CASE REPORT

Ventricular Tachycardia
Nur Nazmi Selan
 PATIENT IDENTITY

• Name : Mr. B K
• Age : 45 y.o
• Medical Record : 799435
• Address : Bira
• Room : ED PJT
• Date : 3 Juli 2018
 ANAMNESIS

• Patient with palpitating chest experienced by 2 days ago disappeared

and getting heavier since 6 hours before entering the hospital.
Palpitation is not affected by activity. Patients never consume coffee
before. No chest pain, no shortness of breath, no cough, no nausea,
no vomiting, no fever. Patient complaining the difficulty of sleep. There
is no history of chest pain and previous dyspnea, history of
hypertension is denied, and history of Diabetes Mellitus is denied.
Patient has been smoking 2 packs per day for ± 20 years, and has
stopped for ± 1 year. Patients also have a habit of consuming alcohol
since senior high school with 3 bottles / day and has stopped for 2
weeks. Patient was treated at PJT with the same complaint, diagnosed
by Ventricular Tachycardia a year ago and controlled. Patient routinely
consume Aspilet 80 mg, Simvastatin 20 mg, and Bisoprolol 3 mg.
 HISTORY TAKING
Previous Complaint
• Riwayat nyeri dada dan sesak
sebelumnya tidak ada
• Previous heart disease
(Ventricular Tachycardia)
• Hypertention is denied
• Diabetes Mellitus is denied
• Dislipidemia
Familes History
• Heart Disease in family is denied
• Diabetes in family is denied
• Hypertention in family is denied
Lifestyle
• Patient has been smoking 2 packs per day for
± 20 years, and has stopped for ± 1 year
• Patients also have a habit of consuming
alcohol since senior high school with 3 bottles
/ day and has stopped for 2 weeks.
• Love to consume fatty foods
• Less of physical activities
 RISK FACTOR

Unmodifiable: Modifiable:
• Age ( 45 years old) • Smoking history
• Sex: Male • Consuming Alcohol
• Overweight
• Dislipidemia
• Less of physical activities
 PHYSICAL
EXAMINATION
• Keadaan umum : Overweight/ Composmentis ( GCS 15 E4M6V5 )
• Weight : 68 kg
• Height : 170 cm
• IMT : 23,53 (overweight)
• Blood Pressure : 130/70mmHg
• Heart Rate : 160 x/min, regular, pulsative
• Respiratory Rate : 20 x/min
• Body Temperature: 36,7°C
 PHYSICAL EXAMINATION

HEAD
EYES :Icteric Sclera (-), pale conjunctivity (-), palpebra oedem(-)
NECK :Enlargement of lymph (-), JVP R+ 2 cmH2O.
EARS :Otorrhea (-)
NOSE :Epistaxis(-) and Rhinore (-)
MOUTH :Dry lips (-), stomatitis (-), Cyanosis (-)
 PHYSIC AL EXAMINATION

• THORAX:
• Inspection : Symetric
• Palpation : Tenderness (-), Neoplasm mass (-)
• Percussion : Sonor in both side, hepar and pulmonary pale in right 6th ICS
• Auscultation :Vesicular, Rhonki -/- Wheezing-/-
PHYSICAL EXAMINATION
• COR
Inspection : Invisibilty Ictus cordis
Palpation : Palpable Ictus cordis
Percussion :
Batas jantung kanan di ICS 5 garis parasternalis kanan, dan
batas jantung kiri di ICS 6 linea axillaris anterior.
Batas jantung atas di ICS 2.

Auscultation : Heart sounds I/II regular, Clatter (-)

 PHYSIC AL EXAMINATION

• ABDOMEN
• Inspection : Flat, follows the breath motion
• Auscultation : Peristaltic (+), Normal
• Palpation : Hepar dan lien (-), Tenderness (-)
• Percussion : Timphany
• Extremities : Limb oedem (-) , Warm
 LABORATORY FINDING (1/05/2018)
Checkout Result Normal Checkout Result Normal

RBC 5.6(10^6/UL) 4.00 - 6.00 10^6/uL HCT 44,5 37.0 - 48.0 %

HGB 17.2(g/dL) 12.0 - 16.0 gr/dl PLT 185 150 - 400 10^3/ul

MCV 79,5 80.0 - 97.0 fL Ureum 19 10 – 50 mg/dl

MCH 30,7 26.5 - 33.5 pg Creatinine 1.24 mg/dl L(<1.3);P(<1.1) mg/dl

WBC 9,67(10^3/UL) 4.00 - 10.0 10^3/ul SGOT 46 U/L <38 U/L

PT 10,3 10-14 detik SGPT 91 U/L <41 U/L

INR 0.97 -- Natrium 132 136 – 145

APTT 22.9 22.0 – 30.0 detik Potassium 3.3 3.5 – 5.1

Cholesterol/ 74.6 < 130 mg/dl Cloride 106 97 – 111

LDL

GDS 137 140

 ECG
3rd July 2018
 ECG INTERPRETATION

• Rythm : Sinus Tachycardi

• Heart Rate : 160 beats/ minute
• Regularity : Regular
• Axis : Normoaxis
• P wave : Missing P wave
• PR interval : Missing PR interval
• QRS Complex : Wide (> 0,12 s) Shape abnormality, similiar size
• T wave : Missing T wave
• Conclusion : Monomorphic Ventricular Tachycardia
 THORAX X-RAY
(ANTEROPOSTERIOR)

• Normal Bronchovascular imaging

• Cardiomegaly
• Aortae dilatation
• Normal sinus and diaphragm
 THERAPY

• NaCl 0,9% ( 500 ml/ 24 hours/ drips )

• Amiodarone bolus 150 mg/intravena, Continue-- 150 mg/ 6 hours/ syringe

pump

• Aspilet 80mg/ 24 hours/ oral

• Alprazolam 6,5 mg/ 24 hours/ oral

• Captopril 12,5 mg/8 hours/ oral

• Atorvastatin 20 mg/ 24 hours/ oral

• Suggestion: Echocardiography, Holter Eelectrocardiography,

Coronary Angiography, Electrophysiological Study
 ETIOLOGY

• Ischemic Ventricular Tachycardia

• Cardiomyopathy VT
• Idiopathic VT
 DIFFERENTIAL DIAGNOSIS

• Supreventricular Tachycardia with aberrancy

• Atrioventricular Node re-entrant tachycardia (AVNRT)
• Atrioventricular Reciprocating Tachycardia (AVRT)
• Ventricle Fibrilation (VF)
• Torsades de Pointes
 ETIOLOGY
(AMI, Ischemic miocard, CAD, cardiomyopathy)
PATHWAY

↓Cardiac Blood supply

Cardiac Metabolism
Disturbance Myocard infarction

Releasing CKMB enzyme

Impulse Delivery
Anaerob Metabolism (Creatinin Kinase-MB)
Disturbance

Activation of sympathetic
Depolarization and
Increasing Lactate Acid Nerves System
Repolarization Disturbance

Increasing impulse pace to Increasing Heartbeat

Pain the Ventricle 

Uncontrolled cardiac
Discomfort rythm Increasing O2 needs ↑

VENTRICULAR TACHYCARDIA
↓ ATP
Vasoconstriction ↑

Ventricle Disability
Activity fatigue High Risk of Perfusion
Intolerance Disturbance