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PLENARY DICUSSION week 6th Friday, Nov 9th 2012

27 D

Dinda Putri Amir Marcella Dorainne Dinda Wijaya Nursyazwani bt Abu Bakar Muhammad Iqbal Ildiani R. Ramli Fadhil Alfino Azmi Rizka Yunidha Anwar Novilla Rezka Sjahjadi Akbara Pradana

SKENARIO 6 : JANTUNG TN. AFIL


Tn. Afil 50 years, came to the clinic with dizziness and palpitation since 1 day ago. Complaints pounding've felt since 4 months ago, but did not interfere with his daily activities The patients blood pressure was 150/100 mm Hg., pulse 120x/minutes ireguler, dan respiration 22 breaths per minute. Lung exam in normal range, on examination of the heart was found HR 160 bpm, ireguler, bising susah dinilai. Following is the ECG obtained Atrial fibrillation with rapid ventricular response. he was admitted to hospital

Mr. Afil hospitalized in CVCU with monitoring, infusion, oxygenation. moments later Mr. Afil asleep and suddenly awakened by the cries of the neighbour patient's family newly enrolled patients died of cardiac arrest, and taken to the forensics to undergo an autopsy at the request of law enforcement. How do you explain what happened to Mr.. Afil and the neighbours?

Terminology
Atrial fibilation : impaired of electrical activity of atrial wall Heart rate : the number of heartbeats per unit of time, typically expressed as beats per minute (bpm). Rapid ventricular response Cardiac arrest :the cessation of normal circulation of the bloof due to failure of the heart to contract effectively

Autopsy : a medical procedure that consists of a thorough examination performed on a body after death, to evaluate disease or injury that may be present and to determine the cause and manner of a person's death

Problem identification and analysis


1. why Mr. afil complained of dizziness and palpitations whether there is a relation with age and gender? Dizziness is caused by impaired of blood supply particularly to the brain tend to be much at the age of 50 years and above, and especially men 2. why even been felt since 4 months ago but did not interfere with the activity?

The specialized conducting system includes the sinoatrial (SA) node, the atrioventricular (AV) nodal region, and the ventricular conducting system composed of bundle of his, the bundle branches, and the Purkinje fibers. so when the function of the SA node is compromised, the heart can still work with the role of another pacemaker cells.

3. What is the interpretation of physical exam? blood pressure 150/100 mmHg HTN Stage II (JNC VII) Pulse 120 bpm, HR 160 bpm tachycardia Respiration rate 22 breaths per minute tachypnoe Lung exam the underlying disease is not from the lung

4. What indications do referrals? Doctors think that this is an emergency and must be followed 5. What is the caused of cardiac arrest? Hipertension Cigarrete Drugs of heart user Previous heart injuries MI

6. what information is obtained from the autopsy? Anatomy of the heart due to infark, thrombus, atherosclerotic lesion, brain lesion, neoplasm, kidney due to TNA, digitalis intoxication. 7. heart rate monitor

Scheme

RISK FACTOR PHYSICAL EXAM EXAMINATION HEART MURMUR AFIB REFERRAL CVCU MANAGEMENT ECG LUNG EXAM Clinical Manifestation (Dizziness, palpitation)

LEARNING OBJECTIVES
ARRYTHMIAS (Epidemiology, etiology, risk factors, pathophysiology, clinical manifestation, examination (routine labs, ECG), Treatment) MEDICOLEGAL ASPECT OF SUDDEN CARDIAC DEATH (SCD)