chf nyha iii ec. alcoholic cardiomyopathy

8/16/2019 Chf Nyha III Ec. Alcoholic Cardiomyopathy

1/27

Present by

Hazmi Adly Harun Bin Harun

(C111 11 828)

Supervisor :

Prof dr Peter Kabo PhD SpFK SpJP(K) FIHAFASCC

Chf nyha iII ec.

ALCOHOLICCARDIO!OPA"H!

CASE PESE !"A" #$!

%epartment o& Cardiolo'y and asular *ediine*edial +aulty o& Hasanuddin ,niversity

*a-assar 2.1/


2/27

PA"#E!" #%E!"#"0

• Name : Mr S

• Age : 56 years old

• Gender : Male

• Admission date : 09-03-2016


3/27

Chief Comlaint : Shortness of !reath

• "elt sin#e aro$% 2 &ee's ago and &orsen 2 days !efore !eing admitted to

the hosital% ($erien#ed &hile doing minimal a#ti)ity s*#h as &al'ing to the

!athroom and is relie)ed &ith rest%

• At times atient get startled d*ring the night d*e to s*dden onset of

shortness of !reath%

• +atient *s*ally slees *sing more than 1 illo&

• No #hest ain

•,eart!*rn -.

• Co*gh -.%

• S&elling e$tremities/ edemas .

H#S"$0 "A#!


4/27

*,istory of hyertension -.

*,istory of dia!etes mellit*s -.

*,istory of family mem!ers &ith same illness-.

*,istory of smo'ing . aro$% 2 !o$es of#igarette a day

*,istory of #on#*mtion of al#ohol .

Past *edial History

+amily History

,istory of #ardio)as#*lar disease infamily -.


5/27

S4 "ACS

!on3 *odi&ied*odi&ied

• Smo'ing

• Al#ohol

#ons*mtion


6/27

eneral Status

*Moderate illness/ 7ell no*rished/ Cons#io*s

*N*tritional Stat*s: Normal*7eight : 68 'g

*,eight : 163 #m

*M : 25%21 'g/m2

ital Si'n

*lood +ress*re : 90/60 mm,g

*+*lse ate : 2 !m

*esiratory ate : 26 !m

* emerat*re : 36%6 0C a$illa.


7/27

PHYSICAL EXAMINATION

Head and Neck Examinations

(ye : Con;*n#ti)a anemi# -/-. S#lera i#teri#-/-.


8/27

• nse#tion : ,eart ae$ not )isi!le

• +alation : ,eart ae$ ala!le• +er#*ssion : ,eart !orders elongates• A*s#*ltation : S / reg*lar m*rm*r ansystoli#

Heart

•

nse#tion : istended follo&s !reathingmo)ement• A*s#*ltation : +eristalti# so*nd . normal• +alation : No mass no tenderness liver ala!le

"cm #rom arc$s costa and sleen $nala!le• +er#*ssion : ymani .

Abdomen

• +reti!ial edema /• orsal edis edema /

E4tremities


9/27

*Rhyth# $ Sin%& rhyth#*Heart rate $ '' bp#

*Re%arity $ re%er

*A*i& $ +or#oa*i&

*P ,a-e $ /0 &*PR inter-a $ /' &

*1RS co#pe* $ d%ration /2&/

*S" Se#ent $ /23 &

*Conc%tion $Sin%& rhyth#/ HR '' bp#/ re%ar/ +or#oa*i&/ L4H

5C6interpretation


10/27


11/27

Radiooy 7ndin&

#!"EPE"A"#$! o& CHES" 5 A0

• Cardiome'aly 6it7 si'ns o&pulmonary edema

#!"EPE"A"#$! $+ ECH$CA%#$APH0• S%stolic #$nction o# the ri&ht and le#t

ventricle decreases d$e to 'CM• 'ilatation o# all heart cham!ers• Excentric L(H• )lo!al h%okinetic•

Severe Mitral re&$r&itation* Lo+ Tric$sidre&$r&itation* Moderate P$lmonal

re&$r&itation*• Moderate P$lmonal h%ertension• Le#t ventric$lar diastolic d%s#$nction &rade

III


12/27

AB$A"$0 +#!%#!SPE*E#SAA! !#A# !#A# ,9,A! ,!#"

BC ,-. "-//01/-// 1/˄23$l

BC 4-54 "-//06-// 1/˄63$l

Hb 16-1 15-/016-/ &r3dl

Plt 115 14/0"// 1/˄23$l

P" 55-, 1/01" 'etik

AP"" 2/-6 55-/022-/ 'etik

#! 1-7. 00%S 7/ 1"/ m&3dl

,reum 112 1/04/ m&3dl

Creatinin 1-5. L9:1-2; P9:1-1; m&3dl

S$" 4,. :2.


