Download - CHF
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CASE REPORTCHF dan Anemia
MARCELLA ANGELICA PUTRI YOSVARA030.11.173
Pembimbing : dr. Nurul, spJp
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Identitas
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Keluhan Utama
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Riwayat Penyakit Sekarang
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Riwayat Penyakit Dahulu
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Riwayat Penyakit Keluarga
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Pemeriksaan Fisik
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Pemeriksaan Fisik• Kepala : Tampak normocephali• Rambut : Hitam, distribusi merata• Wajah : Simetris, pucat (+), ikterik (-), sianosis (-)• Mata : Ptosis (-), ca +/+, si -/-,pupil bulat isokor diameter 3mm, refleks
cahaya +/+• Telinga : normotia, seruman dan sekret (-/-)• Hidung : pernapasan cuping hidung (-), septum deviasi dan sekret (-).• Tenggorokan : tdak tampak hiperemis• Bibir : simetris, sianosis (-)• Leher : KGB tidak teraba membesar, JVP 5+4 cm H20
Head and Neck
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Pemeriksaan Thoraks Paru-paru
• Inspeksi : Gerak Simetris, retraksi otot pernapasan (-)
• Palpasi : Vokal fremitus simetris kedua lapang hemitoraks
• Perkusi : Sonor
• Auskultasi : Suara nafas vesikular, ronkhi +/+, wheezing -/-
Thorax
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Jantung
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Pemeriksaan Abdomen• Inspeksi
– Perut agak buncit• Auskultasi
– bising usus (+) normal 2x/menit• Palpasi
– Supel– Nyeri tekan (-)– Hepar tidak teraba membesar
• Perkusi– Shifting dullnes (+), undulasi (-)
Abdomen
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• Akral hangat : +/+• Akral odem : (+) pada kedua tungkai
Ekstremitas
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Pemeriksaan Laboratorium
Pemeiriksaan Hasil Satuan Nilai rujukan
Hematologi
Hemoglobin
Hematokrit
Leukosit
Trombosit
Kimia klinikFungsi hati SGOT
SGPT
10.4
31.1
6.8
193
95
73
g/dl
%
Ribu/ul
Ribu/ul
u/Iu/l
13-17.5
40-54
5.0-10.0
150-400
< 37
< 41
18 November 2015
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Pemeriksaan LaboratoriumPemeriksaan Hasil Satuan Nilai rujukan
Kimia klinikAlb,globProtein totalAlbuminGlobulin Fungsi ginjal UreumkreatininDiabetes Glukosa darah sewaktuTgl 19 Nov 2015Elektrolit darahNatriumKaliumKlorida
7.104.152.95
301,73
78
1373.895
g/dIg/dlg/dl
mg/dlmg/dl
Mg/dl
mmol/lmmol/lmmol/l
6.6-8.03.5-4.51.5-3.0
20-400.5-1.5
60-110
135-1453.5-5.094-111
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Pemeriksaan LaboratoriumPemeriksaan Hasil Satuan Nilai rujukan
Hematologi Lekosit Hemoglobin HematokritTrombositKimia klinikFungsi hatiSGOTSGPTFungsi ginjal UreumkreatininDiabetes Glukosa darah sewaktuElektrolit darahNatriumKaliumKlorida
9.210.226.8217
9853
291.98
140
1333.393
ribu/ulg/dI%ribu/ul
U/lU/dl
mg/dlmg/dl
mg/dl
mmol/lmmol/lmmol/l
5-1013-17.540-54150-400
< 37< 41
20-400.5-1.5
60-110
135-1453.5-5.094-111
5 Desember 2015
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Pemeriksaan Laboratorium
Pemeriksaan Hasil Satuan Nilai rujukan
Kimia klinikFungsi ginjal Asam uratDiabetes Glukosa darah puasaProfil lipidTrigliserida Kolesterol totalKolesterol HDLKolesterol LDL
8.3
87
117247
25199
mg/dl
mg/dl
mg/dlmg/dl
mg/dlmg/dl
3-7
60-110
< 160< 200
23-65<160
8 Desember 2015
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Pemeriksaan EKG
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X-ray Thoraks
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Ejection fraction 26%MR moderate
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Ringkasan kasus
Tn. Ch, 41 th, datang dengan keluhan lemas dan sesak sejak 1 minggu dan bertambah berat sejak 3 hari SMRS. Sesak dirasakan terus menerus, sesak tidak hilang pada saat istirahat dan posisi duduk, orthopnoe (+), PnD (+), pusing (+), mual (+). Riwayat kolesterol (+), stroke (+), rokok 1 bungkus/hari, suka makanan berlemak.
