laporan jaga chf maheli koto jumat
TRANSCRIPT
7/24/2019 Laporan Jaga Chf Maheli Koto Jumat
http://slidepdf.com/reader/full/laporan-jaga-chf-maheli-koto-jumat 1/46
Konsulen Jaga : dr. M. Fadil, SpJP
Residen Jaga : dr. Ivan/ dr. Nani/ dr. Nikko/dr. Erizon/ dr. Dia
7/24/2019 Laporan Jaga Chf Maheli Koto Jumat
http://slidepdf.com/reader/full/laporan-jaga-chf-maheli-koto-jumat 2/46
Pasien baru1. Tn. Yoherman, 55 tahun
WD/ UAP TIMI 2/7 GS 5
!T Sta"e 1
2. T. Mahe#i $oto, 5% tahunWD/ &!' '& III e( &AD
Post PT&A 2 stent D)S tahun2*1+
!io-a#emia
7/24/2019 Laporan Jaga Chf Maheli Koto Jumat
http://slidepdf.com/reader/full/laporan-jaga-chf-maheli-koto-jumat 3/46
Tn. Mahe#i $oto/ 5% th
K! : Sesa- naas an" menin"-at se0a- 5 hari SMS
RPS
Sesa- naas an" menin"-at se0a- 5 hari SMS.Sesa- tia- men(iut, tia- ien"aruhi o#eh (ua(aatauun ma-anan. Dirasa-an saat asienbera-ti3itas rin"an. i4aat sesa- sebe#umna 6se0a- 2 tahun tera-hir, i4aat P8D 6, D9) 6,9P 6, sembab i -a-i :.
8eri aa :, -erin"at in"in :, mua# :, muntah:
;erebar:ebar :, usin" :,in"san :
7/24/2019 Laporan Jaga Chf Maheli Koto Jumat
http://slidepdf.com/reader/full/laporan-jaga-chf-maheli-koto-jumat 4/46
Pasien ost asan" stent bu#an 0anuari an maret2*1+, -ontro# teratur -e o#i 0antun" SUP r. M.
D0ami#, aat terai ator 1<1** m", ramiri# 1<1*m", urosemie 1<=* m", bisoro#o# 1<2,5 m",sim3astatin 1<=* m", #ansora>o# 1<+* m",a##ourino# 1<1** m".
Di IGD ? Sesa- naas 6, neri aa :
'a-tor resi-o &AD ?
: )<:smo-er 6 berhenti se0a- 2 tahun an" #a#u
@ !T :
@ DM :@ Dis#iiemia :
@ '! :
7/24/2019 Laporan Jaga Chf Maheli Koto Jumat
http://slidepdf.com/reader/full/laporan-jaga-chf-maheli-koto-jumat 5/46
Pemeri-saan si-
$eaaan Umum ? sean"
$esaaran ? &M&
TD ? 1*2/7* mm!"
8ai ? % </m re"u#er
Pernaasan ? 2+ </m
Suhu ? +7,** (
Sat. 92 ? BC
eher ? EFP 5 6 2 (m!2*
Mata ? -on0un"ti3a tia- anemis, s-#era tia-i-teri-
7/24/2019 Laporan Jaga Chf Maheli Koto Jumat
http://slidepdf.com/reader/full/laporan-jaga-chf-maheli-koto-jumat 6/46
Eantun"
Inse-si ? I(tus (oris ta- ter#ihat
Pa#asi ? I(tus (oris teraba 1 0ari #atera# M&S I& FI
Per-usi ? ;atas -anan? SD
;atas Atas ? I& II
;atas $iri 1 0ari #atera# M&S I& FIAus-u#tasi ? S1S2 re"u#er, murmur :/:, an "a##o :/:
Paru
Inse-si ? simetris -iri -ananPa#asi ? remitus -iri -anan
Per-usi ? sonor -iri -anan
Aus-u#tasi ? ;ron-o3esi-u#er, h 6/6 basah ha#us i basa#,
4h :/:
7/24/2019 Laporan Jaga Chf Maheli Koto Jumat
http://slidepdf.com/reader/full/laporan-jaga-chf-maheli-koto-jumat 7/46
Abomen
Inse-si ? tia- tama- membun(it
Pa#asi ? sue#, hear an #ien tia- teraba
Per-usi ? timani
Aus-u#tasi ? ;U 6 norma#
)-stremitas
a-ra# han"at, uem :/:
