Present CHF
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CASE REPORTCASE REPORT
CHFCHF
Presented by:Nisa Uswatun Karimah
Lydia Octasari
Advisor:
dr. Erwin Sukandi, Sp.PD
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IDENTIFICATION
Name : Mrs. n
!"e : #$ years
Se% : &ema'e
!ddress : Ds. e()dadi Ka*. +anyuasin
Marita' status: married
Occupati)n : h)use wi&e e'i"i)n : m)s'em
!dmitted t) h)spita' : N)em*er -, #/
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ANAMNESIS
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CHIEF COMPLAIN
Sh)rtness )& *reath a"ain s) heay since
0 week *e&)re admissi)n
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HISTORY OF ILLNESS
1 m)nths *e&)re admissi)n:
sh)rtness )& *reath, depended )n p)siti)nand actiity. She &e't sh)rtness )& *reathwhen ") t) t)i'et. She &e't *etter i& she sat )rs'ept with takin" #21 pi'')ws. Sh)rtness )&*reath wasn3t depended )n weather 4
em)ti)n, n)t &)'')wed *y men"i )ice. 5akeup midni"ht caused sh)rtness )& *reath 678,heart pa'pitati)n 678. 9hest pain 628, c)u"h628, &eer 628, sweatin" at ni"ht 628.
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Swe''in" in *)th )& ')wer e%tremity 678,
swe''in" in upper eye 'ids 628. +ein"
ye'')wish in eyes and skin 628. Epi"astrium
pain 678, nausea 678 *ut n) )mit. N)
pr)*'em in urinati)n and de&ecati)n. She
went t) SM and was h)spita'i;ed &)r 0
days unti' she ")t we''.
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1 month before admission
She c)mp'ained )& hain" sh)rtness )& *reatha"ain, depend )n p)siti)n 4 actiity. She &e't
sh)rtness )& *reath a&ter wa'kin" - m, *ein"
*etter i& she t))k a rest.
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Swe''in" in upper eye 'ids 628. +ein"
ye'')wish in eyes and skin 628. +ein"
ye'')wish in eyes and skin 628. Epi"astrium
pain 678, nausea 678 *ut n) )mit. N)pr)*'em in urinati)n and de&ecati)n. She
was taken t) S Siti Kh)di(ah and
h)spita'i;ed &)r #- days unti' she ")t we''.
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1 week before admission
She c)mp'ained )& hain" sh)rtness )&*reath a"ain s) heay, depended )n p)siti)n
4 actiity. She &e't *etter i& she sat, *ut she
c)u'dn3t wa'k anym)re.
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Swe''in" in *)th )& ')wer e%tremity 628,
swe''in" in upper eye 'ids 628. +ein" ye'')wish
in eyes and skin 628. Epi"astrium pain 678,
nausea 678 *ut n) )mit. N) pr)*'em in
urinati)n and de&ecati)n. She was taken t)
SM a"ain &)r these c)mp'ains.
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HISTORIES OF PAST ILLNESS
> )& heart disease since 0= years a"),
h)spita'i;ed min. )nce in a year
> )& ()int and *)ne pain 678 since 0 years )'d
> )& hypertensi)n was denied
> )& DM was denied
> )& kidney disease was denied
> asthma was denied
> *ein" *'ue when *a*y was denied
> "astric pain since 0 years a")
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HISTORIES OF FAMILY DISEASE
> )& heart disease 678 in her m)ther
> )& hypertensi)n 678 in her m)ther, t))
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PHYSICAL EXAMINATION
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GENERAL EXAMINATION
?enera' c)nditi)n : sick
Sickness c)nditi)n : seere sickness
9)nsci)usness : c)mp)s mentis
+'))d pressure : @>A mm" Pu'se rate : 0 %>min, irre"u'ar
espirati)n rate : = %>min
Bemp. : 1A,@.9 Dehydrati)n : 628
Nutriti)n : wei"ht C 1- k", hei"ht C 0-- cm
impressi)n : undernutriti)n
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SPESIFIC EXAMINATION
Skin
Skin c)')r is puce, n)rma' pi"mentati)n,e&')resence 628, icteric 628, cyan)tic pa'm 4
pa'mar 628, scar 628, hyperhydr)sis 628,n)rma' hair "r)wth, "))d tur")r, wet>dry inpa'pitati)n 628, su*cutane)us n)du'e 628.
