CONGESTIVE HEART

FAILURE
PRESENT BY :
Musyarrafah Jamil C014172088

Supervisor :
dr. Akhtar Fajar M, Sp.JP FIHA
 Patient Identity
Name : Mrs. S
Age : 53 y.o
Address : Pinrang
MR : 851903
Date of Admission : 20 September 2018
History Taking
Chief Complaint : Shortness of breath
• The complaint was felt since 5 months ago, and suddenly get worse 3 hours before
hospitalization. The shortness of breath was exacerbated by activities and was affected
by position (ortopneu) and was not affected by weather. Patients complaint she was
barely sleep becuse of the shortness of breath. The complaint was relieved by elevating the
head position by adding additional head pillows.

• History of chest pain (-), wheezing (-), fever (-), nausea (-), vomit (-). Defecation is
normal. Urination is normal.

• Diagnosed with Congestive Heart Failure since August of 2018

• Histories of heart attack in 2015

• There is Histories of Hypertension, no history of Diabetes Mellitus, and dyslipidemia.

• There is Family’s history of cardiac disease,

Physical Examination

• General status :
• Vital sign :
Moderate illness/ Compos BP : 110/70 mmHg
Mentis Pulse : 96 bpm, regular
Nutritional status : RR : 28x/minutes
Weight : 52 kg Temperature : 36.7 C
sO2 : 98%
Height : 155 cm
BMI : 21.6 kg/m2

(Normal)
Physical Examination

• Head and Neck examination :

• Eye : Pale Conjunctiva (-), Icteric sclera (-)
• Lip : Cyanosis (-)
• Neck : JVP R + 3 cm H2O, liymphedenopaty (-), thyroid enlargement (-)
Physical Examination
• Chest examination :
• Inspection : Symmetric between left and right hemithorax.
• Palpation : No mass, no tenderness.
• Percussion : Sonor between left and right chest, Lung-Liver
Junction right ICS 6
• Auscultation: Respiratory sound: Vesicular
• Additional sound : Rhonci bilateral on basal hemithorax, Wheezing
-/-
Heart

• Inspection : Heart apex was not visible

• Palpation : Heart apex was not palpable
• Percussion : Upper Heart Border in left ICS II left midclavicular
line, Right heart border in ICS 4 right midclavicular line, Left
heart border hard to determine
• Auscultation : Heart Sounds : S I/II regular, systolic murmur
grade III/VI on apex

Abdomen

• Inspection : Flat
• Auscultation : Peristaltic sound (+), normal
• Palpation : No mass, no tenderness, liver and
spleen impalpable
• Percussion : Tympani

Extremities

• edema +/+
Laboratory Finding (20/9/2018)
• WBC : 7,16 x 103 /uL PT : 13,0 s
• PLT : 176x103 /uL INR : 1.25
APTT : 30,0s
• RBC : 4,56x 106 /uL
Ur : 41 mg/dl
• HGB : 14,5 g/dl
Cr : 0,62 mg/dl
• pH: 7,446 GOT : 14 U/L
• sO2:99% GPT : 19 U/L
• pO2: 128,5mmHg Na : 146 mmol/l
• pCO2: 38,6 mmol/L K : 4.2 mmol/l
• HCO3 26,9 mmol/L Cl : 109 mmol/l
 Electrocardiogram (ECG)
(20/9/2018)

 Sinus Tachycardia with Ventricular Extrasystole

 HR:104 beats/minute
 Left Axis Deviation
 Left Atrial Enlargment
 Left Ventricular Hipertrophy
Radiology Finding:
AP Thorax X-Ray (18/3/2018)
- Homogenous consolidation in
bilateral hemithorax with ground
glass that covered both sinus and
diaphragm
- Cor: enlarged, aorta is dilating
and calcified
- Bones are intact

Impression:
• Pleural Effusion bilateral
• Cardiomegaly along with
pulmonary edema
• dilatation and calsification aortae
Echocardiography
(20/09/2018)

• Decrease Systolic function of left ventricle, Ejection Fraction 27%

• Dilation all of cardiac chamber
• Concentric Left Ventricular Hypertrophy
• TR Mild
• MR Moderate
• Acinetyc and Hypokynetic Segmental
 Working Diagnose

• Congestive Heart Failure NYHA III

• Coronary Artery Disease
• Mitral Regurgitation moderate
• Tricuspid Regurgitation mild
 Management
• Furosemide 40 mg/ 8 hours/ intravenous
• Spironolactone 25 mg/ 24 hours/ oral
• Ramipril 2,5 mg/8 hours/oral
• bisoprolol 1,25 mg/24 hours/oral
• Simarc 2mg/24jam/oral
 CONGESTIVE
HEART FAILURE
DEFINITION
Heart failure is the inability of heart to maintain cardiac output to
fulfill body metabolism. Decrease CO can lead to lower effective
blood volume.

ETIOLOGY
1. Disease in the myocardium
• Coronary heart disease
• Cardiomyopathy
• Myocarditis , etc
2. Abnormal Loading Conditions
• Hypertensions
• Valve and myocardium structural defects
• Pericardial and endomyocardial pathologies
• High output states
• Volume overload
3. Arrythmias
 CLASSIFICATION of CHF

ACCF/AHA
classification:

NYHA
classification:
 PATHOPHYSIOLOGY
Structural Abnormalities of
the Heart
Increasing Preload Increasing Afterload

Precipitating factor

Ventricular wall stretching

• Dilatation Hipertrophy
Afterload

Contractility

Cardiac ouput

Volume of ventricular
Blood pressure & artery filling
volume

Compensation Preload
mechanism

Vasoconstriction
,fluid retention
CLINICAL FEATURES
DIAGNOSIS
MANAGEMENT
- Increase heart contractility
- Decrease preload
- Decrease afterload
- Prevent further remodelling
Management