CONGESTIVE HEART FAILURE (CHF) NYHA II e.c HYPERTENSIVE HEART DISEASEPembimbing : dr. Natalia F. Polittondr. Alfrid D. Robot

IDENTITAS PASIENNama: Tn. GRJenis Kelamin: Laki-lakiUmur: 79 tahunAlamat: Sario Tumpaan L.IPekerjaan : PensiunanTanggal Pemeriksaan : 16 Maret 2015

Anamnesis (1)Keluhan Utama: Sesak NafasSesak nafas dirasakan pasien sejak kurang lebih sejak 3 minggu yang lalu dan memburuk sejak 5 hari yang lalu. Sesak dirasakan ketika melakukan aktivitas berat seperti naik turun tangga dan berjalan jauh dan menghilang jika beristirahat.

Anamnesis (2)Pada malam hari pasien sering terbangun karena tiba-tiba sesak dan membutuhkan waktu setengah jam agar pasien dapat tidur kembali. Pasien tidur dengan 3 bantal.Tidak ada keluhan jantung berdebar, demam, batuk, mual dan muntah.Tidak ada keluhan dalam BAK maupun BAB

Riwayat Penyakit DahuluTerdapat riwayat darah tinggi sejak 6 tahun yang lalu, tidak minum obat teraturRiwayat peny. Jantung, kolesterol, kencing manis, asma, tiroid, stroke, ginjal, asam urat disangkalRiwayat merokok dan alkohol disangkal

Pemeriksaan FisikKeadaan Umum: Tampak sakit sedangKesadaran: Compos MentisVital Signs:Tekanan Darah: 150/90 mmHgFrekuensi Nadi : 76 x/m, regularFrekuensi Nafas : 20 x/mSuhu Tubuh : 36.7 C

Kepala dan Leher:Mata : Conjunctiva anemis (-/-), sklera ikterik (-/-)Bibir : sianosis (-)Neck : tidak ada massa, JVP : 5 + 0 cmH2O

ThoraksParu-paruI : Statis, dinamis simetris kanan sama dengan kiri, sela iga tidak melebarP : Stem fremitus kanan = kiriP : Sonor pada kedua lapangan paru kanan dan kiriA: Vesikuler (+) normal, ronkhi basah halus pada bagian basal kedua lapangan paru (+), wheezing (-)

Pemeriksaan Fisik

JantungI : Ictus cordis tidak terlihatP : Ictus cordis tidak terabaP : Batas atas jantung ICS II, batas kanan jantung linea sternalis dextra, batas kiri jantung linea axillaris anterior sinistra A : HR = 76x/menit, regular, murmur (-), gallop (-)

Pemeriksaan Fisik

PerutI : DatarP : Lemas, hepar tidak teraba, lien tidak terabaP : Shifting dullness (-)A : Bising usus (+) NormalExtremitas Edema pretibial (-)

Pemeriksaan Fisik

DiagnosisCHF NYHA II e.c susp. HHD (Hypertensive Heart Disease)

PlanningRujuk Poli Penyakit Dalam RS Pancaran Kasih

PEMBAHASAN

Definition

Pathophysiology of CHF

LV REMODELING

Symptoms

Major CriteriaMinor Criteria

Paroxysmal Nocturnal Dyspnea CardiomegalyGallop S3Hepatojugular refluxIncreased of JVPRales or ronchiAcute pulmonary edemaProlonged circulation time(> 25 sec)Weigh loss 4,5 kg in 5 days in response to treatment of CHFExtremity edemaNocturnal coughDecreased vital pulmonarycapacity (1/3 of maximal)HepatomegalyPleural effusionTachycardia ( 120bpm)Dyspnea on effort

Classification of CHF

Treatment of CHF STROKE VOLUMEPRELOADCONTRACTILITYCARDIAC OUTPUTHEART RATEAFTERLOAD

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**Chest pain was felt like being stabbed on the chest and last for less than 5 minutes of duration. Chest pain was also relieved by resting.

***********disruption in any part of the mitral valve apparatusFor example: age, calcium build up around mitral annulus, dilatation of mitral annulus, mitral regurgitation*Perubahan struktur, massa, volume dari LV akibat cedera kardiak (iskemi) atau kelainan hemodinamik (HPT)*Major:Paroxysmal nocturnal dyspnoea Neck vein distension Rales Radiographic cardiomegaly Acute pulmonary oedema S3 gallop JVP > 16 cm H2O Hepatojugular reflux Circulation time > 25 seconds Weight loss 4.5 kg in 5 days in response to treatment of CHF Pulm.oedema, visc. congestion or cardiomegaly at autopsy

Minor:Bilateral ankle oedema Nocturnal cough Dyspnoea on exertion Hepatomegaly Pleural effusion Heart rate 120 bpm FVC decreased by 33% from max. value recorded

***Pathophysiology of Congestive Heart Failure.Determinants of ventricular function.Ventricular function, and cardiac function in general, depends upon the interaction of four factors that regulate the volume of blood expelled by the heart (the cardiac output): contractility, preload, afterload, and heart rate. The first three determine the volume of blood expelled with each beat (the stroke or ejection volume), while the heart rate affects the cardiac output by varying the number of contractions per unit time. These four factors, which are intrinsic regulators of heart function, are all influenced by the nervous system. In the failing heart, especially in ischemic heart disease, it is also important to consider some purely mechanical factors, such as the synergy of ventricular contraction, the integrity of the septum, and the competence of the atrioventricular valves.

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