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    Lapkas Jantung

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    Juwita Valen Ramadhannia
    Atrial fibrillation with rapid ventricular response and congestive heart failure NYHA class I-II. A 59-year-old female presented with shortness of breath for 3 weeks that worsened in the last 2 days. Examination found irregular pulse, elevated jugular venous pressure, and cardiomegaly on chest x-ray. ECG showed atrial fibrillation with heart rate of 120-200 bpm. She was diagnosed with atrial fibrillation with rapid ventricular response, congestive heart failure NYHA class I-II, and treated medically in hospital.

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    Lapkas Jantung

    Uploaded by

    Juwita Valen Ramadhannia
    27 views25 pages
    Atrial fibrillation with rapid ventricular response and congestive heart failure NYHA class I-II. A 59-year-old female presented with shortness of breath for 3 weeks that worsened in the last 2 days. Examination found irregular pulse, elevated jugular venous pressure, and cardiomegaly on chest x-ray. ECG showed atrial fibrillation with heart rate of 120-200 bpm. She was diagnosed with atrial fibrillation with rapid ventricular response, congestive heart failure NYHA class I-II, and treated medically in hospital.

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    Atrial fibrillation with rapid ventricular response and congestive heart failure NYHA class I-II. A 59-year-old female presented with shortness of breath for 3 weeks that worsened in the last 2 days. Examination found irregular pulse, elevated jugular venous pressure, and cardiomegaly on chest x-ray. ECG showed atrial fibrillation with heart rate of 120-200 bpm. She was diagnosed with atrial fibrillation with rapid ventricular response, congestive heart failure NYHA class I-II, and treated medically in hospital.

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    Download as pptx, pdf, or txt
    27 views25 pages

    Lapkas Jantung

    Uploaded by

    Juwita Valen Ramadhannia
    Atrial fibrillation with rapid ventricular response and congestive heart failure NYHA class I-II. A 59-year-old female presented with shortness of breath for 3 weeks that worsened in the last 2 days. Examination found irregular pulse, elevated jugular venous pressure, and cardiomegaly on chest x-ray. ECG showed atrial fibrillation with heart rate of 120-200 bpm. She was diagnosed with atrial fibrillation with rapid ventricular response, congestive heart failure NYHA class I-II, and treated medically in hospital.

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    of 25

    ARRYTHMIA:

    Atrial Fibrillation Rapid Ventricular Response


    Congestive Heart Failure NYHA Fc. I-II

    Case report by:


    Juwita Valen Ramadhania
    I4061171009

    Preceptor:
    Letkol (CKM) dr. Prihati Pujowaskito, Sp. JP (K), MMRS
    Cardiology Department Dustira District Hospital
    Faculty of Medicine Tanjungpura University
    2018
    Anamnesis (Autoanamnesis)

     Mrs. T/ 59 y.o/ Ceremai Ward


     Chief Complaint: Shortness of Breath (SOB)
     Patient admitted that she often gets intermittent SOB in the
    last 3 weeks and get worsen in the last 2 days.
     SOB occurs especially when she doing an activity (eg: cleaning
    her house) and decreasing during rest. SOB usually occurs ± 1
    hour. Patient use a pillow when she is spleeing.
     The patient admitted there were no complaints of chest pain,
    palpitations, dizziness, decreased consciousness, weight loss,
    bowel and urinary complaints.
    Anamnesis (Autoanamnesis)

     Patient said that she has hypertension disease and take 5mg of
    Amlodipine everyday in the last 1 year.
     She has relatives that suffer cardiovascular disease.
    Physical Examination
    BP = 110/80 mmHg PR = 128 bpm, irregular, RR = 26 tpm T = 36.5 celcius
    pulsus deficit SpO2 = 82%
    General appearance looked moderately ill GCS E4 V5 M6 ; VAS Score : 0

    Head Anemic (-) Icteric (-)

    Neck JVP 5+3 cmH2O

    Thorax Retraction (-), Ictus Cordis not seen.


