Case Presentation Kardio

7/25/2019 Case Presentation Kardio

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MITRAL

REGURGITATION

Present by

Dionisius Giri S

(C111 09 309)

Supervisor :

dr. Muzakkir !ir" Sp.#P.$%&"$%C

CS' P'S'**%+

Depart!ent o, Cardio-oy and /asu-ar MediineMedia- $au-ty o, &asanuddin niversity

Makassar 201


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PATIENT IDENTITY

Name : Mrs. DS

Age : 25 years old

Gender : emale

MR : !"!#$5 Day o% Adm&ss&on : 'an(ary ##)*

2+#"


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,ISTORY TA-ING*&e% om/la&n) : S*or)ness o% 0rea)*

,&s)ory o% &llness:

S(1ered s&ne 3 #years ago and go) 4orsen 5

days 0e%ore adm&))ed )o )*e *os/&)al. I) 4as

e/er&ened 4*&le do&ng m&n&mal a)&6&)y

4al7&ng )o )*e 0a)*room and rel&e6ed 4&)*

res)&ng. Some)&mes a4a7ed d(r&ng a) n&g*) )&me

)*a) a(sed 0y s(dden s*or)ness o% 0rea)*8

/a)&en) slee/ 4&)* s&) /o)&)&on. *es) /a&n 9;8 on

)*e le%) *es)8 s&ne # mon)* ago 0e%ore


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s/read (n)&l )o )*e le%) arm8/ene)ra)e)o )*e 0a78 %eels l&7e 7neaded. o(g*9; s&ne ! days ago 4&)* s/()(m o%4*&)e olo(red8 e6er 9


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,&s)ory o% DM 9


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RIS- ATORS

on4 Modi5edModi5ed

Gender : emale

Age

,&/er)ens&on

D&a0e)es

Mell&)(s


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Genera- Status

Modera)e &llness@ ?ell no(r&s*ed@ ons&o(s

N()r&)&onal S)a)(s: Normal ?e&g*) : 5+ 7g

,e&g*) : #55 m

MI : 2+.$ 7g@m2

/ita- Sin

lood Press(re : #++@B+ mm,g

P(lse Ra)e : ##" 0/m Res/&ra)ory Ra)e : =2 )/m

Tem/era)(re : =!.$ + 9a&lla;


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P,YSIAL ECAMINATION

,ead and Ne7 Eam&na)&onsEye : on(n)&6a anem& 9


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Ins/e2)&on:,ear)a/e54asno)6&s&0lePal/a)&on:,ear)a/e54asno)/al/a0lePer2(ss&on:R&g*)*ear)0order&nr&g*)

/aras)ernall&ne8Le%)*ear)0order&nle%)m&d2la6&2(larl&neIS>.

A(s2(l)a)&on:,ear)So(nds:SI@IIreg(lar8m(rm(r9;s&s)ol&7grade=@!a/e5

&eart

Ins/e2)&on:la)8%ollo4s0rea)*&ngmo6emen)A(s2(l)a)&on:Per&s)al)&2so(nd9;8normalPal/a)&on:Nomass8no)enderness8l&6erand

s/leen(n/al/a0le

Per2(ss&on:Tym/an&9;

bdo!en

Pre)&0&aledema@Dorsal/ed&sedema@

'6tre!itie

s


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Ele)roard&ogram 9EG; #"@#@2+#"


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EG &n)er/re)a)&on

R*y)*m: S&n(s r*y)*m

,ear) ra)e : ##B 0/mReg(lar&)y : reg(lerA&s : RADP 4a6e : P m&)ral +8#2 s on II8a6L leadPR &n)er6al : +82+ sH /a)*olog&es : %(n)&on &s good8 E !=8==9on )a*&ard&;

D&mens&onal *am0ers o% *ear):LA8RA8R> d&la)a)&on

Derease R> %(n)&on

MR se6ere

TR modera)e


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?or7&ng DIAGNOSIS

Se6ere MITRALREGURGITATION

, NY,A III


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MANAGEMENT 2 7r

Dobuta!in ?>kA @a!> SP i,


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I!CU!!I

"ITRL RGURGITTI


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or!a- !itra- va-ve ,untiondepends on per,et ,untiono, t7e o!p-e6 interation

beteen t7e !itra- -eaets"t7e subvu-var apparatus(7ordae tendinae andpapi--ary !us-es)" t7e!itra- annu-us" and t7e -e,tventri-e.An &m/er%e)&on &n any one o% )*ese

om/onen)s an a(se )*e 6al6e )o lea7.


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Mitra- reuritation &s

re)rograde o4 o% 0lood %romL> )o LA )*ro(g* &nom/e)en)m&)ral 6al6e d(r&ng sys)ol&/*ase.