7/24/2019 Laporan Jaga Chf Maheli Koto Jumat
http://slidepdf.com/reader/full/laporan-jaga-chf-maheli-koto-jumat 8/46
EK" di I"D #a$ %&.'( )i*
S, HS rate %%</I, a<is AD, "e#omban" P norma#, P inter3a# *,2*, HSurasi *,1*, ST JT (han"e :, F! :, F! :
7/24/2019 Laporan Jaga Chf Maheli Koto Jumat
http://slidepdf.com/reader/full/laporan-jaga-chf-maheli-koto-jumat 9/46
Hb : 12,0 mg/dl
Leukosit : 9500/mm3
Ht : 37 %
Trombosit : 190.000/mm3
Na//!l : 13" /3,#/ 10#
$& : 121
'r/!r : "3/ 1,1
!!T : #3,#
!()
Tro* T
: 17
: + 0,01
+a*oraoriu$
7/24/2019 Laporan Jaga Chf Maheli Koto Jumat
http://slidepdf.com/reader/full/laporan-jaga-chf-maheli-koto-jumat 10/46
nalisa "as Dara-
p : (,0
p120 : 0'
p20 : %0
12' : %3,3 4E : 5 &,%
S20 : %66 7
7/24/2019 Laporan Jaga Chf Maheli Koto Jumat
http://slidepdf.com/reader/full/laporan-jaga-chf-maheli-koto-jumat 11/46
Rongen8-oraks :
18R 96 7, Sgo N, SgPo $enon#ol, pinggang #anung $endaar,apeks erana$, kranialisasi 5;, in<lra 5;.
7/24/2019 Laporan Jaga Chf Maheli Koto Jumat
http://slidepdf.com/reader/full/laporan-jaga-chf-maheli-koto-jumat 12/46
WD/ - CHF fc III ec CAD
- Post PTCA 2 stent DES tahun 2013
- Hipokae!ia
7/24/2019 Laporan Jaga Chf Maheli Koto Jumat
http://slidepdf.com/reader/full/laporan-jaga-chf-maheli-koto-jumat 13/46
Terai i IGD ?
IF'D 1 -o#/2= 0am
;o#us 'urosemi =* m" i3 ri urosemie mu#aien"an osis 5 m"/0am
a4at i ban"sa# 0antun"
7/24/2019 Laporan Jaga Chf Maheli Koto Jumat
http://slidepdf.com/reader/full/laporan-jaga-chf-maheli-koto-jumat 14/46
EK" di *angsal #anung 05%0506% #a$ %=.'6 )i*
S, HS rate 7*</I, a<is AD, "e#omban" P norma#, P inter3a# *,2*, HS
urasi *,1*, ST JT (han"e :, F! :, F! :
7/24/2019 Laporan Jaga Chf Maheli Koto Jumat
http://slidepdf.com/reader/full/laporan-jaga-chf-maheli-koto-jumat 15/46
WD/ - CHF FC III ec CAD- Post PTCA 2 stent DES tahun 2013
- Hipokae!ia
7/24/2019 Laporan Jaga Chf Maheli Koto Jumat
http://slidepdf.com/reader/full/laporan-jaga-chf-maheli-koto-jumat 16/46
Terai i ban"sa# 0antun"
? IF'D 1 -o#/2= 0am
92 8M 1* /I
Dri urosemie mu#ai 5 m"/0am
Asi#et 1<1** m"
;isoro#o# 1<2,5 m"
ansora>o# 1<+* m"
amiri# 2<5 m"
Sirono#a-ton 1<25 m"
Sim3astatin 1<1* m"
$& 25 meK
7/24/2019 Laporan Jaga Chf Maheli Koto Jumat
http://slidepdf.com/reader/full/laporan-jaga-chf-maheli-koto-jumat 17/46
P#an
&e- aa# hear, ro# #ii, asam urat, M"
&e- $ ost -ore-si
)-o-ario"ra
7/24/2019 Laporan Jaga Chf Maheli Koto Jumat
http://slidepdf.com/reader/full/laporan-jaga-chf-maheli-koto-jumat 18/46
'o##o4:u i ban"sa# 0antun" 2%:12:2*15 0am *7.** WI;
S/ Sesa- naas 6 ber-uran"9/ -u -es TD 8 8 T
s" &M& BB/%7 %= </ 22L/ A
EFP 56* (m!2*
&or ? S1S28, re", murmur :, "a##o : Pu#mo? 3esi-u#er, rh 6/6 basah ha#us i basa# aru, 4h :/:
