART FAILURE
Physiology
CONGESTIVE HEART FAILURE
Physiology
CONGESTIVE HEART FAILURE
Pathophysiology
CONGESTIVE HEART FAILURE
Pathophysiology
CONGESTIVE HEART FAILURE
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;
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
Treatment of HF w/ Reduce EF
CONGESTIVE HEART FAILURE
1.DiureticsElimination of sodium and water through the kidney intravascular vol. venous return preload the LV