LAPORAN KASUS VENTRICULAR SEPTAL DEFECT

Lia Putranti 20100310192

Identitas Pasien

Nama : Ny. S Jenis Kelamin : Wanita Usia : 44 tahun Alamat : Kemanukan, Bagelen No RM : 33060120029

Keluhan Utama

Datang dengan keluhan nyeri dada, tidak ada sesak napas

Differensial Diagnosis 1

CARDIAC NON-CARDIAC

Iscemic Cardiac Disease GERD

Myocardial Infarction Musculosceletal Condition

Angina Psychiatric Conditions

Congenital Heart Disease Pneumonia

Heart Failure Pneumothorax

Acute pericarditis Esophagus Perforation

Coronary Vasospasm Peptic Ulcer

Valvular Heart Disease Astma and COPD

Anamnesa

RPS : nyeri dada sejak pagi, dimulai dari dada kiri menjalar ke leher, nyeri timbul saat kerja fisik, mereda saat istirahat dg posisi duduk, posisi tidur menambah nyeri. Hal ini dikeluhkan sejak kecil.

RPD : Hipertensi RPK : Orang tua menderita

hipertensi RSE : tidak mengkonsumsi alkohol,

rokok, dan obat2an secara rutin, menikah, pekerjaan petani, lulusan smp

Differensial Diagnosis 2

CARDIAC NON-CARDIAC

Iscemic Cardiac Disease GERD

Myocardial Infarction Musculosceletal Condition

Angina Psychiatric Conditions

Congenital Heart Disease Pneumonia

Heart Failure Pneumothorax

Acute pericarditis Esophagus Perforation

Coronary Vasospasm Peptic Ulcer

Valvular Heart Disease Astma and COPD

Vital Sign

KU : sedang, compos mentis TD : 170/90 mm Hg Nadi : 78 x/ menit Suhu : 37º celcius Pernapasan : 18 x/ menit

Physical Examination (Head)Inspeksi : CA (-) SI (-) simetris edema palpebra (-)Palpasi :Nyeri tekan (-)

Physical Examination (chest) Inspeksi : pasien tampak sakit, bentuk

tubuh normal, tubuh simetri, gerakan rongga dada baik

Palpasi dada : fremikus vokalis baik, ictus cordis terasa di daerah lateral, nyeri tekan (-), masa (-)

Perkusi dada : curiga cor membesar Auskultasi dada : holosystol

murmur pada jantung, vesicular pada dada

Physical Examination (abdomen) Inspeksi :kontur normal, asites (-), stria

(-), parut (-) Auskultasi : frekuensi bunyi usus normal

(8 x/ menit) Palpasi : supel (+), nyeri tekan (-), masa

(-) Perkusi : suara timpani

Physical Examination (ekstremitas) Simetris Parut (-) Edema (-) Tonus baik Hambatan gerak (-)

Differensial Diagnosis 3

Iscemic Cardiac Disease Myocardial Infarction Angina Congenital Heart Disease Heart Failure Acute pericarditis Coronary Vasospasm Valvular Heart Disease

Supporting Examination (blood test)

Test Result Reference Interval

Hb 12,2 11,7-15,5

Leukosit 7,3 3,6-11

Hematrokit 37 35-47

Eritrosit 4,6 3,8-5,2

Trombosit 313 150-400

MCV 81 80-100

MCH 27 26-34

MCHC 33 32-36

Neutrofil 59 50-70

Limfosit 27,4 25-40

Monosit 10,3 2-8

Eosinofil 2,9 2-4

Basofil 0,4 0-1

Supporting Examination (blood test)

Test Result Reference Interval

GDS 160 70-120

Ureum 21 10-50

Cretinin 0,92 0,4-0,9

SGOT 19 0-35

SGPT 17 0-35

HBSaG negative negative

Supporting Examination (chest x-ray)

Corakan pulmo kasar, sinus lancip, diapragma licin, cor CTR >0,5, inverse coma sign pada hilus dextra, pinggang jantung menonjol.Kesan : cardiomegali dg suspek pembesaran chamber atrium sinistra. Suspek hipertensi pulmonal. Corakan pulmo kasar

Supporting Examination (EKG)Terdapat Right Bundle Branch Block

Differensial Diagnosis 4

Congenital Heart Disease specific to Ventricular Septal Defect

Congenital Heart Disease

Acyanotic Congenital Heart Disease (left to right shunt lesions)• Atrial Septal Defect (ASD)• Ventricular Septal Defect (VSD)• Atrioventricular Septal Defect (AV

Canal)• Patent Ductus Arteriosus (PDA)

Congenital Heart Disease

Cyanotic Congenital Heart Disease ( right to left shunt lesions)• Tetralogy of Fallot (TOF)• Tricuspid atresia (TA)• Total anomalous pulmonary venous return

(TAPVR)• Transposition of the great vessels• Hypoplastic left heart syndrome (HLH)• Pulmonary atresia (PA) / critical PS• Double outlet right ventricle (DORV)

Ventricular Septal Defect

Definition

A ventricular septal defect (VSD) is a hole or a defect in the septum that divides the 2 lower chambers of the heart, resulting in communication between the ventricular cavities.

Etiology

Maternal Factors Genetic Risk factor Genotype-phenotype correlation

Pathophysiology

A defect in the interventricular septum Blood flow moves from high pressure to

low pressure (Lv-Rv) Resulting hemodynamic effects =

increased Lv volume load, excessive pulmonary blood flow, increase pulmonary blood pressure, increases pulmonary intertitial fluid > pulmonary edema, reduces systemic cardiac output, salt and water retention by renin-angiotensin system

Epidemology

VSDs affect 2-7% of live births. Accounts for more than 20% of all

congenital heart diseases. An echocardiographic study revealed a

high incidence of 5-50 VSDs per 1000 newborns.

Types

Perimembraneous Supracristal or outlet septum Atrioventricular canal defect or inlet

septum Muscular (low septal) or trabecular

Types

Physical Examination

Small VSDs (< 3 mm in diameter) Patients may have normal vital signs. Arterial pulse normal Small defects can produce a high-pitched or squeaky noise. Physiologic splitting of S2 is usually retained.

Holosystolic murmur is loudest along the lower left sternal border (LSB)

Moderate VSDs (3-5 mm in diameter) Infants often have a normal length and decreased weight. Poor

weight gain is a sensitive indicator of congestive heart failure (CHF). Infants may have mild tachypnea, tachycardia, and an enlarged

liver. Loud murmur and trill Auscultation loud, harsh holosystol murmur ; widening of A2P2 split

Physical Examination

Large VSDs (6-10 mm in diameter) Signs of CHF are present (tachcardia,

tachypnea, and hepatomegaly) Murmur holosystol but poor localized Diastolic rumble Cyanotic after exercise/crying Diminished pulses Auscultaton = narrowing of A2P2 split

Supporting Examination

Radiograph Ecocardiograph MRI Electrocardiograph

Treatment

Medication management Diuretics promote the excretion of water and

electrolytes by the kidneys. They are used in the treatment of hypertension; heart failure; and hepatic, renal, or pulmonary disease when salt and water retention has resulted in edema or ascites.

ACE inhibitors are used to treat congestive heart failure (CHF). They may be of use to treat systemic afterload.

Inotropic Agent to reduce conductivity in the heart, These agents are used to slow the heart rate in supraventricular arrhythmias, especially atrial fibrillation. They are also administered in chronic heart failure.

Treatment

Surgical closure Transcatheter closure Activity restriction