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Group 4

 Alief Fahrony 11310031


 Galih Suharno 11310140
 Mas Redika H 11310205
 M. Ilham P 11310237
CASE OF STUDY
A 66-year-old woman presents to your office complaining of shortness of
breath and bilateral leg edema that have been worsening for 3 months. She
emphatically tells you. “I get out of breath when I do housework and I can’t
even walk to the corner. “ she has also noticed difficulty sleeping secondary to a
dry cough that wakes her up at night and further exacerbation of her shortness
of breath while lying flat. This has forced her to use three pilows for a good
night’s sleep. She denies any chest pain, wheezing, or febrile illness. She has no
past illness and takes no medications. She’s never smoked and drinks socially.
On examination, her blood pressure is 180/90 mmHg, her pilse is 97 bpm, her
respiratory rate is 16 breaths per minute, her temperature is 98 F(36,6 C) and
her oxygen saturation is 93 % on room air by pulse oximetry. She has a
pronounced jugular vein. Cardiac examination reveals a pansysolic murmur.
Examination of her lung bases produces dullness bilaterally. You find 2+ pitting
edema of both ankles. An ECG shows a normal sinus rhythm and a chest x-ray
demostrates mild cardiomegaly with bilateral pleural effusions. You decide she
needs further workup, so you call the hospital where you have admitting
privileges and arrange for a telemetry bed.
Keyword
 shortness of breath
 bilateral leg edema that have been worsening for 3
months
 she has also noticed difficulty sleeping secondary to a
dry cough that wakes her up at night
 further exacerbation of her shortness of breath while
lying flat
 She denies any chest pain, wheezing, or febrile illness
Problem
 A 66-year-old woman presents to your office
complaining of shortness of breath and bilateral leg
edema that have been worsening for 3 months
Definition
 Heart failure is a condition in which the heart can’t
pump enough blood to meet the body’s needs. Is
somem cases, the heart can’t fill with enough blood. In
other cases, the heart can’t pump to the rest of the
body with enough force. Some people have both
problems.
Symptomps
 Shortness of breath (dyspnea) when you exert yourself or when you lie down
 Fatigue and weakness
 Swelling (edema) in your legs, ankles and feet
 Rapid or irregular heartbeat
 Reduced ability to exercise
 Persistent cough or wheezing with white or pink blood-tinged phlegm
 Increased need to urinate at night
 Swelling of your abdomen (ascites)
 Sudden weight gain from fluid retention
 Lack of appetite and nausea
 Difficulty concentrating or decreased alertness
 Sudden, severe shortness of breath and coughing up pink, foamy mucus
 Elevated blood pressure
 Chest pain, if your heart failure is caused by a heart attack
Diagnose
o Physical Examination
- Increased jugular venous pressure
- Ronkhi not loud wet
- Cardiomegaly
- S3 gallop rhythm
- Ankle edema
- Hepatomegaly
- Tachycardia (>120x/minutes)
Investigation
 Blood tests
 Electrocardiogram(EKG or ECG)
 Stress Test
 Chest X-ray
 Echocardiogram
 Cardiac catheterization
 Liver Enzymes Examination
Criteria Diagnostic
 Major criteria:
1. Paroxysmal nocturnal dyspnea or orthopnea.
2. Increased jugular venous pressure
3. Ronkhi not loud wet
4. Cardiomegaly
5. Acute pulmonary edema
6. S3 gallop rhythm
7. Increased venous pressure> 16 cm H20
8. Reflux hepatojugular.

 Minor criteria:
1. Ankle edema
2. Cough evening
3. Dyspnoea d'effort
4. Hepatomegaly
5. Pleural effusion
6. Vital capacity was reduced to 1/3 the maximum
7. Tachycardia (> 120x/menit)
Diagnosis is made of 2 major criteria or 1 major criterion and 2 minor criteria must be
present at the same time.
Treatment
1. Improve oxygenation with oxygen delivery and decreasing O2
consumption through
rest / activity restriction.
2. Repairing heart muscle contractility
- Digoksin 0,5-2 mg 6 hourly in 24 hours p.r.n
3. Reduced the burden of heart
- Captopril 6,25 mg b.d.s
- Furosemid 40-80 mg p.r.n
- ISDN 10-15 mg t.d.s
- Nitrogliserin 0,4-0,6 mg p.r.n
4. Surgical Treatment
- Transmyocardial Laser Revascularization (TLR)
- Heart Bypass Surgery
- Heart Transplant
Education
• The patient should multiply rest
• patient should a low salt diet
• Patient should avoid smoking habit
• Patient should weight loss for the obese
• Patient should avoid drinking alcohol
• patient should education for drug side effects
• patient should check condition on EKG or ECG
Conclution
 Heart failure is a disease in which the heart is unable
to function properly due to multiple risk factors,
especially in older people who experience a decline in
function of his organs.
 Circumstances in which the heart can no longer pump
blood in sufficient quantities to meet the needs of the
agency for the purposes of circulation metabolism of
body tissues in certain circumstances.
 While cardiac filling pressures into the still quite.
THANK YOU