Lymph "'and
n) en'ar"ement )& the 'ymph n)des )nsu*mandi*u'ar, neck, a%i''aries, 4 in"uina'.
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ead
)a', symmetrica', pu&&y &ace 628, de&)rmity
628, ma'ar rash 628, a')pecia 628
Eyes
e%)phta'mus 4 end)phta'mus 628,
edemat)us superi)r pa'pe*ra 628, pa'e )&
c)n(unctia pa'pe*ra 628, icteric sc'era 628
N)se
epista%is 628, n)rma' nasa' septum and
muc)us 'ayer
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Ears
"))d hearin", n)rma' *)th )& meatus
acusticus e%ternus
M)uth
rha"aden )& 'ips 628, st)matitis 628, papi'
atr)phy 628, "um *'eedin" 628, &et)r )ris 628
Neck
thyr)id "'and n)t pa'pa*'ed, thyr)id *ruit
628, P 6-7#8 cm#O, hypertr)phy )&
muscu'us stern)c'eid)mast)ideus 628,
sti&&ness 628
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Bh)ra%
n)rma' shape, e%tended interc)sta' secti)n 628,
retracti)n 628, enectasis 628, spider naei 628 Lun"
< : symmetrica' )& static 4 dynamic ri"ht C 'e&t
P: ri"ht stem&remitus is weaker )n *ase )&'un"
P: du'' in ri"ht 'un" started at
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9)r
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!*d)men
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Upper e%tremity
pain )n ()in 678, pa'e )n &in"er 628, erythema
)& pa'm 628, pittin" edema 628, c'u**in"
&in"er 628, trem)r 628, n)rma' physi)')"ica'
re&'e%
L)wer e%tremity
pain )n ()in 678, pa'e )n &in"er 628,
erythema )& pa'm 628, pittin" edema 628,
c'u**in" &in"er 628, trem)r 628, n)rma'physi)')"ica' re&'e%
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ADDITIONAL EXAMINATION
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ELECTROCARDIOGRAPHY
(Nov 5, 2008)
!F, n)rma' a%is, C 0020= %>min, P
wae can3t *e ea'uated, GS c)mp'e%
.= sec)nds, >S 0 H 0, S 0 7
0>->A I 1-, S persistent 678 in -2A
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LABORATORY FINDINGS (Nov 5, 2008)
+'))d ana'ysis
em)"')*in : 0./ ">d'60=20/ ">d'8
emat)crite : 1#J 6=2=/J8
Leuc)cyte : A->mm1 6-20>mm18
ES : 1 mm>hr 6H 0 mm>hr8
Bhr)m*)cyte: #@0,/mm3 6#,2-,>/mm3)
Di&& c)unt : >->#>$$>0#>=
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+SS : 0- m">d'
9h)'ester)' t)ta' : 0-- m">d' 6H #8
DL2ch)'ester)' : =- m">d' 6I --8
LDL2ch)'ester)' : @0 m">d' 6H 018
Bri"'yceride : @A m">d' 6H 0-8
Uric acid : =.- m">d' 60.A2A.8
Ureum : 0/ m">d' 60-21@8
9reatinin : .$ m">d' [email protected]
B)ta' pr)tein : A.A ">d' 6A2$./8
!'*umin : 1.0 ">d' 61.-2-8
?')*u'in : 1.- ">d'
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B)ta' *i'iru*in : 0./ m">d' 6.0208
Direct *i'iru*in : 0.## m">d' 6H .#-8
' 6H =8
S?PB : 1@ U>' 6H =08 LD : #AA U>' 60A21#8
S)dium : 01- mm)'>' 601-20--8
P)tassium : -. mm)'>' 61.-2-.-8
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Urina'ysis
Epithe'ia' ce'' : 678
Leuc)cyte : 20>LP+ 62->LP+8
Erythr)cyte : 21>LP+ 620>LP+8
9y'inder : 628 6ne"atie8 9rysta' : 628 6ne"atie8
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CHEST X-RAY (Nov 5, 2008)