Causes by Pr&mary 9&n)r&ns&6al6(lar d&sease; and

(n)&onal 9reg&onal or glo0al

L> remodell&ng ;


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Pri!ary (intrinsiva-vu-ar

disease)

MR &s almos) al4ays9K+; asso&a)ed 4&)*MS &n R,D

Degenera)&6e/roesses o% leae)sand *ordals)r()(res

In%e)&6e endoard&)&s

M&)ral ann(laral&a)&on

S)r()(rally normalleae)s and *ordae)end&neae

Is*em& *ear) d&sease9Is*em& MR;

Id&o/a)*& d&la)edard&omyo/a)*y

M&)ral ann(lard&la)a)&on


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E)&ology


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Pa)*o/*ys&ology o% MR

Mitral regurgitation

Systolic (Retrograde) ejection into LA

Acute Chronic

Volume overload in LA & LV ed LV afterload (into LA)

ed LA! LV "ressure ed LA#LV si$e# com%liance

"ulmonary edema ed Cardiac out%ut LA dilatation ed contractilityA C'"ulmonary congestion


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Pa)*o/*ys&ology


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Sym/)oms o% MR

Dys/nea

a)&g(e

Or)*o/nea

Pal/&)a)&on

P(lmonary edema 9o%)en )*e&n&)&al man&%es)a)&on;


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P*ys&al EamPal/a)&on may re6eal )*e %ollo4&ng:

r&s7 aro)&d (/s)ro7e and *y/erdynam& ard&a&m/(lse

Prom&nen) L> ll&ng 4a6e

A(s(l)a)&on may re6eal )*e %ollo4&ng: D&m&n&s*ed S#&n a()e MR and *ron& se6ere MR

4&)* de%e)&6e 6al6e leae)s

?&de s/l&))&ng o% S2as a res(l) o% early los(re o%

)*e aor)& 6al6e

S=as a res(l) o% L> dys%(n)&on or &nreased 0lood

o4 aross )*e M>

Aen)(a)ed P2&% /(lmonary *y/er)ens&on &s

/resen)

*ara)er&s)& m(rm(r


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A(s(l)a)&on


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l&n&al ea)(res

ute

Presen) 4&)* s(ddenonse) o% /(lmonaryedema8 *y/o)ens&o8

ard&ogen& s*o7M(rm(r early

sys)ol&8 so%)&na(d&0le

Normal LA s&e andom/l&ane

C7roni

Us(allyasym/)oma)&8 &%)*ere &s /resen) 4&)*

lo4 O sym/)omO6er )&me ,

%ea)(res

Inreased LA s&e

Lo4er O


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D&agnos)& Tes)s CR: LA and L> enlargemen)

EG: L> *y/er)ro/*y8

some)&mes A

E*o:

LAE L> enlargemen)


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Med&al T*era/y

AE


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S(rg&al &n)er6en)&on

Sym/)oma)& 4&)* se6ere MR

Asym/)oma)& 4&)* se6ere MR and/reser6ed L> %(n)&on

Asym/)oma)& 4&)* se6ere MR andL>ESD "5 mm and E J 55


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I!CU!!I

HEART FAILURE

DEINITION


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T*e s)a)e &n 4*&*a0normal &r(la)ory

onges)&on o(rs as )*eres(l) o% *ear) %a&l(re.

DEINITION

,ear) &s no longer a0le )o /(m/ anade(a)e s(//ly o% 0lood &n rela)&on)o )*e 6eno(s re)(rn and &n rela)&on)o )*e me)a0ol& needs o% )*e 0ody)&ss(es a) )*e /ar)&(lar momen)

.onges

)&6e

,ear)

a&l(re

,ear)

a&l(r

e

ETIOLOGY O ,EARTAILURE


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ETIOLOGY O ,EARTAILURE

M&oardD&sease

AD

ard&omyo/a)*y

Ia)rogen&

M&oard&)&s

Mioard Me7ania-Dys,untion

Press(re o6erloaded

9S)enos&s Aor)ae8,y/er)ens&on8 oar)a)&oAor)ae;

>ol(me O6erloaded

9M&)ral@Aor)ae Reg(rg&)a)&on8ongen&)al ,ear) D&sease8

,&/er)rans%(s&on;

M&oard &ll&ng In*&0&)a)&ng

(Cardia *a!ponade"Periarditis)


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*7e $ra!in7a! riteria ,or C&$C&$ onsidered present i, 2 !a@or or 1 !a@or E 2 !inor

Maor r&)er&a M&nor r&)er&a

Paroysmal No)(rnal

Dys/nea

ard&omegaly

Gallo/ S=

,e/a)o(g(lar re(

Inreased o% '>P

Rales or ron*&

A()e /(lmonary edema

Prolonged &r(la)&on

)&me9 25 se;

?e&g* loss "85 7g &n 5

days &n

E)rem&)y edema

No)(rnal o(g*

Dereased 6&)al

/(lmonary a/a&)y

9#@= o% ma&mal;

,e/a)omegaly

Ple(ral e1(s&on

Ta*yard&a 9

#2+0/m;

Dys/nea dQe1or)


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lASSIIATION O ,


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PAT,OP,YSIOLOGY O ,

Pla(e &noronaryar)ery


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S&gn sym/)om/ o% *%


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Lo4 sal)8 eno(g*

alor&es and/ro)e&ns de)ary

Red(e P*ys&alA)&6&)y

O/)&mal&edO&gena)&on

, MANAGEMENT

Nonenod&la)or

AE&n*&0&)orsAR

0lo7ers

0lo7ersAE&n*&0&)orsAR

C&$ MG'M'*

arma7olog&


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T*an7 Yo(

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