CRT-D IMPLANT WORKSHOP

Case 1Name : Mr. Raja InganAge : 65 Years oldSex : Male

Chief Complaint :Worsening dyspnea on exertion.

Medical History : Mr. Raja Ingan Budi, was diagnosed with Chonic heart failure NYHA functional class II, Coronary artery dissease 3 VD, Hypertension stage II, vestibular vertigo, and Dyspepsia. Patient had undergone coronary artery bypass graft surgery in 2006. During the past year, patient had frequent hospital readmissions due to worsening shortness of breath on exertion symptoms.

Current medications are as follows: Ramipril 5 mg (1x1), Letonal (Spironolactone) 25 mg (1x1), Bisoprolol 5 mg (1x1/2), Lasix (Furosemide) 40 mg (1x1), Trizedon ( Trimetazidine) 35 mg (2x1), and Crestor (Rosuvastatin) 5 mg (1x1), aspilet 1x 80 mg.

ECG

ECG

• ECG : Sinus Rhythm• QRS Duration: 120-140 ms

Echocardiography

Echocardiography

• LA, LV Dilation• Global Hypokinetic• Functional MR• Low EF : 27%

Echocardiography

Echocardiography (Dyssynchrony Analysis)

Echocardiography (Dyssynchrony Analysis)

Method Predicting responders Patient

SPWMD >130 ms 160 ms

LVPEI >140 ms

IVMD >65 ms 31 ms

TDI Septal – Lateral LV >60 ms 19 ms

SD of 12 LV TDI >32,5 ms 58,75 ms

Coronary Angiography• LMS : 40% distal stenosis • LAD : 70% multiple stenosis of proximal –

middle LAD, CTO in middle LAD

• LCX : 70% proximal stenosis, 80% middle stenosis

Graft study:• SVG-RCA graft : patent graft/ good• SVG-LCX graft : patent graft/ good• LIMA to LAD graft: patent graft/ good

Conclusion : CAD 3 vessel disease + LM disease with good graft

Current Assessment

1. Chonic heart failure NYHA functional class II2. Coronary artery dissease 3 Vessels Disease

post CABG3. Hypertension stage II4. Vestibular vertigo 5. Dyspepsia

Post CRT-D