CONGESTIVE HEART

FAILURE e.c ASD

By Irma Fita Sampe

IDENTITY

Name
Age
Date
Time

:
:
:
:

Mr. K
40th
April 17th 2007
16.45

Medical record
Mr. K came to the hospital with
dyspnea since a week ago,
uncontinuosly, influence by activity,
sleep with one pillow, not influence
by weather, with the chest pain in
right side ecpecially when he cough,
sometimes with white mucous. He
had fever since 5 days ago, and he
lost his appetite.He has a Congenital
heart disease ( ASD)

Physical examination
Neck : JVP R+1 cm
Cor : ictus cordis seen
ICS V - VI

ECG
April 24th 2007 : S. Takikardi

: HR 108
: Inferior + antero
septoapico
ischemic

Thorax Fhoto
Cardiomegaly ec Left to Right
Shunt with sign of hypertension
pulmonal
Right pleura efusion lamellar.

Laboratory
Natrium : 137 mmol/L
Kalium : 4,5 mmol/L
Clorida : 102 mmol/L
CK
: 117 U/I
CKMB : 2 U/I
GDS
: 144 mg/dl
Ureum : 18 mg/dl
Kreatinin: 0,54 mg / dl

ECHO
Large ASD II, PH
PR TR mild
Left to right shunt

Working diagnose
CHF NYHA III e.c SUSP. VSD/ASD

THERAPY
April 17th 2007 : O2 2-3 ltr
IVFD, RL 18 tts
Farsorbid 10 gr 1-1-1
Aspilet 80 0-1-1
Carpiaton 2 gr
Lab : Whole blood, GDS,
ureum, creatinin

CONGESTIVE HEART
FAILURE ec ASD

Defenition :
Congestive heart
failure (CHF), or heart
failure, is a condition in
which the heart can't
pump enough blood to
the body's other organs

This can result from :

narrowed arteries that supply blood to
the heart musclecoronary artery
disease
past heart attack, or myocardial
infarction, with scar tissue that interferes
with the heart muscle's normal work
high blood pressure
heart valve disease due to past
rheumatic fever or other causes

 primary disease of the heart

muscle itself, called
cardiomyopathy.
heart defects present at
birthcongenital heart defects.
infection of the heart valves and/or
heart muscle itselfendocarditis
and/or myocarditis

Mortality/Morbidity:
The most common cause of death
is progressive heart failure, but
sudden death may account for up to
45% of all deaths. After auditing
data on 4606 patients hospitalized
with CHF between 1992-1993, the
total in-hospital mortality rate was
19%, with 30% of deaths occurring
from noncardiac causes.

Sex
Prevalence is greater in males
than in females for patients
aged 40-75 years.
No sex predilection exists for
patients older than 75 years.

Age
Prevalence of CHF increases
with increasing age and affects
about 10% of the population
older than 75 years.

SIMPTOMS AND SIGN

Anxiety
Dyspnea at rest
Dyspnea on exertion has been found to be the most
sensitive symptom reported, yet the specificity for
dyspnea is less than 60%.
Orthopnea and paroxysmal nocturnal dyspnea
(PND) are symptoms; however, sensitivity for
orthopnea and PND is only 20-30%.
Cough productive of pink, frothy sputum is highly
suggestive of CHF.
Edema

 Nonspecific symptoms reported

include the following:

Weakness
Lightheadedness
Abdominal pain
Malaise
Wheezing
Nausea

Weight gain
Swelling of feet and ankles
Swelling of the abdomen
Loss of appetite, indigestion
Nausea and vomiting
Difficulty sleeping
Sensation of feeling the heart beat
(palpitations)
Irregular or rapid pulse
Need to urinate at night

Physical
Findings such as peripheral edema, jugular
venous distention, and tachycardia are highly
predictive of CHF. Overall specificity of physical
examination has been reported at 90%; however,
this same study reported a sensitivity of only
10-30%.
Tachypnea, using accessory muscles of
respiration
Hypertension
Pulsus alternans (alternating weak and strong
pulse indicative of depressed left ventricle [LV]
function)
Skin may be diaphoretic or cold, gray, and
cyanotic.
Jugular venous distention (JVD) frequently is
present.

 Wheezing or rales may be heard

on lung auscultation.
Apical impulse frequently is
displaced laterally.
Cardiac auscultation may reveal
aortic or mitral valvular
abnormalities, S3 or S4.
Lower extremity edema also
may be noted, especially in the
subacute process.

ATRIAL SEPTAL DEFECT

Is a hole between the left and right atria (a

hole between the upper chambers of the
heart ).
The term "atrial septal defect" usually refers
to holes in the atria resulting from a lack of
atrial septal tissue, rather than those related
to a condition called patent foramen ovale
(PFO). Patent foramen ovale occurs when
part of the normal fetal heart circulation fails
to close properly at birth. During fetal heart
development, a channel (the foramen ovale) is
present between the atria to allow blood to
bypass the lungs. At birth, once the lungs
take over breathing, the hole normally closes.
In about one in three people, this opening
doesn't close.