13/27

Blood as AnalysispH ; ;


14/27


15/27

A+A655+"

Bed rest

$4y'en =3? lpm via nasal anule

#+% !aCl . /.. 2? 7r

%iureti

?$rosemid 5 am3. hr3iv

ACE #n7ibitor

Catoril 15-4m&3.hr3oral

E4petorant

Am!roxol 5/m&3.hr3oral


16/27

DISCUSSION

HEART FAILURE


17/27

he state in &hi#ha!normal #ir#*latory

#ongestion o##*rs as theres*lt of heart fail*re%

D5FI+I"IO+

,eart is no longer a!le to *m anade*ate s*ly of !lood in relationto the )eno*s ret*rn and in relationto the meta!oli# needs of the !odytiss*es at the arti#*lar moment

C o n & e s t

i v e

H e a r t

? a i l $ r e

H e a r t

? a i l $ r e


18/27

5"IOLO6! OFH5AR"FAIL:R5

M%ocard'isease

CA'

Cardiom%oath%

Iatro&enic

Miocarditis

*yoard *e7anial%ys&untion

Press$re overloaded

9Stenosis Aortae* H%ertension*Coartatio Aortae;

(ol$me Overloaded

9Mitral3Aortae @e&$r&itation*Con&enital Heart 'isease*

Hiertrans#$sion;

Miocard ?illin& Inhi!itatin&

(Cardia "amponade Periarditis)


19/27

"he Fra#inha# criteria for CHFCHF con&idered pre&ent if 3 #a;or or 2 #a;or <

3 #inor*aDor Criteria *inor Criteria

•

Parox%smal Noct$rnal'%snea

• Cardiome&al%

• )allo S2

• Heato$&$lar re#l$x

• Increased o# B(P

• @ales or ronchi

• Ac$te $lmonar% edema

• Prolon&ed circ$lation time9

54 sec;• Dei&h loss "*4 k& in 4 da%s

in

resonse to treatment o# CH?

•

Extremit% edema• Noct$rnal co$&h

• 'ecreased vital $lmonar%

caacit% 9132 o# maximal;

• Heatome&al%

• Ple$ral e##$sion

• Tach%cardia 9 15/!m;

• '%snea dFe##ort


20/27

*Si'ns o& CH+


21/27

cASSIFICA"IO+ OFCHF


22/27

*PA"H$PH0S#$$0 $+ CH+


23/27

Lo+ salt* eno$&h

calories and roteinsdetar%

@ed$ce Ph%sical

Activit%

OtimaliGed

Oxi&enation

CHF A+A655+"

Non0?armakolo&i

?l$id restriction


24/27

Mana&in& a#terloadMana&in& reload

Ne$rohormonalmod$lationMana&in&contractilit%

Inotroic a&ents • Cardiac &l%cosides• 0 adrener&ic

• 'i$retics• (enodilator •ACE inhi!itors

•A@•J !lockers•CC •J !lockers

•ACE

inhi!itors•A@

CHF A+A655+"

?armakolo&i


25/27

*edial "7erapy

*ACE0Inhi!itor

*'i&italis

*'i$retic

*Anti0arrh%tmia

*'i&oxin

*Anti0coa&$lant

*Anti!iotic


26/27

• S%mtomatic +ith severe M@

• As%mtomatic +ith severe M@ and reserved L(

#$nction

• As%mtomatic +ith severe M@ and Le#t ventricle end

s%stolic diameter 9L(ES';

Sur'ial intervention


27/27

"7an- 0ou

chf nyha iii ec. alcoholic cardiomyopathy

Documents