Pbl 3 Congenital Heart Disease Group 10

7/24/2019 Pbl 3 Congenital Heart Disease Group 10

1/23

PBL 3 CONGENITAL HEART

DISEASE SCENARIO 3

GROUP 10


2/23

SCENARIO

A ten year old girl o!e" #it$ %ain and "#ellingle&t 'nee(&e)er(%al%itation* T$i" $a" $a%%ened"ine t$ree day" ago* P$y"ial e+a!ination "$o#"yano"i" ,-.(%/l"e 10!in/te reg/lar* Blood

%re""/re 1200 !!Hg* Te!%erat/re 34Celi/"(D5S nor!al* T$ora+ e+a!6 le&t )entrileati)ity inrea"e"* T$rill i" %al%a7le at a%e+* Heartlining i" #iden* P/re $eart "o/nd 1 and 2(nor!al

inten"ity* Sy"toli !/r!/r i" $eard(dia"tole grade2-3 %*! at a%e+* 8e!oral artery i" to/$ed7o/nding* No dr/!"ti' 9nger"* In:a!!atory "ign

at $er le&t 'nee ,;.*


3/23

ORD

10 year" old girl

Pain and "#elling le&t 'nee

8e)er(%al%itation

Cyano"i" ,-. P/l"e 10!in/te

T$ora+ e+a!6le&t )entrile ati)ity inrea"e(t$rill%al%a7le at a%e+($eart lining #iden

Sy"toli !/r!/r i" $eard No dr/!"ti' 9nger

,;. in:a!!ation "ign at le&t 'nee


4/23

?UESTIONS

1* >$y "$e &eel %ain at le&t 'nee@

2* >$y le&t )entrile ati)ity inrea"e@

3* >$y "y"toli !/r!/r i" $eard@

* >$y t$e "#elling and %ain i" not "y!!etry@

* Pat$o!eani"! o& &e!oral artery i" to/$ed 7o/nding

* >$y t$rill i" %al%a7le at a%e+@

* >$at i" t$e %at$o!eani"! o& %ain("#elling and &e)er@

4* >$at i" t$e relation"$i% 7et#een gender and age #it$

"y!%to!"@* >$y doe" "y"toli !/r!/r and dia"tole grade 2-3 %*!

at a%e+ i" $eard@

10*>$y t$ere" no dr/!"ti' 9nger@


5/23

Diferentia

l Diagnosis

Sy!%to!PRHD ENDOCARDI

TIS

5SD

S#elling and %ain 'nee +

10 year" old

8e)er +

Pal%ita"i + +

Ta$yardia +

Cardio!egaly

P5S nor!al +

Le&t 5entrile ati)ity inrea"e + +

T$rill at a%e+ + +

Bi"ing "y"tole dia"tole at a%e+ +

$tt%6"etioada)eri"*#ord%re""*o!arti'el-'edo'terande&e'-"e%t/!-)entri'el-)entri/lar-"e%ta$tt%6%n"*#e7*id%enya'it-endo'arditi"

$tt%67olin03&e7r/ary*#ord%re""*o!20100201r$e/!ati-

$eart-di"ea"e

DI88ERENTIAL DIAGNOSIS


6/23

Introd/tion o& r$e/!atoid $eart

di"ea"e

A/te r$e/!ati &e)er i" an a/te or$roni "y"te!i di"ea"e t$at an$eal it"el&( "o lear( and a/"e

de&et" in $eart )al)e" "lo#ly*R$e/!ati $eart di"ea"e i" a di"ea"et$at o/r" a&ter in&etion o& gro/% A

Stre%too/" 7eta $e!olyti/" "/$a" ton"illiti"( %$aryngiti"( and otiti"!edia*

S!%o"i/! Fa"aala$ De!a! Re/!ati' dan ant/ng Re/!ati' di Indone"ia* La%oranLo'a'arya a'arta* Bagian


