Congestive Heart Failure et

causa Mitral insuficiency

By: Herud Eka Putra
SUPERVISOR :
DR. IDAR
MAPPANGARA,SP.PD,SP.JP(K),FIHA

Patient Identity
Name
age

: Samira
: female
: 22 years

old
hospital
No. reg

: 1-5-2009
: 386531

gender

HISTORY TAKING :
Chief complaint: dyspneu
anamnesis addition: undergone since 2 months ago

continual and more weight until patient can not do

activity whatever. patient can not sleep supine and
must use two pillows so that the dyspneu decrease.
The patient also felt chest pain and this conditon
appears to recurrent and when does pain emerge to go
on during 1-2 hour of clock.
cough since 1 month ago but not continual, sick and
vomit there is no, swollen in stomach and leg is
undergone since 2 months ago. He has chest pain
story since 10 year ago especially heavy activity. The
patient story is cared at hospital as much as 4 times
with complaint same. There is not jaundice story.
Diabetes Mellitus (-), hipertension (-), Heart disease (-),
gastritis (-), Family history of hearth disease (-).
Defecate and mictirity : were normal

RISK FACTOR
Gender : Female (10%)
Underweight
Chest wall was mild deformity
Rematic Fever (unknown)

Physical Examination :
General Status

: heavy Ill/ Nutrient Less/

compos mentis
Head
: anemis (+), ikterus (-), sianosis (-)
Neck
: MT (-), NT (-), DVS R +2 cmH2O
Thorax :
I : Simetris left same right
P : MT (-), NT (-), VF left more than right
P : sonor
A : Respiratory sound : vesiculer, Rh +/+, Wh -/-

Physical Examination :
Heart

:
I : Ictus cordis was visible
P : Ictus cordis is felt, thrill (+)
P: deaf
A : BJ I/II irreguler, pansistolik murmur
sound(+)
Abdomen
: Ascites (+)
Oedem
: +/+

Laboratory Examination
Laboratory finding

Blood Complete :
WBC
: 6,0. 103
RBC
: 3,63. 106
HGB
: 8,5 g/dl
HCT
: 31,1 %
PLT
: 311 x 103/
ul
GDS
: 97
Ureum : 17

Electrolite :
Na
K
Cl

: 130
: 3,3
: 101

Chemical Blood :
Creatinin
: 0,6
SGOT : 17
SGPT : 8
Cardiac Enzime :
CK/CK-MB
: 27/ 17

ECHOCARDIOGRAPHY

Echocardiography :
Echokardiography (4-5-2009)
:
LA & RA dilatation
Contractility LV good, EF 85%
MI severe vegetasi appearance
TI
PH (PAP : 27 mmHg)
Doppler
: E/A>1
conclusion
: MI severe dengan
vegetasi, TI, PH

EKG

EKG

EKG
Junctional Rhythm
HR = 100 bpm
QRS kompleks 0,08
Axis : RAD
RVH
T inverted in I, II, aVF, V5, V6
Recent : ischemic in lateral and inferior wall

X-RAY Thorax

USG ABDOMEN

USG ABDOMEN
Hepatomegaly disertai dengan Congestive

liver
Ascites

PATHOLOGYCAL ANATOMY
LABORORATORY
EVALUATION PLEURAL FLUID IS NON

SPECIFIC INFLAMMATION

DIAGNOSIS
Anamnese
Physical examination
Laboratory
EKG
Echocardiography

Diagnosis :
CHF NYHA IV ec. Mitral Insuficiency

Management:
Position Half site
Oksigen 4-6 liter/ menit
Lasix 2 amp/ 12 hour/ IV
Farsorbid 10 mg 3 x 1
Aspilet 80 mg 1 x 1
Alprazolam 0,5 mg 0-0-1
Laxadyn Syr 3 x C
Dorner 2 x 1
Spironolactone 25 mg 2 x 1

Congestive Heart Failure

Congestive heart failure (CHF) is a condition in

which the heart's function as a pump to deliver

oxygen rich blood to the body is inadequate to meet
the body's needs. Congestive heart failure can be
caused by:
diseases that weaken the heart muscle,
diseases that cause stiffening of the heart muscles,

or

diseases that increase oxygen demand by the body

tissue beyond the capability of the heart to deliver.

Congestive Heart Failure

Heart failure is CO dan BP are inadequate

for the bodys requirement.

