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DILATED CARDIOMYOPATHY

SUPERVISOR: DR. TINA CHRISTINA


L.TOBING SpA(K)
PRESENTER: GOUTHAMI KATAN
DCM is characterised by left ventricular systolic
dysfunction, with an increase in mass and volume
Develops at any age, in either
sex and ethnic origin
More common in men

More in black people
CLASSIFICATION
DCM
PRIMARY
FAMILIAL
AND GENETIC
SECONDARY
TOXICITY
RELATED
SIGNS AND
SYMPTOMS
HEART
FAILURE
PERIPHERAL
OEDEMA
TACHYCARDIA
MURMURS
INVESTIGATIONS
Generalised enlargement
Dilation of the left ventricle with
poor global contraction functions
diffuse, non-specific ST segment & T
wave changes , sinus tachycardia,
arrhythmias
ROLES OF TREATMENTS
Relieve symptoms
Retard disease progression
Prevent complications
CASE REPORT
AAM,, 14 years
Date of Admission: April 29
th
2014
HISTORY
PREVIOUS
ILLNESS
Cardiomyopathy
and minimal
pulmonary
embolus
PREVIOUS
MEDICATIONS
Propranolol,
Aldactone,
Digoxin
LABOR
Normal delivery,
cried as soon as
baby was born,
no cyanosis
HISTORY
GROWTH AND
DEVELOPMENT
Suitable with
toddler in same
age
IMMUNIZATION
Complete
PRESENT STATUS
Sensorium : Alert
Temperature : 37,5C
Heart Rate : 110 bpm, regular, murmur (-),soft heart
sound
Respiratory Rate : 72 x/minute, regular, rales (-)
Blood Pressure : 80/50 mmHg
Weight : 28 kg BW/A= 53% severe
malnutrition
Height : 146 cm BH/A = 90% normal
Nutrition Status : BW/BH = 71% Severe malnutrion
Dyspnea, cyanosis, icteric, anemic, and edema were not
present
LOCALIZED STATUS
SKIN
Pale
HEAD
Old man face
EYES
Light reflex (+/+), pupils was isochoric
Pale conjungtiva palpebra inferior (+/+)
E/N/T
Normal in appearance
NECK
No enlargement of lymph nodes
THORAX
Symmetrical fusiform, retraction(+) epigastrial, distinct intercostal space.
HR: 110 bpm, reglar,murmur (-), soft heart sound
RR: 72rpm, regular, rales (-/-)
ABDOMEN
Soft, peritalsis (+) N, liver and spleen not palpable

EXTREMITIES
Pulse 110 bpm, reglar, p/v was adequate , warm
extremities , CRT < 3
GENITAL
, normal in appearance.
CHF ec dilated cardiomyopathy +
moderate MR +mild TR +minimal
PE + severe malnutrition
Working
diagnosis
Total bed rest, semi fowler position,
O2 , IVFD D5% , INJ.Lasix,
Propranolol, Aldactone, Digoxin,
Multivitamin tanpa Fe, Lacfolac
syrup, Folic acid, Diet F75 + mineral
mix, Balance cairan
Management
Laboratory finding on April 27
th
2014
Complete Blood Count (CBC)
Hematology Unit Result Reference
Hemoglobin (HGB) g%
11.6
12.0-14.4
Erythrocyte (RBC) 10
6
/mm
3

4.54
4.75-4.85
Leucocyte (WBC) 10
3
/mm
3

5.240
4.5-11.0
Hematokrit %
35.1
36-42
Thrombocyte (PLT) 10
3
/mm
3

351
150-450
MCV fL
77.4
75-87
MCH Pg
25.7
25-31
MCHC g%
33.2
33-35
RDW %
18.0
11.6-14.8
MPV fL
6.14
7.0-10.2
Difftel Count
Neutrofil %
61.17
37-80
Limfosit %
26.4
20-40
Monosit %
11.8
2-8
Eosinofil %
0.113
1-6
Basofil %
0.01
0-1
April 30
th
- Mei 2
nd
, 2014
S : shortness of breath (+), fever (+), cough (+), pale (+)
O: Sens: alert, Temp: 37-37.6
o
C. Body weight : 28 kg.
Head
Eyes: light reflex: (+/+), pupils were isochoric, no pale of conjunctiva palpebra inferior; Ear/nose/mouth: normal in
appearance
Neck
Enlargement of lymph nodes (-)
Thorax
Symmetrical fusiform, no epigastrial retraction
HR: 108 bpm, regular, murmur (+) soft heart sound RR: 60rpm, regular, rales (-/-)
Abdomen
Soft, peristaltic (+) normal, liver/spleen: not palpable
Extremities
Pulse 108 bpm, regular, p/v was adequate, warm extremities, CRT <3
BP: 90/70 mmHG, hypotrophy muscle (+),loss of subcutaneous fat (+),
A : CHF ec dilated cadiomyopathy +moderate MR + mild TR + minimal PE + severe malnutrition
P :
Total bed rest + Semi fowler position
IVFD D5%k
O2
Inj.lasix
Propranolol
Aldactone
Digoxin
Multivitamin tanpa fe
Vitamin A
Lacfolac syrup
F75 diet 250cc/ 3 h/ oral) + 5cc mineral mix