7/23

Anato!y and Hi"tology o&

Heart

BASIC SCIENCE


8/23


9/23

Nor!al !itral )al)e $i"tology Pat$ology o& !itral)al)e


10/23

R$e/!at

i HeartDi"ea"eI5-FitralSteno"i"6Pat$ologi

Anato!y


11/23

Nor!al !itral )al)e

Pat$ology o& !itral %/l)e


12/23

Pathomechanism o Pediatric RheumaticHeart Disease

Gro/% A 7eta-$e!olytiStre%tooalin&etion

R$e/!ati&e)er

Body !a'e" it" o#nanti7odie" to 9g$t t$e7aterial in&etion

Anti7odie" reogniJe t$e

"tr/t/re o& ertain %art" o&t$e 7aterial "/r&ae( atta$to it and de"troy it

S/r&ae "tr/t/re

o& ertain 7odyti""/e" "/$ a"$eart )al)e"( !ayre"e!7le %art" o&"tre%tooal7ateria

A/toanti7ody reation

5al)e

de&or!itie"5al)e !ig$t&/"e toget$er

5al)e "teno"i" or 7ot$

"teno"i" andreg/rgitation

$tt%6###*n7i*nl!*ni$*go)%/7!ed143030$tt%6e!ediine*!ed"a%e*o!artile414-o)er)ie#a010

$tt%6yo/r-dotor*o!$ealt$in&oenter!edial-ondition"ardio)a"/larardia-ondition")al)/lar-dJ)al)edJ*$t!l
http://www.ncbi.nlm.nih.gov/pubmed/18306530http://emedicine.medscape.com/article/891897-overviewhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.htmlhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.htmlhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.htmlhttp://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/cardiac-conditions/valvular-dz/valvedz.htmlhttp://emedicine.medscape.com/article/891897-overviewhttp://www.ncbi.nlm.nih.gov/pubmed/18306530


13/23

Sy"toli !/r!/r

A $eart !/r!/r i" a 7lo#ing( #$oo"$ing( or ra"%ing"o/nd $eard d/ring a $eart7eat* T$e "o/nd i" a/"ed

7y ro/g$ 7lood :o# t$ro/g$ t$e $eart )al)e" or neart$e $eart* F/r!/r" an $a%%en &or !any rea"on"("/$ a" #$en a )al)e doe" not lo"e tig$tly and7lood lea'" 7a'#ard #$i$ 7eing alled a"reg/rgitation and #$en 7lood :o#" t$ro/g$ anarro#ed or "tiM $eart )al)e t$at alled "teno"i"*

$tt%6###*nl!*ni$*go)!edline%l/"enyartile0032*$t!
http://www.nlm.nih.gov/medlineplus/ency/article/003266.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003266.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003266.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003266.htm


14/23

Fe$ani"! o& noi"e "y"tole dia"toledegree" 2-3 %! at a%e+@

Ca/"e #$en got t/r7/lene energy*

T/r7/lene energy a/"e" o%%o"ing/rrent" ,eddie". t$at $it t$e #all and

a/"e )i7ration i" $eard a" noi"e e+a!iner* Degree 2 i" a noi"e Tre!endo/" #ea' 7/t

ea"ily $eard( %ro%agation i" li!ited*

Degree 3 i" a noi"e Tre!endo/" lo/deno/g$( not #it$ noi"e %ro%agation("%reading !oderate to e+ten"i)e


15/23

Sign and "y!%to!

symptom

&e)er

At$ralgiaAne!ia

Le'o"ito"i"

Tranta A( Far'o#itJ F*R$e/!ati &e)er* FTP Pre"" L1d*Bo"ton(141

signCarditi"

%olyart$riti"

