raja ingan
DESCRIPTION
m,TRANSCRIPT
CRT-D IMPLANT WORKSHOP
Case 1Name : Mr. Raja InganAge : 65 Years oldSex : Male
Chief Complaint :Worsening dyspnea on exertion.
Medical History : Mr. Raja Ingan Budi, was diagnosed with Chonic heart failure NYHA functional class II, Coronary artery dissease 3 VD, Hypertension stage II, vestibular vertigo, and Dyspepsia. Patient had undergone coronary artery bypass graft surgery in 2006. During the past year, patient had frequent hospital readmissions due to worsening shortness of breath on exertion symptoms.
Current medications are as follows: Ramipril 5 mg (1x1), Letonal (Spironolactone) 25 mg (1x1), Bisoprolol 5 mg (1x1/2), Lasix (Furosemide) 40 mg (1x1), Trizedon ( Trimetazidine) 35 mg (2x1), and Crestor (Rosuvastatin) 5 mg (1x1), aspilet 1x 80 mg.
ECG
ECG
• ECG : Sinus Rhythm• QRS Duration: 120-140 ms
Echocardiography
Echocardiography
• LA, LV Dilation• Global Hypokinetic• Functional MR• Low EF : 27%
Echocardiography
Echocardiography (Dyssynchrony Analysis)
Echocardiography (Dyssynchrony Analysis)
Method Predicting responders Patient
SPWMD >130 ms 160 ms
LVPEI >140 ms
IVMD >65 ms 31 ms
TDI Septal – Lateral LV >60 ms 19 ms
SD of 12 LV TDI >32,5 ms 58,75 ms
Coronary Angiography• LMS : 40% distal stenosis • LAD : 70% multiple stenosis of proximal –
middle LAD, CTO in middle LAD
• LCX : 70% proximal stenosis, 80% middle stenosis
Graft study:• SVG-RCA graft : patent graft/ good• SVG-LCX graft : patent graft/ good• LIMA to LAD graft: patent graft/ good
Conclusion : CAD 3 vessel disease + LM disease with good graft
Current Assessment
1. Chonic heart failure NYHA functional class II2. Coronary artery dissease 3 Vessels Disease
post CABG3. Hypertension stage II4. Vestibular vertigo 5. Dyspepsia
Post CRT-D