Present CHF

7/23/2019 Present CHF

1/47

CASE REPORTCASE REPORT

CHFCHF

Presented by:Nisa Uswatun Karimah

Lydia Octasari

Advisor:

dr. Erwin Sukandi, Sp.PD


2/47

IDENTIFICATION

Name : Mrs. n

!"e : #$ years

Se% : &ema'e

!ddress : Ds. e()dadi Ka*. +anyuasin

Marita' status: married

Occupati)n : h)use wi&e e'i"i)n : m)s'em

!dmitted t) h)spita' : N)em*er -, #/


3/47

ANAMNESIS


4/47

CHIEF COMPLAIN

Sh)rtness )& *reath a"ain s) heay since

0 week *e&)re admissi)n


5/47

HISTORY OF ILLNESS

1 m)nths *e&)re admissi)n:

sh)rtness )& *reath, depended )n p)siti)nand actiity. She &e't sh)rtness )& *reathwhen ") t) t)i'et. She &e't *etter i& she sat )rs'ept with takin" #21 pi'')ws. Sh)rtness )&*reath wasn3t depended )n weather 4

em)ti)n, n)t &)'')wed *y men"i )ice. 5akeup midni"ht caused sh)rtness )& *reath 678,heart pa'pitati)n 678. 9hest pain 628, c)u"h628, &eer 628, sweatin" at ni"ht 628.


6/47

Swe''in" in *)th )& ')wer e%tremity 678,

swe''in" in upper eye 'ids 628. +ein"

ye'')wish in eyes and skin 628. Epi"astrium

pain 678, nausea 678 *ut n) )mit. N)

pr)*'em in urinati)n and de&ecati)n. She

went t) SM and was h)spita'i;ed &)r 0

days unti' she ")t we''.


7/47

1 month before admission

She c)mp'ained )& hain" sh)rtness )& *reatha"ain, depend )n p)siti)n 4 actiity. She &e't

sh)rtness )& *reath a&ter wa'kin" - m, *ein"

*etter i& she t))k a rest.


8/47

Swe''in" in upper eye 'ids 628. +ein"

ye'')wish in eyes and skin 628. +ein"

ye'')wish in eyes and skin 628. Epi"astrium

pain 678, nausea 678 *ut n) )mit. N)pr)*'em in urinati)n and de&ecati)n. She

was taken t) S Siti Kh)di(ah and

h)spita'i;ed &)r #- days unti' she ")t we''.


9/47

1 week before admission

She c)mp'ained )& hain" sh)rtness )&*reath a"ain s) heay, depended )n p)siti)n

4 actiity. She &e't *etter i& she sat, *ut she

c)u'dn3t wa'k anym)re.


10/47

Swe''in" in *)th )& ')wer e%tremity 628,

swe''in" in upper eye 'ids 628. +ein" ye'')wish

in eyes and skin 628. Epi"astrium pain 678,

nausea 678 *ut n) )mit. N) pr)*'em in

urinati)n and de&ecati)n. She was taken t)

SM a"ain &)r these c)mp'ains.


11/47

HISTORIES OF PAST ILLNESS

> )& heart disease since 0= years a"),

h)spita'i;ed min. )nce in a year

> )& ()int and *)ne pain 678 since 0 years )'d

> )& hypertensi)n was denied

> )& DM was denied

> )& kidney disease was denied

> asthma was denied

> *ein" *'ue when *a*y was denied

> "astric pain since 0 years a")


12/47

HISTORIES OF FAMILY DISEASE

> )& heart disease 678 in her m)ther

> )& hypertensi)n 678 in her m)ther, t))


13/47

PHYSICAL EXAMINATION


14/47

GENERAL EXAMINATION

?enera' c)nditi)n : sick

Sickness c)nditi)n : seere sickness

9)nsci)usness : c)mp)s mentis

+'))d pressure : @>A mm" Pu'se rate : 0 %>min, irre"u'ar

espirati)n rate : = %>min

Bemp. : 1A,@.9 Dehydrati)n : 628

Nutriti)n : wei"ht C 1- k", hei"ht C 0-- cm

impressi)n : undernutriti)n


15/47

SPESIFIC EXAMINATION

Skin

Skin c)')r is puce, n)rma' pi"mentati)n,e&')resence 628, icteric 628, cyan)tic pa'm 4

pa'mar 628, scar 628, hyperhydr)sis 628,n)rma' hair "r)wth, "))d tur")r, wet>dry inpa'pitati)n 628, su*cutane)us n)du'e 628.