 Ostium secundum ASD is the most

common type of ASD. It occurs in the
center of the septum between the
right and left atrium. A variant of this
type of ASD is called a patent foramen
ovale (PFO) and is very small.
Normal heart for comparison.
Ostium primum is the next most
common type and is located in the
lower portion of the atrial septum.
This type of ASD often will have a
mitral valve defect associated with it
called a mitral valve cleft. A mitral
valve cleft is a slit-like or elongated
hole in one of the leaflets (anterior
leaflet) that form the mitral valve.

 A sinus venosus defect is the least

common type of ASD and is located in
the upper portion of the atrial septum.
A sinus venosus ASD often has an
abnormal pulmonary vein connection
associated with it. Four pulmonary
veins, two from the right lung and two
from the left lung, normally return red
blood to the left atrium. Usually with a
sinus venosus ASD, a pulmonary vein
from the right lung will be abnormally
connected to the right atrium instead of
the left atrium. This is called an
anomalous pulmonary vein.

Mortality/Morbidity:
ASD is present in 4 out of
100,000 people..

Symptoms

Frequent respiratory infections in children

Difficulty breathing (dyspnea)
Shortness of breath with activity
Sensation of feeling the heart beat
(palpitations)
When the person has no other congenital defect,
symptoms may be absent, particularly in children.
Symptoms usually have manifested by age
People with small-to moderate-sized defects may
show no symptoms at all, or not until middle age
or later.

Any condition causing reduced

left ventrikluler compliance
( systemic hypertnsion,
cardiomiopathy, MI), or
increased atrial pressure ( MR
and MS ) will tend do increased
the left to right shunt that make
people fell the simptoms.

Pathofisiology

An atrial septal defect allows freshly

oxygenated blood to flow from the left upper
chamber of the heart (left atrium) into the
right upper chamber of the heart (right
atrium). There it mixes with deoxygenated
blood and is pumped to the lungs, even
though it's already refreshed with oxygen. If
the atrial septal defect is large, this extra
blood volume can overfill the lungs and
overwork the heart. If not treated, the right
side of the heart eventually enlarges and
weakens. In some cases, the blood pressure
in your lungs increases as well, leading to
pulmonary hypertension.

THERAPY
Although small defects may close on there
own, many atrial septal defects need
surgery. In a child, doctors may observe
the atrial septal defect for a period of time
to see if it closes on its own. If a hole
hasn't closed early in childhood, it usually
will never close on its own and requires
surgery to correct.
If child needs surgery, the timing of it
depends on child's condition and whether
child has any other congenital heart
defects.

 Medications
Medications won't cure an atrial
septal defect but may be used to
alleviate some of the signs and
symptoms. Medications may
include those to:
Keep the heartbeat regular.
Examples include beta-blockers
(Lopressor, Inderal) and digoxin
(Lanoxin).

 Increase the strength of the heart's

contractions. Examples include digoxin
(Lanoxin).
Decrease the amount of fluid in circulation.
Doing so reduces the volume of blood that
must be pumped. These medications, called
diuretics, include furosemide (Lasix).
Reduce the risk of blood clots.
Anticoagulants, often called blood thinners,
can help reduce the chances of developing a
blood clot and having a stroke. Anti-coagulants
include warfarin (Coumadin) and anti-platelet
agents such as aspirin.

 Surgery
Many doctors recommend repairing an atrial
septal defect diagnosed during childhood to
prevent complications as an adult. For adults
and children, surgery involves plugging or
patching the abnormal opening between the
atria. Doctors can do this through two
methods:
Open-heart surgery. This type of surgery is
done under general anesthesia and requires
the use of a heart-lung machine. Through an
incision in the chest, surgeons use patches or
stitches to close the hole.
Cardiac catheterization. A thin tube
(catheter) is inserted into a blood vessel in the
groin and guided to the heart. Through the
catheter, a small mesh patch or plug is put into
place to close the hole. The heart tissue grows
around the mesh, permanently sealing the
hole.

 Cardiac catheterization. A thin tube (catheter) is

inserted into a blood vessel in the groin and guided
to the heart. Through the catheter, a small mesh
patch or plug is put into place to close the hole.
The heart tissue grows around the mesh,
permanently sealing the hole.
Follow-up care depends on the type of defect and
whether other defects are present. For simple atrial
septal defects closed during childhood, only
occasional follow-up care is needed. For adults,
follow-up care may depend on any resulting
complications.

THANK YOU VERY MUCH