Cor Pulmonal
Chronic
Yanis Indiana Yacma
Preceptor :
Laporan Kasus
Name
: Tn.R
Sex
: Man
Age
: 31 years old
Religion
: Islam
Ethnic
: Aceh
Adress
: Pidie
Occupation
:No. RM
: 1051747
Date on arrival : 12 Mei 2015
Date on examination: 5 Juni 2015
Anamnesis
Chief complaint:
Dyspneu
Current medical history: The patient came to the emergency department with
dyspneu, its happened from 3 months ago and feel more in 2 days ago. Itsnt
have a correlation between temperature and food. Firstly the dyspneu not
effected from activity, but now patient feel dyspneu when do some daily
living activity. Patient also got a cough. A cough with a mucous secret and
sometimes with blood. Now patient feel cannt do daily activity, he just lay in
his bed. He also have a fever. A chest pain for patient feel sometimes, its also
feel in his back. Now he say he feel weight loss in several months.
Physical Examination
Skin
Head
Faces
Eyes
Ears
Nose
Mouth
Neck
Anterior thoracic
Inspection
Static
Dynamic
Palpation
Percussion
Percussion
Auscultation
Auscultation
wheezing
wheezing ((- // +)
+)
: Symmetric
: Asymmetric
: Left SF > right SF, tenderness (+/-),
crepitus
crepitus ((- // -)
-)
:: Dim/
Dim/ hypersonor
hypersonor
:: Vesicular
Vesicular ((- // +),
+), rhonki
rhonki (+
(+ // +)
+) 2/3
2/3 lower
lower lung,
lung,
Posterior thoracic
Inspection
Inspection
Static
Static
Dinamic
Dinamic
Palpation
Palpation
Percussion
Percussion
Auscultation
Auscultation
(-/+)
(-/+)
:: symetris
symetris
:: Asymetris
Asymetris
:: right
right SF<left
SF<left SF
SF , crepitus
crepitus (-/-)
(-/-)
:: Dim/hypersonor
Dim/hypersonor
:: vesikuler
vesikuler (-/+),
(-/+), rhonki (+/+),
(+/+), wheezing
wheezing
Heart
Inspection
Inspection
:: ictus
ictus cordis
cordis not
not visible
Palpation
Palpation :: ictus
ictus cordis
cordis palpable
palpable in
in ICS
ICS IV,
IV, right
right
midcalivularis
midcalivularis line.
line.
Percussion
Percussion
:: cardiac
cardiac border
border
Up
Up
Left
Left
Right
Right
:: ICS
ICS III
III left
left parasternal
parasternal line
line
:: ICS
ICS V
V left
left parasternal
parasternal line
line
:: ICS
ICS III
III right
right axillaris
axillaris anterior
anterior line
line
Auskultation:
Auskultation: heart
heart sound
sound II >
> Heart
Heart sound
sound IIII in
in right
right
hemithoraks,
hemithoraks, reguler
reguler (+),
(+), noisy
noisy (-),
(-), gallop
gallop (-),
(-), murmur
murmur (-).
(-).
Abdomen
Inspection
Inspection
symetric,
symetric, distension
distension (-),
(-), collateral
collateral vein
vein (-),
(-), scar
scar (+)
(+)
Palpation
Palpation
organomegaly
organomegaly (-), tenderness (-), defans muscular
muscular (-)
Percussion
Percussion
timpani,
timpani, shifting
shifting dullness
dullness (-),
(-), undulation
undulation (-)
(-)
Auscultation
Auscultation
peristaltic
peristaltic normal
normal
Exremity
cyanosis
cyanosis (-),
(-), clubbing
clubbing finger
finger (-),
(-), edema
edema (-/-) capillary
capillary refill
time
time > 3s
Hasil
Nilai Normal
Hb
10,5 gr/dl
12-15 gr/dl
Ht
34 %
37-47 %
Leukosit
6.400 /mm3
4.500-10.500/mm3
Eritrosit
4,4 x 106 /L
4,2-5,4 jt/ L
224.000 / mm3
150.000-450.000/mm3
Darah Rutin
Trombosit
Hitung Jenis
Eosinofil
0-6
Basofil
0-2
Netrofil batang
0-1
Netrofil segmen
65
50-70