Abomen ? Sue#, ;U 6 8)-stremitas ? a-ra# han"at, eema :/:
A/ : &!' '& III e( &AD
: Post PT&A 2 stent D)S tahun 2*1+: !io-a#emia
I : 1500 cc/24 jam
O : 3000 cc/24jam Balanced : -1500 cc
Diuresis : 2,08 cc/kgBB/jam
7/24/2019 Laporan Jaga Chf Maheli Koto Jumat
http://slidepdf.com/reader/full/laporan-jaga-chf-maheli-koto-jumat 19/46
EK" di *angsal #anung 095%0506%
S, HS rate %=</I, a<is AD, "e#omban" P norma#, P inter3a# *,2*, HSurasi *,1*, ST JT (han"e :, F! :, F! :
7/24/2019 Laporan Jaga Chf Maheli Koto Jumat
http://slidepdf.com/reader/full/laporan-jaga-chf-maheli-koto-jumat 20/46
WD/ - CHF fc III ec CAD
- Post PTCA 2 stent DES tahun 2013
- Hipokae!ia
7/24/2019 Laporan Jaga Chf Maheli Koto Jumat
http://slidepdf.com/reader/full/laporan-jaga-chf-maheli-koto-jumat 21/46
Terai ?
IF'D 1 -o#/2= 0am
92 8M 1* /I
Dri urosemie 5 m"/0am Asi#et 1<1** m"
;isoro#o# 1<2,5 m"
ansora>o# 1<+* m"
amiri# 2<5 m" Sirono#a-ton 1<25 m"
Sim3astatin 1<1* m"
7/24/2019 Laporan Jaga Chf Maheli Koto Jumat
http://slidepdf.com/reader/full/laporan-jaga-chf-maheli-koto-jumat 22/46
P#an
&e- aa# hear, ro# #ii, asam urat, M"
&e- $ ost -ore-si
)-o-ario"ra
7/24/2019 Laporan Jaga Chf Maheli Koto Jumat
http://slidepdf.com/reader/full/laporan-jaga-chf-maheli-koto-jumat 23/46
'o##o4:u i ban"sa# 0antun" 27:12:2*15 0am *7.** WI;
S/ Sesa- naas 6 ber-uran"9/ -u -es TD 8 8 T
s" &M& 1**/%+ %* </ 22L/ A
EFP 56* (m!2*
&or ? S1S28, re", murmur :, "a##o : Pu#mo? 3esi-u#er, rh 6/6 basah ha#us i basa# aru, 4h :/:Abomen ? Sue#, ;U 6 8)-stremitas ? a-ra# han"at, eema :/:
I ? 15** ((/ 2= 0am
9 ? 17** ((/ 2= 0am ;& ? : 2** ((/ 2= 0amDiuresis ? 1,1 ((/-";;/0am
7/24/2019 Laporan Jaga Chf Maheli Koto Jumat
http://slidepdf.com/reader/full/laporan-jaga-chf-maheli-koto-jumat 24/46
EK" di *angsal #anung 0(5%0506%
S, HS rate %*</I, a<is AD, "e#omban" P norma#, P inter3a# *,2*, HS
urasi *,1*, ST JT (han"e :, F! :, F! :, ;;; in-om#it
7/24/2019 Laporan Jaga Chf Maheli Koto Jumat
http://slidepdf.com/reader/full/laporan-jaga-chf-maheli-koto-jumat 25/46
aboratorium
8a/ $/ &#/ &a ? 1+%/ =,*/ 1**/ 7,1
7/24/2019 Laporan Jaga Chf Maheli Koto Jumat
http://slidepdf.com/reader/full/laporan-jaga-chf-maheli-koto-jumat 26/46
nalisa "as Dara-
p : (,'=
p120 : 0=
p20 : 006
12' : %(,9
4E : 5 (,&
S20 : %66 7
7/24/2019 Laporan Jaga Chf Maheli Koto Jumat
http://slidepdf.com/reader/full/laporan-jaga-chf-maheli-koto-jumat 27/46
WD/ - CHF fc III ec CAD
- Post PTCA 2 stent DES tahun 2013
- Hipocase!ia
7/24/2019 Laporan Jaga Chf Maheli Koto Jumat
http://slidepdf.com/reader/full/laporan-jaga-chf-maheli-koto-jumat 28/46
Terai i ban"sa# 0antun"
?