Classification :
LVF
RVF
Congestive cardiac failure

NYHA Clasification :
Heart disease present, but no undue
dyspnoea from ordinary activity
II. Comfortable at rest; dyspnoea on
ordinary activities
III. Less than ordinary activity cause
dyspnoea, which is limiting
IV. Dyspnoea present at rest, all activity
causes discomfort

I.

Heart Failure

PATHOGENESIS

CXR Heart failure :

Prominent upper lobe vein (upper lobe

diversion), peribronchial cuffing, difuse

interstitial or alveolar shadowing, classical
perihilar bat wing shadow, fluid in the
fissures, pleural effusions, kerley B lines
(variously attibuter to interstitial oedema
and engoged peripleural limphatics

EKG :
May indicate cause (look for evidence of

ischaemia, MI or ventricular hypertrophy). It

is rare to get a completely normal ECG in
CHF.

ECHOCARDIOGRAPHY
It may indicate the cause (MI, valvular

Heart disease) and can confirm the

presence or absence of LV dysfunction.

You will need to carefully monitor yourself

and help manage your condition. One

important way to do this is to track your
weight on a daily basis. Weight gain can be
a sign that you are retaining fluid and that
the pump function of your heart is
worsening. Make sure you weigh yourself at
the same time each day and on the same
scale, with little to no clothes on.

PREVENTIF AND CURE

Other important measures include:
Take your medications as directed. Carry a list of

medications with you wherever you go.

Limit salt intake.
Dont smoke.
Stay active. For example, walk or ride a stationary
bicycle
Lose weight if you are overweight.
Get enough rest, including after exercise, eating,
or other activities. This allows your heart to rest as
well. Keep your feet elevated to decrease swelling

MITRAL INSUFICIENCY..

Mitral Insufficiency
Mitral regurgitation (MR), a
valvular heart disease also
known as mitral insufficiency
or mitral incompetence, is
the abnormal leaking of blood
through the mitral valve, from
the left ventricle into the
left atrium of the heart

ETIOLOGY
Rheumatic Heart disease (50%) : MS

and MR
Non Rematic Fever acute :
a.Musculus Papillaris disfunction
b.Mitral valve prolapse (most common
cause)
c. Perforation of valve, Chorda tendinea
rupture in), endocarditis infective, acute
rheumatic fever, trauma, infarc miocard,
ect.

Etiology
The mitral valve is composed of the valve

leaflets, the mitral valve annulus (which

forms a ring around the valve leaflets), the
papillary muscles (which tether the valve
leaflets to the left ventricle, preventing
them from prolapsing into the left atrium),
and the chordae tendineae (which connect
the valve leaflets to the papillary muscles).
A dysfunction of any of these portions of
the mitral valve apparatus can cause mitral
regurgitation.

PATHOGENESIS

Symptoms and signs ;

The symptoms associated with mitral

regurgitation are dependent on which phase

of the disease process the individual is in.
Individuals with acute mitral regurgitation will
have the signs and symptoms of
decompensated congestive heart failure (ie:
shortness of breath, pulmonary edema,
orthopnea, paroxysmal nocturnal dyspnoea),
as well as symptoms suggestive of a low
cardiac output state (ie: decreased exercise
tolerance).).

Cardiovascular collapse with shock

(cardiogenic shock) may be seen in individuals

with acute mitral regurgitation due to papillary
muscle rupture or rupture of a chordae
tendineae.
Individuals with chronic compensated mitral
regurgitation may be asymptomatic, with a
normal exercise tolerance and no evidence of
heart failure. These individuals may be
sensitive to small shifts in their intravascular
volume status, and are prone to develop
volume overload (congestive heart failure

Chest x-ray
The chest x-ray in individuals with chronic

mitral regurgitation is characterized by

enlargement of the left atrium and the left
ventricle. The pulmonary vascular markings
are typically normal, since pulmonary
venous pressures are usually not
significantly elevated.

Echocardiography
transesophageal echocardiogram of mitral

valve prolapse
The echocardiogram is commonly used to
confirm the diagnosis of mitral
regurgitation. Color doppler flow on the
transthoracic echocardiogram (TTE) will
reveal a jet of blood flowing from the left
ventricle into the left atrium during
ventricular systole.

Treatment
The treatment of mitral regurgitation

depends on the acuteness of the disease

and whether there are associated signs of
hemodynamic compromise.

Thank you