ACUTE HEART

FAILURE

BY:
Tjut Farahiya Hadi
1407101030373

Supervisor :
dr. Nurkhalis, Sp.JP FIHA
BACKGROUND
 Acute heart failure is clinical syndrome in which
patients have the following feature: symptom, sign,
and structural or functional abnormality of the heart
at rest.
 Heart failure (HF) is a growing problem worldwide:
more than 20 million people around the world are
affected, and more than 5 million in the United
States.
 The treatment of HF has a direct cost of over $34
billion per year, most of which results from
hospitalization
 Patient Identity
 Name : Ms.MN
 Age : 51 y.o
 Sex : Female
 No. CM : 1066207
 Occupation : Teacher
 Address : Banda Alam, Aceh Timur
 Admission date : 21 October 2015
 Physical Exam date: 29 October 2015
Chief Complaint

Breathlessness
History of the present ilness 
Nephrolithiasis
Removal

2 days after

Breathlessness Cough
Past Medical History
 Hypertension since 8 years ago
 History of breathlessness (-)
 Nephrolithiasis
Family Disease
 Her Father has hypertension.
Medication History
 Captopril
 HCT
Social History
 The patient seldom doing exercise/sport.
 Vital Sign

GCS : E4M6V5
BP : 160/100 mmHg
Pulse : 102x/i
RR : 32 x/i
T : 36,8 oC
 Physical Exam

Skin

Colour : Fair skin

Turgor : Rapid return
Cyanosis : negative
Icterus : negative
Physical Exam

Head

Hair : Black with little sum of grey hair

Face : Symmetrical, oedema (-), deformity (-)
Eye :Anemis(+/+), icterus(-/-),light reflex direct and
indirect (+/+),
Pupil round isocor 3 mm/3mm
Ear : Serumen (-/-)
Nose : Secret (-/-), epistaxis (-)
Physical Exam

Mouth
Lips : Symmetrical, pale(-), mukosa basah (+), cyanosis (-)
Tounge: Tremor (-), hiperemis (-), falling aside (-)
Tonsil : Hiperemis (-/-), T2 – T2
Pharing: Hiperemis (-)

Neck
Inspection : Symmetrical, retraction (-)
Palpation : JVP R-2 cmH2O, Nodes limph enlargement (-)
Physical Exam

Thorax

Inspection
Static : Symmetrical, normochest configuration
Dynamic : Symmetrical, retraction (-)
Palpation : Tender area (-), Tactical fremitus right= left
Percussion : Sonor/Sonor
Auscultation : Vesiculer (+/+), Rhonchi (+/+) , Wheezing(-/-)
Physical Exam

Heart

Inspeksi : Apical impulse not visible

Palpasi : Apical impulse not palpabled

Percussion :
- Superior right : ICS II parasternalis line
- Inferior right : ICS V parasternalis line
- Superior left : ICS II parasternalis line
- Inferior left : ICS V left mid clavicularis line

Auscultasion : S I > SII, reguler, murmur (-)

Physical Exam
 Genitalia : not examined
 Anus : not examined

Extremity

Edema Pale Cyanotic Warmth

- - - - - - + +
+ + - - - - + +
Laboratorium
ECG
Thorax Photo

Conclusion :
1.Cardiomegaly
2.Lung
Congestive
Diagnose
 Acute Heart Failure
 Hypertension Stage II
Therapy
 Bed rest semi fowler
 O2 Nasal canul 2 liter
 Drip furosemid 2cc per hour
 ISDN 3X5mg
 Valsartan 2X80mg
 Diltiazem 1X30mg
Acute Heart Failure
 Symptom (breathlessness, fatique, tiredness, ankle
sweeling)
 Sign (Tachycardia, tachypneu, pleural effusion,
raise of JVP, peripheral oedema, hepatomegaly)
 Structural or functional abnormality of the heart at
rest (cardiomegaly, third heart sound, cardiac
murmurs, raised BNP)
RAA system
Patophysiology
Case Analysis
Case Theory
Breathlessness Imbalance cardiac
input and output.
Output↓ so that
blood in left atrium
go back to lungs then
make a congestive.
Congestive make ↓
lungs elasticity
breathlessness
Case Analysis
Case Theory
Cough 1. Lungs congestive
due to heart
failure make
water go through
bronkiolus
cough reflex(+)
2. Side effect of
captopril
Case Analysis
Case Theory
Cardiomegaly Hypertension 
Left Ventricular ↑contractility 
Hypertrophy hypertrophy
Case Analysis
Case Theory
Drip Furosemid Furosemid makes
2cc/hour hyperexcretion so
that extra fluid may
go out

Valsartan2X80mg angotensin receptor

blockers give negative
effect of RAA so that the
contractility of heart
decrease
Case Analysis
Case Theory
ISDN 3X5mg ISDN may decrease
the congesty

Diltiazem Calcium channel blocker

works to block Calcium
go out, so that the
myocardium minimum
to contract.
THANK YOU