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Pulmonary Hypertension

Presented by: Sri Mahtufa Riski, MD Supervisor : dr. Pendrik Tandean, SP.PD-KKV, FINASIM

DEPARTMENT OF CARDIOLOGY AND VASCULAR MEDICINE MEDICAL FACULTY OF HASANUDDIN UNIVERSITY MAKASSAR 2013

General data
Name MR number Birth Date / Age Religion Address Admitted
• Ny. H.R • 642261

• Desember, 30th 1973 / 39 y.o.
• Moslem • Perumanan Maros Regensi, Kab. Maros • Desember, 16th 2013

Chief Complaint
“Difficulty of Breathing”

continuously. in spite of take a rest Proxymal Nocturnal Dyspneu (+) Ortopneu (+) More plesant if lay right sideways Had productive cough.History of Present Illness • • • • • 14 days prior • to admission • • • Difficulty of breathing. Vomiting (+) Normal defecation and urination • Persistence difficulty of breathing 1 days prior to admission . fever (-) Chest pain (+) Fill weakness (+) Syncope (-) Nausea (+).

Patient sought consult to Wahidin Sudirohusodo Emergency Room and subsequently admitted .

Ovarium Cancer.Hospitalized at RS Pelamonia for 8 days with diagnose Susp.Hospitalized at RS awal bros for 16 days. then she was consult to RS Wahidin Sudirohudoso .Past Medical History (-) Diabetes mellitus (-) Hypertension (-) Hypercholesterolemia (-) Heart disease (-) Allergies to food or drug (-) Previous surgery (-) Endocrine and Metabolic problems (+) Prior medication hystory . then she was consult to RS Awal Bros .

Family History • • • • • (-) Diabetes Mellitus (-) Hypertension (-) Heart disease (-) Asthma (-) Cancer .

equal distribution of hairs.Physical Examination • General: being sick. conscious • Vital sign: BP: 90/60 mmHg PR: 75 bpm RR: 22 cpm Temp: 36.7°C • HEENT: Head: no lesion. Eyes: icteric sclera. Nose: no nasoaural discharge. (+)cyanotic lip Ears: no discharge. Throat: no hyperemic and enlargement tonsil . good nutrition. no inflammation. palpebral oedema Mouth: moist oral mucosa. pink palpebral conjuctiva.

clear breath sounds. no retraction. • Chest/Lungs: symmetrical chest expansion.Physical Examination • Skin: good skin turgor. no cervical lymphadenopathy. no lesion • Neck: (+) Jugular vein distension R+1 cmH2O. . no rashes. no neck rigidity.

non tender. normoactive bowel sounds.Physical Examination • Heart: adynamic precordium. . soft. regular of I/II heart sound. (+) systolic murmur gr 3/6 • Breast: N/A • Abdomen: flat.

Physical Examination • Genitalia: not assessed. • Extremities: – Upper : (+) cyanotic – Lower : (+) cyanotic. (+) oedema pretibial & dorsum pedis . • Back and spines: No deformities.

39 y/o Difficulty of breathing. .Salient Features • • • • • • • • • Female. diabetes mellitus. continuously Proxymal Nocturnal Dyspneu (+) Ortopneu (+) Weakness (+) cyanotic lip (+) Jugular vein distension (+) systolic murmur gr 3/6 (+) Cyanosis No history of hypertension. heart disease.

8 units : 2.5mg/l : 16.9 mg/dl : 2.6 gr/dl Complete blood Blood chemistry .2 g/dL : 36.9 second : 28.Laboratory Examination WBC HGB HCT PLT : 17.4 mmol/l : 100 mmol/l RBS SGOT SGPT Ureum Creatinin PT APTT D-Dimer Total Bilirubin Direct Bilirubin Albumin : 91 mg/dl : 31 u/l : 16 u/l : 75mg/l : 1.65x103/mm3 : 13.4 % : 263.000/uL Electrolyte Sodium Potassium Chloride : 131 mmol/l : 4.7 second : 1.1 mg/dl : 3.

ECG .

ECG Impression: • -Sinus rhythm • -Heart rate 75 bpm • -Right axis deviation • -Right Ventricular hypertrophy (V1 R/S >1) .

2d-Echocardiography .

1 mmHg . EF 85% • -Right Ventricular Hypertrophy (+) • .pulmonary artery preasure 80.2d-Echocardiography Impresssion : • -Good sytolic LV function.

Chest x-ray PA • Cardiomegaly with aortae dilatation .

MSCT of the thorax with contrast .

MSCT of the thorax with contrast Impression: Cardiomegaly with pericard effusion Ascites .

Lasix 120 mg/24hours by siringe pump • Potassium-sparing diuretic: Spironolactone 25 mg 1x1 • Beraprost Na: Dorner 20mg 2x1 • Laxative: Laxadine 0-0-2 cth .9% 500cc/24hours • β1-adrenergic agonist: Dobutamine 5mg/kgbw/m by siringe pump • Norepinephrine: Vascon 0.1 mcg/kgbw by siringe pump • Antibiotic: Ceftriaxone 2gr/24hours/iv • Diuretic: Inj.Treatment • O2 2-4L/minute/mask • IVFD Nacl 0.

Final diagnosis PULMONARY HYPERTENSION .

PULMONARY HYPERTENSION .

What is Pulmonary Hypertention ? • A disease characterized by the progressive increase in pulmonary arterial pressures and pulmonary vascular resistance. .

PH preassure in pulmonary circulation • Resting mean pulmonary artery pressure > 25 mmHg • Pulmonary vascular resistance > 3 Wood units • Pulmonary capillary wedge pressure < 15 mmHg .

.

Pathophysiology .

Symptom and Signs .

Functional Assesment .

Diagnose Anamnesis & Physical Examination • Pulmonary hypertension sign & symptoms ECG : • Right axis deviation • Right ventricular hypertrophy Radiology • Dilatated pulmonary arteries • Lateral view : right ventricular enlargement .

to know the etiology.Echocardiography • to diagnostic. and prognosis Angiography • Gold standart • confirm diagnostic of PH • Asses the severity .

Possible Treatment for Pulmonary Hypertension .

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Thank you!!! .