IF'D 1 -o#/2= 0am 92 8M 1* /I
Dri urosemie mu#ai 5 m"/0am
ASA 1<1** m"
;isoro#o# 1<2,5 m" ansora>o# 1<+* m" i3
amiri# 2<5 m"
Sirono#a-ton 1<25 m"
Sim3astatin 1<1* m"
&a "#u(onas 1 "r
7/24/2019 Laporan Jaga Chf Maheli Koto Jumat
http://slidepdf.com/reader/full/laporan-jaga-chf-maheli-koto-jumat 29/46
P#an
&e- aa# hear, ro# #ii, asam urat, M"
&e- &a ost -ore-si
7/24/2019 Laporan Jaga Chf Maheli Koto Jumat
http://slidepdf.com/reader/full/laporan-jaga-chf-maheli-koto-jumat 30/46
'o##o4:u i ban"sa# 0antun" 2:12:2*15 0am *7.** WI;
S/ Sesa- naas 6 ber-uran"9/ -u -es TD 8 8 T
s" &M& B5/%+ %2 </ 22L/ A
EFP 56* (m!2*
&or ? S1S28, re", murmur :, "a##o : Pu#mo? 3esi-u#er, rh 6/6 basah ha#us i basa# aru, 4h :/:Abomen ? Sue#, ;U 6 8)-stremitas ? a-ra# han"at, eema :/:
I ? 1+** ((/ 2= 0am
9 ? 155* ((/ 2= 0am ;& ? : 25* ((/ 2= 0amDiuresis ? 1,*7 ((/-";;/0am
7/24/2019 Laporan Jaga Chf Maheli Koto Jumat
http://slidepdf.com/reader/full/laporan-jaga-chf-maheli-koto-jumat 31/46
EK" di *angsal #anung 035%0506%
S, HS rate %5</I, a<is AD, "e#omban" P norma#, P inter3a# *,2*, HS
urasi *,1*, ST JT (han"e :, F! :, F! :, ;;; in-om#it
7/24/2019 Laporan Jaga Chf Maheli Koto Jumat
http://slidepdf.com/reader/full/laporan-jaga-chf-maheli-koto-jumat 32/46
aboratorium
Tota# (ho#/ !D/ D/ Tri"#iseria ? 151/ 22/ 1*B/ 1*1
Asam urat ? 12,1
$a#sium ? ,2
7/24/2019 Laporan Jaga Chf Maheli Koto Jumat
http://slidepdf.com/reader/full/laporan-jaga-chf-maheli-koto-jumat 33/46
nalisa "as Dara-
p : (,&9
p120 : '
p20 : 000
12' : 0&,=
4E : %,%
S20 : %66 7
7/24/2019 Laporan Jaga Chf Maheli Koto Jumat
http://slidepdf.com/reader/full/laporan-jaga-chf-maheli-koto-jumat 34/46
WD/ - CHF fc III ec CAD
- Post PTCA 2 stent DES tahun 2013
- Hipocase!ia pe"#aikan
7/24/2019 Laporan Jaga Chf Maheli Koto Jumat
http://slidepdf.com/reader/full/laporan-jaga-chf-maheli-koto-jumat 35/46
Terai i ban"sa# 0antun"
?