Lymph "'and

n) en'ar"ement )& the 'ymph n)des )nsu*mandi*u'ar, neck, a%i''aries, 4 in"uina'.


16/47

ead

)a', symmetrica', pu&&y &ace 628, de&)rmity

628, ma'ar rash 628, a')pecia 628

Eyes

e%)phta'mus 4 end)phta'mus 628,

edemat)us superi)r pa'pe*ra 628, pa'e )&

c)n(unctia pa'pe*ra 628, icteric sc'era 628

N)se

epista%is 628, n)rma' nasa' septum and

muc)us 'ayer


17/47

Ears

"))d hearin", n)rma' *)th )& meatus

acusticus e%ternus

M)uth

rha"aden )& 'ips 628, st)matitis 628, papi'

atr)phy 628, "um *'eedin" 628, &et)r )ris 628

Neck

thyr)id "'and n)t pa'pa*'ed, thyr)id *ruit

628, P 6-7#8 cm#O, hypertr)phy )&

muscu'us stern)c'eid)mast)ideus 628,

sti&&ness 628


18/47

Bh)ra%

n)rma' shape, e%tended interc)sta' secti)n 628,

retracti)n 628, enectasis 628, spider naei 628 Lun"

< : symmetrica' )& static 4 dynamic ri"ht C 'e&t

P: ri"ht stem&remitus is weaker )n *ase )&'un"

P: du'' in ri"ht 'un" started at


19/47

9)r


20/47

!*d)men


21/47

Upper e%tremity

pain )n ()in 678, pa'e )n &in"er 628, erythema

)& pa'm 628, pittin" edema 628, c'u**in"

&in"er 628, trem)r 628, n)rma' physi)')"ica'

re&'e%

L)wer e%tremity

pain )n ()in 678, pa'e )n &in"er 628,

erythema )& pa'm 628, pittin" edema 628,

c'u**in" &in"er 628, trem)r 628, n)rma'physi)')"ica' re&'e%


22/47

ADDITIONAL EXAMINATION


23/47

ELECTROCARDIOGRAPHY

(Nov 5, 2008)

!F, n)rma' a%is, C 0020= %>min, P

wae can3t *e ea'uated, GS c)mp'e%

.= sec)nds, >S 0 H 0, S 0 7

0>->A I 1-, S persistent 678 in -2A


24/47

LABORATORY FINDINGS (Nov 5, 2008)

+'))d ana'ysis

em)"')*in : 0./ ">d'60=20/ ">d'8

emat)crite : 1#J 6=2=/J8

Leuc)cyte : A->mm1 6-20>mm18

ES : 1 mm>hr 6H 0 mm>hr8

Bhr)m*)cyte: #@0,/mm3 6#,2-,>/mm3)

Di&& c)unt : >->#>$$>0#>=


25/47

+SS : 0- m">d'

9h)'ester)' t)ta' : 0-- m">d' 6H #8

DL2ch)'ester)' : =- m">d' 6I --8

LDL2ch)'ester)' : @0 m">d' 6H 018

Bri"'yceride : @A m">d' 6H 0-8

Uric acid : =.- m">d' 60.A2A.8

Ureum : 0/ m">d' 60-21@8

9reatinin : .$ m">d' [email protected]

B)ta' pr)tein : A.A ">d' 6A2$./8

!'*umin : 1.0 ">d' 61.-2-8

?')*u'in : 1.- ">d'


