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Panel 1st Module : Dyspnoea
1st ScenarioPresented By
1A Group
Thanks to our Tutor : dr. Sri Vitayani, Sp. KK
Medical Faculty Universitas Muslim Indonesia
2010
1A Group
• Maria Ulfah (1102090049)• Irfan Thamrin (1102090056)• Rizki Rahmadhan (1102090063)• Akhmad Edwin Indra Pratama (1102090064)• Fakhrurrazi (1102090065)• Muh. Fadly Aditya (1102090070)• Muhammad Assadul Malik (1102090072)• Inna Mthmainnah Musa (1102090084)• Andi Firman Mubarak (1102090088)• Ainun Martoni (1102090093)• Andi Fajar Apriani (1102090106)• Dzul Ikram (1102090108)• Zarah Alifani Dzulhijjah (1102090115)• Sigit Dwi Pramono (1102090133)• Andi Anugrah Suci (1102090142)• Nur Sabriany Lihawa (1102100156)
1st Scenario
A 60 years old woman complain of feeling easily get tired and heard to breath when she is doing an activity. She can not do chores longer without taking a rest because of hard breathing. Her legs swelling during the day, and lessen at night. Frequent breath and crepitating sound in auscultations exam, are found from physical examinations. Artery pulse and blood pressure are normal, but there is jugular vein obstruction when the patient in a standing position. Ictus cordis is in anterior left of axillary line/intercostals V space. Her chest x-ray shows CTR 0,69 and the lung vascular obstruction is indicated. The patient has been treated with digoxin and diuretic to alleviate her symptoms.
Difficult Words
• CTR: examination to identify cardiomegaly, CTR (Cradiothoracic Ratio) normal range = ≤ 0,5.
• Crepitating sounds : sounds like friction or break from two slices or two parts (fluid and tissue).
• Digoxin : may improve patient well being and reduce hospital admission for worsening heart failure, but has no effect on survival.
• Diuretic: diuretics are recommended in patients with heart failure and clinical signs or symptoms of congestion.
Keywords
• 60 years old women• Tired and difficult to breathe• Complain of rapid fatigue• She has congestion on neck vein• Swelling of the ankle• Crepitation sound on auscultation
examination• Artery pulse and blood pressure in
normal range• CTR 0,69• In rontgen examination there are
congestion of pulmonal vessel dam• Ictus cordis palpable in
axillary/intercostals V space• History of digoxin and diuretic
QUESTIONS AND
ANSWERS
1. Explain about all basic sciences of cardiovascular system!
• Anatomy• Physiology• Histology
AnatomyLeft : linea
medioclavicularis
sinistraRight : linea
parasternalis dextra
Top : intercostal IIBottom : intercostal V
References: SOBOTTA human anatomy Atlas , Understanding of anatomy and physiology Meder
• Aorta
• Vena cava superior
• Vena cava inferior
• Pulmonary Trunk
• Right Auricula
• Right Atrium
• Right Ventriculus• Left Ventricle
• Left Auricula
• Apex
Circumflex arteryLeft coronary artery
Anterior interventricular arteryRight coronary artery
Marginal branch
Great cardiac vein
small cardiac vein
Physiology
HEART CYCLE
References: GUYTON Medical Physiology, Sherwood physiology, Color atlas of physiology
CONDUCTING SYSTEM
Histology
Circulatory System • Heart
Tunica:a. Endocardiumb. Myocardiumc. Epicardium (visceral pericardium)
• Blood Veesels:-Arteries : Elastic (large) arteries (aorta, pulmonary arteries)Muscular (medium, distributing)Small arteries and arteriolesPre capillariesCapillaries-Veins : Venules and small veinsMedium veinsLarge veins
Reference:Digital Histology An Interactive CD Atlas with Review Text
Large medium small (arteriole)
Small Medium Large
2. What are the phatomechanism of dyspnoea?
pumping capacity of the left heart
the pulmonary capillary pressure,
fluid begins to transude into the lung
tissues and alveoli
fluid begins to transude into the lung
tissues and alveoli
Crepitating sound
oxygen in the blood
peripheral vasodilation
venous return of blood from the peripheral
blood in the lungs
transudation of fluid, more arterial oxygen
desaturation, venous return
Dyspnoea
3. Are there any relation between all the symptoms? Explain it!
• D’ effort dyspnoea: The heart is not able to
increase its pumping capacity to the levels required for the exercise.
Decrease of oxygen.
• Swelling ankle
• Tachypnoea : Metabolic Acidosis
• Crepitating sound : fluid and air in the alveolar (heard when inspirate)
• Vein congestion : increasing the venous return from peripher.
• Palpable ictus cordis: enlargement of left ventricle
• Pulmonary vascular congestion : swelling in the interstisial space of the lungs
4.How to established the dyspnoea in cardiovascular system and the other system?
Cardiovascular Respioratory Gastrointestinale
Accompanied by swelling on the legs
No swelling on the legs Accompanied by pain in the pit of the stomach
Typical breath sound (crapitation sound)
Wheezing sound No sound
High blood pressure Normal blood pressure Feeling full
Irregular e heartbeat. Fast, chest pain in the left side
Faster but regulare Heart burn
5. What are the effects (main effect and side effect) of digoxin and diuretic?
Main Effects of Diuretic: To decrease edema
especially in lung To repair oxygenation and
repair the function of myocardium
Adversed effect of Diuretic: Hypokalemia Dehidration Neurohormonal activation
The main effect : to increase the strength of heart contraction For congestive heart failure, atrial fibrilation
The side effects :*Anorexia, nausea, vomit, and
headache*Toxic symptoms for the heart*Neurologic symptoms*Eye disorders
7. What is the differential diagnosis?
• Congestive Heart Failure • Mitral Regurgitation• Mitral Stenosis• Aortic Stenosis• Coronary Heart Disease
Disease
60 age woman
Fatigue
Dypsnoea
Swelling ankle
Tachypneu
Crapitating Sound
Vein congestion
Palpable ictus cordis
CTR>0,5
Xraycongestion of pulmonal vessel
CHF + + + + + + + + + +
MR + +
MS + + +
AS M>F + + - + + - + + +
CHD F>M + + - + - (S3 n S4)
Thank you
so much !