Supraventricular

Tachycardia with a History

of Coronary Artery Disease
3-vessels-disease

a Case Report
by
Isma Resti Pratiwi, S. Ked

Cardiology Department
Dustira Educational Hospital
Cimahi
2017
Mr. YM, a Male,
51 Years Old
Chief Complaint: Palpitation
Summary of
Database

Male, 51 y.o. came with palpitations

felt since 3 hours before administered.
He also felt a chest pain 1 day before,
the chest pain is typical for cardiac
chest pain, and the symptom persists
until he came to the Emergency
Department
He had history of the same complaint
before, had been through DCA procedure
-- found 3-vessel-disease and had
been undergone the PCI procedures
second times a year ago,
Past Medical History

History of well controlled

hypertension since 5 years ago
No history of diabetes or asthma
Physical Examination
(5/2/17)
BP = 110/80mmHg PR : 167 tpm, regular, RR = 34 tpm, T ax 36,5C
pulsus defisit (-) 97%

General appearance looked moderately ill GCS 456 , compos menits

Head Anemic (-/-) Icteric -
Neck JVP 5+2 cmH2O

Thorax Invisible Palpable at Ictus ICS VI MCL S,

Heart RHM SL D, LHM as ictus,
S1 S2 single, mur mur (-), gallop (-)

lung Simetric, SF D = S SS v v Rh - - Wh - -
SS bv bv - - - -
DS bv bv - - - -

Abdomen Convex, Soefl, Hepar : Liver span 12 cm, tenderness point (+)
epigastric

Extremities Oedema (-/-)

 Laboratory Findings
(5/2/17)
Lab Value

Hb 14,8 13,0 18,0

RBC 5,9 4,0 5,5

WBC 6,1 4,0 10,0

HT 46,3 38,0 51,0

PLT 198 150 450

CKMB 18 <24

GDS 150 >160

ECG Records
(5/2/17) Supraventricular
tachycardya,
133x/minutes
Left Axis Deviation
Pathologic Q in
lead II, III, AVF
Broad, notched R
in V6
Absent R and
prominent S in V1

Conc:
Supraventricular
Tachycardia with
Incomplete Left
Bundle Branch
Block and
DCA (16/6/2016)

Right dominant
circulation,
normal LM vessel,
95% stenosis on
proximal RCA,
40-45% stenosis
on mid RCA, CTO
on LAD, patent
old stent on LCx.

The PCI
procedure was
done to the
proximal RCA
 Further
Examinations

DCA to
Lipid Echocardio-
evaluate
profil graphy
the stent
Diagnosis
Clinical Diagnosis: Supraventricular
Tachycardia with Unstable
Angina

Anatomical Complete Total Occlusion

Diagnosis in LAD, Stenosis in LCx
and RCA and Inferior
Infarction
Planning Therapy

Non Pharmacological
Pharmacological IVFD NS 500 cc / 24
O2 2-4 lpm hour
Natrium restriction Amiodarone 150mg in
Bed rest 10 min IV via syringe
Refer to Cardiologist pump (loading)
Pro DCA and PCI 600mg/24 hour IV
(maintenance)
Copidogrel 1 x 75mg
PO
Aspillet 1 x 80 mg PO
Concor 1 x 2,5mg PO
Atorvastatin 1 x 20mg
Prognosis

Quo ad vitam : Dubia ad malam

Quo ad sanactionam: Dubia ad malam
Quo ad Functionam : Dubia ad malam
Thanks!
Any questions ?