9)nditi)n )& the ph)t) was "))d
i"ht and 'e&t are eua' Brachea was in the midd'e
N) e%tended interc)sta' secti)n
9)nditi)n )& the *)ne was "))d, n) &racture 9B was di&&icu't t) seen
i"ht c)st)phrenicus an"'e was di&&icu't t)
ea'uated, 'e&t c)st)phrenicus was keen
i"ht diaphra"m is at
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ECHOCARDIOGRAPHY
EDO : -.=$
ESO : =.A
P5 : .A-
!O : =.1$
L di'atati)n, L! di'atati)n
L 628
L EF -J
MS seere, M! C 0.$A,MP? 0120@
M seere
! m)derate
!S mi'd2m)derate B m)derate
MD e.c. D
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RESUME
! w)man initia'ed Mrs. n, #$ years,admitted t) h)spita' in N)em*er -, #/ withsh)rtness )& *reath a"ain s) heay since 0 week*e&)re admissi)n as the chie& c)mp'ain.
1 m)nths *e&)re admissi)n, she c)mp'ained)& hain" sh)rtness )& *reath, depended )np)siti)n 4 actiity a&ter ")in" t) t)i'et. She &e't*etter i& she t))k a rest and s'ept with #21 pi'')ws.5ake up in midni"ht caused *y sh)rtness )&*reath 678, heart pa'pitati)n 678. Swe''in" in *)th)& ')wer e%tremity 678, epi"astric pain 678, nausea
678. She went t) SM 4 h)spita'i;ed.
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0 m)nth *e&)re admissi)n, she
c)mp'ained hain" sh)rtness )& *reath a"ain,
depended )n p)siti)n 4 actiity a&ter wa'kin" -m. She &e't *etter i& she t))k a rest )r s'ept
with 12= pi'')ws.
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0 week *e&)re admissi)n, she c)mp'ainedhain" sh)rtness )& *reath a"ain, depended )n
p)siti)n 4 actiity. She &e't *etter i& she t))k a rest)r s'ept with =2- pi'')ws. She c)u'dn3t wa'kanym)re.
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Fr)m physica' e%aminati)n, the "enera'c)nditi)n was seere sickness, c)nsci)usnesswas c)mp)s mentis. +P was @>A mm", pu'serate 0 %>min, irre"u'ar, C =%>times, [email protected], +5 C $,$J with undernutriti)nimpressie, P 6-7#8 cm#O.
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FRAMINGHAM SCORE
Ma()r criteria : Par)%ysma' n)cturna' dyspnea 678
Distenti)n )& neck ein 628
a'es )n pu'm) 678 9ardi)me"a'y 678
!cute pu'm)nary edema 678
?a'')p S1 628
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Min)r criteria :
E%tremity edema 628
9)u"h in ni"ht time 628
Dispnea d3e&&)rt 678
epat)me"a'y 678 P'eura' e&&usi)n 628
Decreased )& ita' capacity 628
Bachycardia 6I 0# %>min8 628
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OR!ING DIAGNOSIS
9F e.c. MD e.c. D
DIFFERENTIAL DIAGNOI
9F e.c. MMS e.c. D
9F e.c. c)n"enita' a'e a*n)rma'ity
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TREATMENTS
N)npharmac)')"y :
O#1 '>min
+edrest 6ha'&2sit
p)siti)n8 9)r diet
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PLANNING
epeat ech)cardi)"raphy
E'ectr)'yte e%aminati)n
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PROGNOSIS
Gu) ad itam : du*ia et ma'am
Gu) ad &uncti)nam : du*ia et ma'am
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TERIMA !ASIH