IF'D 1 -o#/2= 0am 92 8M 1* /I
Dri urosemie mu#ai 5 m"/0am
Ator 1<1** m"
;isoro#o# 1<2,5 m" ansora>o# 1<+* m"
amiri# 2<5 m"
Sirono#a-ton 1<25 m"
Sim3astatin 1<1* m"
7/24/2019 Laporan Jaga Chf Maheli Koto Jumat
http://slidepdf.com/reader/full/laporan-jaga-chf-maheli-koto-jumat 36/46
P#an
Pantau ba#an(e (airan/hari
)-o-ario"ra
AGD
Do4ntitrasi urosemie
7/24/2019 Laporan Jaga Chf Maheli Koto Jumat
http://slidepdf.com/reader/full/laporan-jaga-chf-maheli-koto-jumat 37/46
'o##o4:u i ban"sa# 0antun" 2B:12:2*15 0am *7.** WI;
S/ Sesa- naas 6 ber-uran"9/ -u -es TD 8 8 T
s" &M& 1**/%+ %5 </ 22L/ A
EFP 56* (m!2*
&or ? S1S28, re", murmur :, "a##o : Pu#mo? 3esi-u#er, rh 6/6 basah ha#us i basa# aru, 4h :/:Abomen ? Sue#, ;U 6 8)-stremitas ? a-ra# han"at, eema :/:
I ? 1=** ((/ 2= 0am
9 ? 1%** ((/ 2= 0am ;& ? : 2** ((/ 2= 0amDiuresis ? 1,1 ((/-";;/0am
7/24/2019 Laporan Jaga Chf Maheli Koto Jumat
http://slidepdf.com/reader/full/laporan-jaga-chf-maheli-koto-jumat 38/46
EK" di *angsal #anung 0=5%0506%
S, HS rate %5</I, a<is AD, "e#omban" P norma#, P inter3a# *,2*, HS
urasi *,1*, ST JT (han"e :, F! :, F! :, ;;; in-om#it
7/24/2019 Laporan Jaga Chf Maheli Koto Jumat
http://slidepdf.com/reader/full/laporan-jaga-chf-maheli-koto-jumat 39/46
WD/ - CHF fc III ec CAD
- Post PTCA 2 stent DES tahun 2013
7/24/2019 Laporan Jaga Chf Maheli Koto Jumat
http://slidepdf.com/reader/full/laporan-jaga-chf-maheli-koto-jumat 40/46
Terai i ban"sa# 0antun"
?
IF'D 1 -o#/2= 0am 92 8M 1* /I
Dri urosemie mu#ai 5 m"/0am
Ator 1<1** m"
;isoro#o# 1<2,5 m" ansora>o# 1<+* m"
amiri# 2<5 m"
Sirono#a-ton 1<25 m"
Sim3astatin 1<1* m"
7/24/2019 Laporan Jaga Chf Maheli Koto Jumat
http://slidepdf.com/reader/full/laporan-jaga-chf-maheli-koto-jumat 41/46
P#an
Pantau ba#an(e (airan/hari
)-o-ario"ra
AGD/hari
Do4ntitrasi urosemie
7/24/2019 Laporan Jaga Chf Maheli Koto Jumat
http://slidepdf.com/reader/full/laporan-jaga-chf-maheli-koto-jumat 42/46
444.theme"a##er.(om
Framingham Criteria for Congestive Heart Failure
7/24/2019 Laporan Jaga Chf Maheli Koto Jumat
http://slidepdf.com/reader/full/laporan-jaga-chf-maheli-koto-jumat 43/46
Framingham Criteria for Congestive Heart Failure
Dia$nosis of CHF "e%ui"es the si!utaneous p"esence of
at east 2 !a&o" c"ite"ia o" 1 !a&o" c"ite"ion in con&unction 'ith 2 !ino" c"ite"ia(
)a&o" c"ite"ia*+Pa"o,s!a noctu"na .spnea+
eck ein .istention+aes+a.io$"aphic ca".io!e$a inc"easin$ hea"t sie on chest "a.io$"aph4+ Acute pu!ona" e.e!a+S3 $aop+Inc"ease. cent"a enous p"essu"e 516 c! H27 at "i$ht at"iu!4+Hepato&u$ua" "efu,
+Wei$ht oss 58(9 k$ in 9 .as in "esponse to t"eat!ent
)ino" c"ite"ia*+:iate"a anke e.e!a+octu"na cou$h+Dspnea on o".ina" e,e"tion+Hepato!e$a+Peu"a effusion+Dec"ease in ita capacit # one thi". f"o! !a,i!u! "eco".e.+Tachca".ia hea"t "ate5120 #eats/!in(4)ino" c"ite"ia a"e accepta#e on if the can not #e att"i#ute. to anothe"
!e.ica con.ition such as pu!ona" hpe"tension; ch"onic un$ .isease;
ci""hosis; ascites; o" the neph"otic sn."o!e4(The F"a!in$ha! Hea"t Stu. c"ite"ia a"e 100< sensitie an. =>< specific fo" i.entifin$ pe"so
hea"t faiu"e(
7/24/2019 Laporan Jaga Chf Maheli Koto Jumat
http://slidepdf.com/reader/full/laporan-jaga-chf-maheli-koto-jumat 44/46
7/24/2019 Laporan Jaga Chf Maheli Koto Jumat
http://slidepdf.com/reader/full/laporan-jaga-chf-maheli-koto-jumat 45/46