24D

SCENARIO 6: MR. AFILS HEART

Tn. Afil 50 years, came to the clinic with dizziness and chest thumping since 1 day ago. Complaints pounding've felt since 4 months ago, but did not interfere with daily activities Tn. Afil. From the physical examination the doctor finds, blood pressure 150/100 mmHg, pulse 120 x / min irregular, and 22 breaths / min. Lung examination within normal limits, and the cardiac examination discovered HR 160 x / min, irregular, noisy hard to assess. Of Atrial Fibrillation EKG was found with "rapid ventricular response." Mr. referring physicians. Afil to RSUP. In the department of Tn. Afil hospitalized in CVCU and installed monitoring, infusion, oksigen.Beberapa moments later Mr. Afil asleep and suddenly awakened by shouts next to the patient's family. It turns next to the new incoming patients died of cardiac arrest, and taken to the forensics to undergo an autopsy at the request of law enforcement. How do you explain what happened to Mr.. Afil and the next patient?

TERMINOLOGY

 atrial fibrillation

disturbance of electrical activity in the atria, it can be caused by atrial muscle contractions that are not coordinated, the rhythm is not intermittent, chaotic pattern rapid vascular response excessive response by the ventricles (pulse> 100x / min) cardiac arrest cessation of function of the heart and blood vessels suddenly. disappearance of arterial blood pressure, suggests stopping / ventricular dysfunction heart rate heart rate, calculated per unit time autopsy examination to determine the cause of death forensic medical services for the optimal support for the interests of law enforcement and justice

PROBLEM IDENTIFICATION

1.

2.
3. 4. 5.

6.
7. 8.

9.

why mr. afil dizziness and palpitations since 1 day ago? Why complained pounding from 4 months ago did not interfere with the activity? how the interpretation of the results of physical examination and ECG? why mr. afil CVCU admitted, and installed monitoring, infusion, and oxygen? Any treatment of the mr. afil next? how prognosis mr. afil? what is the cause of cardiac arrest? how the management of cardiac arrest? why the autopsy and what disturbances obtained from the autopsy?

PROBLEM ANALYTIC

why mr. afil dizziness and palpitations since 1 day ago?

causes of dizziness:

disruption of the blood supply to the brain, could be because: 1. orthostatic hypotension 2. drugs 3. ear 4. hypertension 5. Excessive coffee drinking 6. pressure in the face of the sinuses Source:http://awandragon.blogspot.com/2011/02/penyeb

ab-pusing-kepala.html

 palpitations can be caused by:

1. heart rhythm disorders (arrhythmias): irregular contractions - reduced blood supply - vasoconstriction - dizziness 2. magnesium and potassium deficiency 3. drinking alcohol 4. drug 5. Cigarette

Source: http://www.deherba.com/waspadai-jantungberdebar.html

Why complained pounding from 4 months ago did not interfere with the activity?
at the beginning of atrial fibrillation: no symptoms
pounding and unobtrusive: may be used to consume

caffeine or tobacco Source: http://medicastore.com/penyakit/3028/Fibrilasi_Atrium .html

results of physical examination and ECG?

physical examination blood pressure: hypertension stage 1 pulse: tachycardia breath: tachypnea

ECG: tachycardia irregular rhythm rapid ventricular response P interval can not be calculated picture is similar to cardiac arrest wave fibrillation: irregular and very rapid, frequency 300-500, there is a rough and smooth, the amplitude of> 1 mm
Source: IPD

why mr. afil CVCU admitted, and installed monitoring, infusion, and oxygen?
CVCU: emergency where heart disease. atrial fibrillation need treatment immediately. infusion: overcoming interference tissue perfusion
oxygen: to maintain myocardial cell function addressing the hypoxia improve systolic function

Any treatment of the mr. afil next?

Cardioversion

pharmacology: amiodarone Elektric: 200-300 joules shock

Source: IPD

how prognosis mr. afil?

dependent handling
if not handled> 5 minutes, affects the other organs

Source: www.google.com

what is the cause of cardiac arrest?

faktor resiko usia
jenis kelamin merokok

penyakit jantung yang mendasari: wpw sindrom, aritmia, penyakit arteri koroner

Source: http://www.scribd.com/doc/106576193/CardiacArrest-Dan-Post-Cardiac-Arrest

how the management of cardiac arrest?

Basic live support
Advanced life support

Source: http://www.scribd.com/doc/106576193/Cardiac-ArrestDan-Post-Cardiac-Arrest

why the autopsy and what disturbances obtained from the autopsy?
examine the organs in the body (heart, lungs, brain) to

determine the cause of death Histological examination and toxicology to look at other diseases Source: Mrs. Rika KP

SCHEM

DIZZINESS

BLOOD SUPPLY TO THE BRAIN DISORDERS

MR. AFIL

PALPITATION

DISTURBANCE CARDIAC CONTRACTILITY

ECG

PHYSICAL EXAMINATION

STAGE 1 HYPERTENSIO N tachycardia

REFERENCES

atrial fibrillation

MANAGEMENT

SIGNS arrhythmia

tachypnea NEXT PATIENT TN. AFIL

PROGNOSIS COMPLICATIO N

ARRHYTMIA DIED CARDIAC ARREST

AUTOPSY

LEARNING OBJECTIVE

students are able to explain: arrhythmias cardiac arrest sudden death