Limfosit
22
20-40
Monosit
2-8
Natrium (Na)
141 mmol/L
135-145 mmol/L
Kalium (K)
4,7mmol/L
3,5-4,5 mmol/L
Klorida (Cl)
96 mmol/L
90-110 mmol/L
Elektrolit
Diabetes
Glukosa Darah Sewaktu
<200 mg/dl
Ginjal-Hipertensi
Ureum
Kreatinin
13-43 mg/dl
0,51-0,95 mg/dl
Hasil
Nilai Normal
Hb
11,1 gr/dl
12-15 gr/dl
Ht
35 %
37-47 %
Leukosit
16.800 /mm3
4.500-10.500/mm3
Eritrosit
4,7 x 106 /L
4,2-5,4 jt/ L
287.000 / mm3
150.000450.000/mm3
Darah Rutin
Trombosit
Hitung Jenis
Eosinofil
0-6
Basofil
0-2
Netrofil batang
0-1
Netrofil segmen
76
50-70
Limfosit
11
20-40
Monosit
11
2-8
Natrium (Na)
142 mmol/L
135-145 mmol/L
Kalium (K)
3,0 mmol/L
3,5-4,5 mmol/L
Klorida (Cl)
95 mmol/L
Elektrolit
Kalsium (Ca)
Ginjal-Hipertensi
Ureum
Kreatinin
90-110 mmol/L
8,6-10,3 mg/dl
13-43 mg/dl
0,51-0,95 mg/dl
Examination
Electrocardiogram (EKG)
04/06/2015
Onterpretation:
Rhythm : Sinus, regular
Rate
: 300/3 = 100 x / min
axis: RAD
P wave
: 0.08 s 0.1 mV
PR interval
: 0.16 s
QRS
: 0.08 s
pathological Q: (-)
T inverted
: II, III, AVF, V1
ST elevation
: (-)
ST depression: (-)
RSR
: Conclusion: Sinus, regular, HR 100 x / min, RAD, ischemic inferior
Conclusion:
Working diagnosis
Cor pulmonal chronic
Bronkiektasis with destroyed lung
Pneumonia
Therapy
Therapy of cardio:
Bed Rest
IVFD NaCl 15 gtt/i
O2 2-4 l/i
Inj Lasix 1 amp/12 H
Digoxin 1x0,25 mg
Sildenafil 2x12,5 mg
Therapy of Pulmonology:
Bedrest
IVFD Futrolit 10 gtt/i
Asam traneksamat 3x500mg
Nebule ventolin / 8 H
Fosfomycin 1gr/12 H
Sucralfat syr 3xCI
Planning
1. ECHO
2. Follow up ECG
3. Blood gas analysis
Prognosis
Quo ad vitam
: dubia ad malam
Quo ad fungsionam: dubia ad malam
Quo ad sanactionam
: dubia ad malam
Definition
It is the hypertrophy of the right
ventricle resulting from diseases
affecting the function and/or
structure of the lung, except when
these pulmonary alterations are
the result of diseases that
primarily affect the left side of the
heart or congenital heart
World heart association
Etiology
Conditions that restrict or compromise ventilatory
function, leading to hypoxemia or acidosis e.g.
deformities of the thoracic cage, massive obesity
Conditions that reduce the pulmonary vascular
bed e.g. primary idiopathic pulmonary arterial
hypertension, pulmonary embolus
Disorders involving nervous system, respiratory
muscles, chest wall , and pulmonary arterial tree
may also be responsible for cor pulmonale
PATHOGENESIS
GENETIC CAUSES
UNKNOWN CAUSES
PATHOGENESIS
CONTINUED
PATHOGENESIS
CONTINUED
VASOCONSTRICTION
REMODELLING
PATHOGENESIS
CONTINUED
SUSTAINED PULMONARY HYPERTENSION
PATHOGENESIS
CONTINUED
COR PULMONALE
CLINICAL MANIFESTATIONS
Dyspnea
Chronic productive
cough
Wheezing
respirations
Retrosternal or
substernal pain
Fatigue
Polycythemia
Peripheral edema
Weight gain
Distended neck veins
Full bounding pulse
Enlarged liver
Palpitation
Atypical chest pain
Swelling of the lower extremities
Dizziness and even syncope
DIAGNOSIS
HISTORY COLLECTION
DIAGNOSIS
PHYSICAL EXAMINATION
DIAGNOSIS
LABORATORY TESTS
DIAGNOSIS
CHEST
RADIOGRAPHY
DIAGNOSIS
ELECTROCARDIOGRAPHY
ECHOCARDIOGRAPHY
DIAGNOSIS
CARDIAC CATHETERIZATION
DIAGNOSIS
LUNG BIOPSY
MEDICAL MANAGEMENT
OXYGEN THERAPY
MEDICAL MANAGEMENT
PHARMACOTHERAPY
Diuretic agents
Vasodialators
Digitalis
Anticoagulant
Thank you
Tachypnea