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Ringkasan kasus
• TD : 90/60 mmHg, nadi 100x/menit, RR 28 x/menit, konjungtiva anemis (+/+), JVP 5+4cmHg, ronkhi (+/+), iktus cordis teraba di ICS 5 ±2 cm linea midclav kiri, batas jantung kiri melebar ke lateral, shifting dullnes (+), odem tungkai (+). Laboratorium, Hb 10,4 g/dL, HT 31,1 %, SGOT/SGPT 95/73, kreatinin 1,73 mg/dl, asam urat 8,3 mg/dl, kol. Total 247 mg/dl, HDL 25 mg/dl, LDL 199 mg/dl, pada EKG didapatkan adanya st depresi pada lead V4-V6, dan echo adanya Mitral Regurgitasi
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• Non medikamentosa • Medikamentosa
– Lasix 1x3 ampul– Dobutamin 10 g/kg/menit– Atrovastatin 1x20 mg– ISDN 3 x 5 mg– Carvediol 2 x 3,125 mg– Digoxin 1 x ½ tab– Simarc 1x 2mg– Curcuma 3x1– Renapar 2x1– Ranitidin 2x1ampul– Pantoprazole 2x1 ampul– Allopurinol 1x 300 mg– Valsartan 1x40 mg– Transfusi PRC 3x 350 cc selama 3 hari
Penatalaksanaan
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Prognosis
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TINJAUAN PUSTAKA
CHF dan Anemia
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Definsi Definis gagal jantungGagal jantung merupakan kumpulan gejala klinis pasien dengan tampilan seperti:
Gejala khas gagal jantung : sesak nafas saat istirahat atau aktivitas, kelelahan, edema tungkai
DAN
Tanda khas gagal jantung : Takikardi, takipnu, ronki paru, efusi pleura, peningkatan tekanan vena jugularis, edema perifer, hepatomegali.
DAN
Tanda objektif gangguan struktur atau fungsional jantung saat istirahat, kardiomegali, suara jantung ke 3, murmur jantung, abnormalitas dalam gambaran ekokardiografi, kenaikan konsentrasi peptida natriuretik.
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Definsi
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Manifestasi klinis
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Manifestasi klinis
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Kriteria Framingham
Kriteria Mayor Kriteria Minor
-Paroxysmal Nocturnal Dyspneu (sesak
malam hari)
-Bendungan vena sentral
-Peninggian tekanan vena jugularis
-Ronkhi paru
-Bunyi jantung S3 Gallop
-Refluks hepatojugular
-Edema paru
-Kardiomegali
-Batuk malam hari
-Dyspneu d'effort (sesak saat aktivitas)3.
-Edema ekstremitas (bengkak pada kaki
atau tangan)
-Takikardi (nadi >120x/menit)5.
-Hepatomegali
-Efusi pleura
-Penurunan kapasitas vital 1/3 dari
normal
Diagnosis gagal jantung ditegakkan minimal ada 1 kriteria mayor dan 2 kriteria minor.
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Klasifikasi gagal jantung
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Klasifikasi gagal jantung
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Gagal jantung menyebabkan anemia
• Defisiensi zat besi: intake,malabsorpsi, perdarahan kronik karena penggunaan obat anti platelet.
• Gagal ginjal kronik • Hilangnya EPO dan transferin melalui urine• ACE inhibitors dan ARB • Peningkatan aktivitas sitokin• Hemodilusi
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Date of download: 12/21/2015 Copyright © The American College of Cardiology. All rights reserved.
From: Etiology of Anemia in Patients With Advanced Heart Failure
J Am Coll Cardiol. 2006;48(12):2485-2489. doi:10.1016/j.jacc.2006.08.034
Distribution of various etiologies of anemia among 37 patients with advanced congestive heart failure.
Figure Legend:
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Pemeriksaan penunjang
• EKG• Pemeriksaan radiologi• Pemeriksaan laboratorium• Peptida natriuretik• Troponin I atau T• Ekokardiografi
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EKG
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EKG
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Pemeriksaan radiologi
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Pemeriksaan radiologi
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Pemeriksaan laboratorium
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Pemeriksaan laboratorium
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Pemeriksaan laboratorium
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Peptida natriuetik
• Terjadinya peningkatan peptida natriuetik dengan efek vasokonstriktor, retensi Na dan air,hormon adrenergik, RAA dan arginine vasopressin.
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Troponin I atau T
• Pemeriksaan troponin dilakukan pada penderita gagal jantung jika gambaran klinisnya disertai dugaan sindroma koroner akut.
• Peningkatan ringan kadar troponin kardiak sering pada gagal jantung berat atau selama episode dekompensasi gagal jantung pada penderita tanpa iskemia miokard.
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Ekokardiografi
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Ekokardiografi
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Penatalaksanaan anemia
• EPO subkutan 1x/1-2 minggu (4000-10000 iu)• IV iron (venofer- iron sucrose/ iron gluconate)• Transfusi PRC (Hb < 8 g/dl)
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Dosis obat
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Dosis obat
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