    Cor S1 S2 single, mur mur (-), gallop (-) extrasystole (-)

    Pulmo Simetric, SF D = S Rh +/+ Wh - /-

    Abdomen Convex, Soefl, Hepar : Liver span 11 cm, spleen traube space tympani.
    Tenderness (-)

    Extremities Pitting oedem of lower extremities (+/+)


    Laboratorium Findings
    July 3rd 2018

    Hemoglobin : 12.3 g/dl RBS : 109 mg/dl


    Eritrosit : 4.2 x 106/µl Sodium : 148 mmol / L
    Leukosit : 7.200/µl Potassium : 4.10 mmol / L
    Hematokrit : 36,7% Chloride : 108 mmol / L
    Trombosit : 289.000/µl Ureum : 35 mg / dl
    MCV : 87,2 fl Creatinin : 0.9 mg / dl
    MCH : 29,2 pg Triglycerides : 42 mg / dl
    MCHC : 33,5 g/dl LDL Cholesterol : 124 mg / dl
    RDW : 13,1 %
    Ba/Eo/Sg/Li/M :
    0,7/4,3/60,1/26,3/8,6 %
    ECG
    July 30rd 2018
    In the ER:
    ECG
     Rhythm : Arrhythmia
     Frequency : 120-200 bpm
     Frontal Axis : Normoaxis
     Horizontal Axis : Normoaxis
     P wave : Normal P wave disappeared and
    replaced by fibrillation waves
     P-R interval : Can not be calculated
     Q Wave : Normal
     QRS complex : 0.08 s
     R-R Interval : Irregular
     ST segment : Normal
     T wave : Normal
    Conclusion : AF RVR HR 120-200 bpm
    ECG
    July 30rd 2018
    30-7-2018 06.30

    30-7-2018 12.10
    ECG
    July 30rd 2018
    30-7-2018 12.10

    30-7-2018 16.10
    ECG
    30-7-2018 22.10

    31-7-2018 08.00
    Thorax X-Ray
    Conclusion: Cardiomegaly
    SCORING
     Framingham criteria:
     Mayor criteria : neck vein distention, rales, and cardiomegaly.
     Minor Criteria : dyspnea on ordinary exertion, bilateral
    ankle oedema and tachycardia.
     NYHA Fc I-II
     CHA2DS2-VASc: 3
    Diagnosis
    Clinical Diagnosis
    AF RVR

    Anatomical Diagnosis
    AV Node

    Etiologic diagnosis
    Non-atherosclerotic

    Additional diagnosis
    1. CHF NYHA Fc I-II
    2. HT Controlled
    3. Dyslipidemia
    Therapy

    ER
     Non medical:
     Semi fowler position
     Medical:
     Oxygen 8 Lpm
     NaCl 500 cc/24 hours
     Furosemide 1x20mg (iv)
     Amiodaron 1x150mg for 10min, then 1mg/min for
    6h
     Warfarin 1x2mg (Po)
    Therapy
    Ward
     Non-Medical:
     Take control of risk factors
     Serial ECG per 4-6 hours
     Medical:
     Furosemide 3x20mg (iv)
     Digoxin 1x0.25mg (iv), maintenance 0.125-0.25mg
     Warfarin 1x2mg (po)
     Ramipril 1x5mg (po)
     Atorvastatin calcium 1x20mg po (night)
    Therapy
    Post hospitalized
     Non-Medical:
     Take control of risk factors
     INR test after 7 days consuming warfarin
     Medical:
     Warfarin 1x2mg (po)
     Ramipril 1x5mg (po)
     Bisoprolol 1x2,5mg (po)
     Atorvastatin calcium 1x20mg (po: night)
    Prognosis
     Quo ad vitam : dubia ad bonam
     Quo ad sanactionam : dubia ad bonam
     Quo ad functionam : dubia ad bonam
    Thank you

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