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