26/47

B)ta' *i'iru*in : 0./ m">d' 6.0208

Direct *i'iru*in : 0.## m">d' 6H .#-8

' 6H =8

S?PB : 1@ U>' 6H =08 LD : #AA U>' 60A21#8

S)dium : 01- mm)'>' 601-20--8

P)tassium : -. mm)'>' 61.-2-.-8


27/47

Urina'ysis

Epithe'ia' ce'' : 678

Leuc)cyte : 20>LP+ 62->LP+8

Erythr)cyte : 21>LP+ 620>LP+8

9y'inder : 628 6ne"atie8 9rysta' : 628 6ne"atie8


28/47

CHEST X-RAY (Nov 5, 2008)

9)nditi)n )& the ph)t) was "))d

i"ht and 'e&t are eua' Brachea was in the midd'e

N) e%tended interc)sta' secti)n

9)nditi)n )& the *)ne was "))d, n) &racture 9B was di&&icu't t) seen

i"ht c)st)phrenicus an"'e was di&&icu't t)

ea'uated, 'e&t c)st)phrenicus was keen

i"ht diaphra"m is at


29/47

ECHOCARDIOGRAPHY

EDO : -.=$

ESO : =.A

P5 : .A-

!O : =.1$

L di'atati)n, L! di'atati)n

L 628

L EF -J

MS seere, M! C 0.$A,MP? 0120@

M seere

! m)derate

!S mi'd2m)derate B m)derate

MD e.c. D


30/47


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33/47


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35/47


36/47


37/47

RESUME

! w)man initia'ed Mrs. n, #$ years,admitted t) h)spita' in N)em*er -, #/ withsh)rtness )& *reath a"ain s) heay since 0 week*e&)re admissi)n as the chie& c)mp'ain.

1 m)nths *e&)re admissi)n, she c)mp'ained)& hain" sh)rtness )& *reath, depended )np)siti)n 4 actiity a&ter ")in" t) t)i'et. She &e't*etter i& she t))k a rest and s'ept with #21 pi'')ws.5ake up in midni"ht caused *y sh)rtness )&*reath 678, heart pa'pitati)n 678. Swe''in" in *)th)& ')wer e%tremity 678, epi"astric pain 678, nausea

678. She went t) SM 4 h)spita'i;ed.


38/47

0 m)nth *e&)re admissi)n, she

c)mp'ained hain" sh)rtness )& *reath a"ain,

depended )n p)siti)n 4 actiity a&ter wa'kin" -m. She &e't *etter i& she t))k a rest )r s'ept

with 12= pi'')ws.


39/47

0 week *e&)re admissi)n, she c)mp'ainedhain" sh)rtness )& *reath a"ain, depended )n

p)siti)n 4 actiity. She &e't *etter i& she t))k a rest)r s'ept with =2- pi'')ws. She c)u'dn3t wa'kanym)re.


40/47

Fr)m physica' e%aminati)n, the "enera'c)nditi)n was seere sickness, c)nsci)usnesswas c)mp)s mentis. +P was @>A mm", pu'serate 0 %>min, irre"u'ar, C =%>times, [email protected], +5 C $,$J with undernutriti)nimpressie, P 6-7#8 cm#O.


41/47

FRAMINGHAM SCORE

Ma()r criteria : Par)%ysma' n)cturna' dyspnea 678

Distenti)n )& neck ein 628

a'es )n pu'm) 678 9ardi)me"a'y 678

!cute pu'm)nary edema 678

?a'')p S1 628


42/47

Min)r criteria :

E%tremity edema 628

9)u"h in ni"ht time 628

Dispnea d3e&&)rt 678

epat)me"a'y 678 P'eura' e&&usi)n 628

Decreased )& ita' capacity 628

Bachycardia 6I 0# %>min8 628


43/47

OR!ING DIAGNOSIS

9F e.c. MD e.c. D

DIFFERENTIAL DIAGNOI

9F e.c. MMS e.c. D

9F e.c. c)n"enita' a'e a*n)rma'ity


44/47

TREATMENTS

N)npharmac)')"y :

O#1 '>min

+edrest 6ha'&2sit

p)siti)n8 9)r diet


45/47

PLANNING

epeat ech)cardi)"raphy

E'ectr)'yte e%aminati)n


46/47

PROGNOSIS

Gu) ad itam : du*ia et ma'am

Gu) ad &uncti)nam : du*ia et ma'am


47/47

TERIMA !ASIH

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