!igran"'$orea

erite!ia

!arginat/!Nod/l "/7/tan


16/23

EXAMINATIN


17/23

THROAT

CULTURE

RAPID

ANTIGEN

DETECTION

TEST


18/23

TREATMENT


19/23

Treat!ent &or r$e/!ati $eart di"ea"e i" 7a"ed /%on

t$e indi)id/al* A dotor loo'" at a n/!7er o& t$ing" in

order to de9ne t$e treat!ent %lan t$ey #ill %/r"/e &or

t$e %arti/lar %er"on* T$e"e t$ing" inl/de6

T$e %er"on" tolerane &or "%ei9 !ediation"(

%roed/re"( or t$era%ie" T$e %er"on" e+%etation" &or t$e o/r"e o& t$e

di"ea"e

T$e %er"on" o)erall $ealt$ and !edial $i"tory

T$e %er"on" o%inion or %re&erene

T$e e+tent o& t$e di"ea"e


20/23

MEDI!ATIN Primary prophyla"is #initial course o anti$iotics administered

to eradicate the streptococcal inection% also ser&es as the

'rst course o secondary prophyla"is #pre&ention o recurrent

rheumatic e&er and rheumatic heart disease%(

Anti$iotics such as penicillin) commonly used to treat strep

throat caused $y the streptococcus A $acterial inection* as

+ell as to stop acute rheumatic e&er rom de&eloping(

Reduction o the in,ammation related to rheumatic heart

disease can in&ol&e administration o aspirin( -teroids. or

non)steroidal medications* can also $e used

surgery is necessary in order to either repair or replace heart

&al&es that ha&e $een damaged(


21/23

American Heart Association /rrently reo!!end" t$at %atient"

#it$ r$e/!ati &e)er #it$o/t arditi" reei)e %ro%$ylati anti7ioti"&or year" or /ntil aged 21 year"( #$i$e)er i" longer

Patient" #it$ r$e/!ati &e)er and arditi" 7/t no )al)e di"ea"e "$o/ld

reei)e %ro%$ylati anti7ioti" &or 10 year" or #ell into ad/lt$ood(

#$i$e)er i" longer* 8inally( %atient" #it$ r$e/!ati &e)er #it$ arditi"

and )al)e di"ea"e "$o/ld reei)e anti7ioti" &or at lea"t 10 year" or

/ntil age 0 year"*

Patient" #$o $ad r$e/!ati &e)er #it$o/t )al)e da!age do not need

endoarditi" %ro%$yla+i"* Do not /"e %eniillin( a!%iillin( or a!o+iillin

&or endoarditi" %ro%$yla+i" in %atient" already reei)ing %eniillin &or

"eondary r$e/!ati &e)er %ro%$yla+i" ,relati)e re"i"tane o& PO

"tre%tooi to %eniillin and a!ino%eniillin".


22/23

RE/EREN!E- !itation0 Disa$led 1orld Ne+s #2334)35)36% )

Rheumatic heart disease is a condition in&ol&ingpermanent damage to a persons heart caused $y

rheumatic e&er0 http077+++(disa$led)

+orld(com7health7cardio&ascular7rheumatic)heart)

disease(php8i"992As:9H4;

This National

Heart /oundation o Australia #NH/A% and

the !ardiac -ociety o Australia and Ne+ ?ealand#!-AN?% Diagnosis and management o acute

rheumatic e&er and rheumatic heart disease in

Australia @ an e&idence)$ased re&ie+( 2335


23/23

PROGNOSIS

O/to!e i" related to #$i$ )al)e i"in)ol)ed( "e)erity o& t$e a7nor!ality(t$e %re"ene or a7"ene o&

o!%liation"( t$e %re"ene ora7"ene o& %rior $eart di"ea"e( and#$et$er or not "/rgery i" %er&or!ed*

T$e i!%ortane o& %re)entingre/rrene" o& r$e/!ati &e)er i"e)ident*

$tt%6###*!dg/ideline"*o!r$e/!ati-$eart-di"ea"e-$roni%rogno"i"
http://www.mdguidelines.com/rheumatic-heart-disease-chronic/prognosishttp://www.mdguidelines.com/rheumatic-heart-disease-chronic/prognosishttp://www.mdguidelines.com/rheumatic-heart-disease-chronic/prognosishttp://www.mdguidelines.com/rheumatic-heart-disease-chronic/prognosis

Documents

Pbl 3 Congenital Heart Disease Group 10