Mei 2
nd
- Mei 6
th
, 2014
S : shortness of breath (+), fever (-), cough (+), pale (+)
O: Sens: alert, Temp: 37-37.1
o
C. Body weight : 28 kg.
Head
Eyes: light reflex: (+/+), pupils were isochoric, no pale of conjunctiva palpebra inferior; Ear/nose/mouth: normal in
appearance
Neck
Enlargement of lymph nodes (-)
Thorax
Symmetrical fusiform, no epigastrial retraction
HR: 104 bpm, regular, murmur (+) soft heart sound RR: 62rpm, regular, rales (-/-)
Abdomen
Soft, peristaltic (+) normal, liver/spleen: not palpable
Extremities
Pulse 104 bpm, regular, p/v was adequate, warm extremities, CRT <3
BP: 90/70 mmHG, hypotrophy muscle (+),loss of subcutaneous fat (+),
A : CHF ec dilated cadiomyopathy +moderate MR + mild TR + minimal PE + severe malnutrition
P :
Total bed rest + Semi fowler position
IVFD D5%k
O2
Inj.lasix
Propranolol
Aldactone
Digoxin
Multivitamin without fe
Vitamin A
Lacfolac syrup
F75 diet 250cc/ 3 h/ oral) + 5cc mineral mix

Mei 7th Mei 8th , 2014
S : shortness of breath (+), fever (-), cough (+), pale (+)
O: Sens: alert, Temp: 37-37.1
o
C. Body weight : 28 kg.
Head
Eyes: light reflex: (+/+), pupils were isochoric, no pale of conjunctiva palpebra inferior; Ear/nose/mouth: normal in
appearance
Neck
Enlargement of lymph nodes (-)
Thorax
Symmetrical fusiform, no epigastrial retraction
HR: 104 bpm, regular, murmur (+) soft heart sound RR: 62rpm, regular, rales (-/-)
Abdomen
Soft, peristaltic (+) normal, liver/spleen: not palpable
Extremities
Pulse 104 bpm, regular, p/v was adequate, warm extremities, CRT <3
BP: 90/70 mmHG, hypotrophy muscle (+),loss of subcutaneous fat (+),
A : CHF ec dilated cadiomyopathy +moderate MR + mild TR + minimal PE + severe malnutrition
P :
Total bed rest + Semi fowler position
IVFD D5%k
O2
Inj.lasix
Propranolol
Aldactone
Digoxin
Multivitamin without fe
Folic Acid
Lacfolac syrup
F100 diet 200cc/ 3 h/ oral) + 4cc mineral mix

Mei 9th Mei 10th , 2014
S : shortness of breath (), fever (-), cough (+), pale (+)
O: Sens: alert, Temp: 36.9-37
o
C. Body weight : 28 kg.
Head
Eyes: light reflex: (+/+), pupils were isochoric, no pale of conjunctiva palpebra inferior; Ear/nose/mouth: normal in
appearance
Neck
Enlargement of lymph nodes (-)
Thorax
Symmetrical fusiform, no epigastrial retraction
HR: 98 bpm, regular, murmur (+) soft heart sound RR: 30rpm, regular, rales (-/-)
Abdomen
Soft, peristaltic (+) normal, liver/spleen: not palpable
Extremities
Pulse 98 bpm, regular, p/v was adequate, warm extremities, CRT <3
BP: 90/70 mmHG, hypotrophy muscle (+),loss of subcutaneous fat (+),
A : CHF ec dilated cadiomyopathy +moderate MR + mild TR + minimal PE + severe malnutrition
P :
Total bed rest + Semi fowler position
IVFD D5%k
O2
Inj.lasix
Propranolol
Aldactone
Digoxin
Cotrimoxazole
Multivitamin without fe
Folic Acid
Lacfolac syrup
F100 diet 200cc/ 3 h/ oral) + 4cc mineral mix

DISCUSSION
DCM is a disease
that develops at any
age, sex or ethnics.
In this case, the patient
is a 14 years old
Indonesian girl.
DISCUSSION
DCM is a disease
that develops at any
age, sex or ethnics.
In this case, the patient
is a 14 years old
Indonesian girl.
DISCUSSION
Diagnosis of DCM is primarily
on echocardiography to
evaluate the heart looking
for dilated chambers and
pump function.
In this case, the patients Echo
showed that there is a chamber
enlargement and minimal
pulmonary embolus .
DISCUSSION
Diagnosis of DCM is primarily
on echocardiography to
evaluate the heart looking
for dilated chambers and
pump function.
In this case, the patients Echo
showed that there is a chamber
enlargement and minimal
pulmonary embolus .
DISCUSSION
Patients with DCM usually
have sign symptoms of heart
failure. Common types of
medication used to treat CHF
is diuretics, inotropic agens
and beta blockers
In this case, the patient are
diagnosed with CHF caused by DCM
and taking diuretics, inotropic
agents and beta blockers.
NUTRITIONAL STATUS
Severe malnutrition.
The calories target for this patient, female, 14 years
with body weight 28 kg, body height 146cm, and
height age 11 years is 2220 kkal (RDA based on
height age X ideal body weight)
Managed by giving F75 and gradually changed to
F100 until switched to reguler diet to achieved her
calorie targets

PROGNOSIS
Although DCM can be reversed
with proper treatment but many
progresses to heart failure.
Higher mortality rate is
associated with age, sex and
severity
In this case, the patient have a bad
prognosis due to severity of her heart
failure.

The patient was discharged from hospital on
12
th
of Mei due to some personal reasons.
SUMMARY
This paper reports a case of dilated
cardiomyopathy of a 14 year old female.
Diagnosis is made by patient history, clinical
features and echocardiography.
This patient is treated with diuretics, beta
blockers and inotropic agents
It is important for her to have good health
practices to improve her quality of life
PERTANYAAN
FLASHBACK?
SESAK CARDIO /NON CARDIO
HARUS DISINGKIRKAN KELAINAN PARU
DCM X ADA MURMUR, SESAK BERAT,
PALING SERING INFEKSI VIRUS
BISA SUDDEN DEATH!!!!!!!!
MEDIKAMENTOSA PENTING!!!