Morning Report

Friday, September 13th 2019

Randy
Nirsyad
Dervin
Doddy
Deni S
James
Okto
Sarnings
No. Identity Diagnosis
1. Mr. BM/47 years old STEMI Whole Anterior, Inferor, and Right
Ventricular wall Onset 10 hours Killip I Post
Trombolytic
2. Mr. RM/78 years old - NSTEMI High Risk
- Congestive Heart Failure NHYA 3
- Community Acquired Pneumonia curb 65
SCOR 2
- Akut Kidney Injury DD/ Acute on CKD
3. Mrs. JS/52 years old Non ST Elevation Myocard Infarct High Risk
Post op Total Thyroidectomy
4. Mr. HS/77 years old ST Elevation Myocardial Infarction Whole
Anterior Wall Onset > 24 hours Killip 1
5. Mr. AH/50 years old ST Elevation Myocardial Infarction Anteroseptal
Wall Onset > 24 hours Killip 1 Post trombolityc
 1st Patient

Name : Mr. BM
Age : 47 years old
Address : Makassar
MR : 895289
Date of Admission: September 13nd, 2019
DPJP : dr. KS
The patient was referred from Faisal Hospital with
diagnosis STEMI Whole Anterior
 Echocardiography (13/09/2019)
• Preserved LV systolic function, EF 62,7% by TEICH, 58,5% by Biplane
• Dimension of heart chambers : No. chamber dilatation (LVEDd 3,78 cm, LVEDs 2,52 cm, LA Mayor
3,7 cm, LA Minor 2,7 cm, RA Mayor 3,5 cm, RA Minor 2,5 cm, RVDB 2,1 cm, Ao 3,3 cm, LA 3 cm,
LA/Ao 0,9)
• Left Ventricular Hypertrophy: positive concentric (LVMI 116 g/m2, RWT 0,81)
• Myocard movement: Hypokinetic mid anteroseptal, anterior, apikoanterior
• Normal RV systolic function, TAPSE 1,9 cm
• Valves :
o Mitral : Normal Function and Movement
o Aorta : 3 cuspis, Calcificatio (+) at NCC, RCC
o Tricuspid : Normal Function and Movement
o Pulmonal : Normal Function and Movement
• E/A < 1, eRAP 8 mmHg (IVC Exp 1.8 cm, Insp 1.3 cm), LVSV 63 ml, LVOT VTI 18.1 cm, LVCO 5.8
L/min
• SVR 1101: dynes/sec/cm-5
Conclusion
• Preserved LV & RV systolic function, EF 58.5% (Biplane)
• LVH Concentric
• Hypokinetic segmental
• Mild Diastolic Disfunction LV
 2st Patient

Name : Mr. RM
Age : 79 years old
Address : Makassar
MR : 895296
Date of Admission : Sep 13 th, 2019
DPJP : dr. KS
 ECHOCARDIOGRAPHY
• Decreases LV systolic function, EF 51.2 % (Teich) 50.9% (Biplane)
• Chamber dimensions: no dilatation (LVEDd 4.96 cm, LVEDs 3.66 cm, LA mayor 4.3 cm, LA minor 3,3cm,
RA mayor 3.2cm, RA minor 2.9 cm RVDB 2,4cm)
• Hypertrophy LV : positive concentric (LVMI 165 g/m2, RWT 0,43)
• Myocardial Movement : hipokinetic basal mid inferior
• Normal RV systolic function, TAPSE 1.9 cm
• Cardiac Valves :
• Mitral : normal function and movement
• Aorta : 3 cuspis. Calcification (+) NCC.RCC
• Tricuspid : normal function and movement
• Pulmonal : normal function and movement
• E/A < 1
• ERAP 8 mmHg, IVC exp / insp 1.0 cm/0.7 cm

Conclusion:
- Preserved LV and RV systolic function EF 50.9 % (BIPLANE)
- LVH Concentric
- hypokinetic segmental
- Mild Mitral regurgitation
- Mild diastolic dysfunction LV
 3nd Patient

Name : Mrs. JS
Age : 52 years old
Address : Makassar
MR : 895306
Date of Admission : Sep 14th, 2019
DPJP dr. Abdul Hakim
Alkatiri, Sp.JP

The patient was referred from Grestelina Hospital with

diagnosis NSTEMI
 Echocardiography (14/09/2019)
• Preserved LV systolic function, EF 74,8% by Biplane
• Dimension of heart chambers : No dilatation (LVEDd 3,9 cm, LVEDs 2,4 cm, LA Mayor 5,1 cm, LA
Minor 3,4 cm, RA Mayor 4,4 cm, RA Minor 2,8cm, RVDB 2,5 cm, Ao 3,7 cm, LA 3,3 cm, LA/Ao 0,89)
IVSd 2,4 cm, IVSs 2,57 cm
• Left Ventricular Hypertrophy: concentric (LVMI 184 g/m2, RWT 0,77)
• Myocard movement: global hypokinetic
• Normal RV systolic function, TAPSE 1,7 cm
• Valves :
o Mitral : Good function and movement
o Aorta : 3 cuspis, Calcificatio (-) Good function and movement
o Tricuspid : Good function and movement
o Pulmonal : Good function and movement
• E/A < 1, eRAP 3 mmHg (IVC Exp 1.2 cm, Insp 0. cm),
• LVSV 32 ml, LVCO 2,1 L/min, SVR 3008 dyne/sec/cm5
Conclusion :
• Poor echo window
• Preserved LV systolic function, EF 74.8% (Biplane)
• LVH Concentric
• Diastolic Disfunction LV Grade I
 4nd Patient

Name : Mr. HS
Age : 77 years old
Address : Makassar
MR : 895304
Date of Admission : Sep 13 th, 2019
DPJP : dr. ZD

Patient was reffered from Maros Hospital with

Acute Myocardial Infarction
 History Taking
A 77 y.o man was admitted with Chest pain

It was felt since 2 days before admission, pressed-like sensation, duration more than 20 minutes and
radiating to back, to left shoulder and to the left arm. The pain was not aggravated by activity and not
relieved by rest. The pain was accompanied with diaphoresis and nausea, no vomiting. Pain at PJT was
VAS 5/10. There was no shortness of breath, nor palpitation.

Coronary Risk Factor:

History of hypertension (-)

History of DM (-)

History of smoking (-)

History of cardiovascular disease (-)

From the referred hospital, the patient was given aspilet loading dose 160 mg, clopidogrel loading dose
300 mg
 Physical Examination
• BP: 110/70 mmHg Temp: 36,8°C
• HR: 80 bpm RR : 20x/min,

• Conjunctiva not anemic,sclera not icteric

• JVP R+1 cmH2O
• Vesicular breath sound, No rales nor wheezing
• S1/ S2 reguler, no murmur
• Normal peristaltic, no hepatomegaly, no
splenomegaly
• Extremity: no edema
 ECG (13/09/2019) FAISAL ER
21.30

Sinus Rhytm, HR 105x/min, axis -30o, P wave 0,08 s, PR Interval 0.16 s, QRS duration 0,08, ST
segment elevation on V2-6, II, III, aVF
Conclusion: Sinus rhythm, normoaxis, acute whole anterior wall and inferior myocardial
infarction, possible posterior wall infarction
 Echocardiography (14/09/2019)
• Decreased LV systolic function, EF 36,8% by TEICH, 35,1% by Biplane
• Dimension of Heart Chambers : No dilatation (LVEDd 4,65 cm, LVEDs 3,83cm, LA Mayor 4,9 cm,
LA Minor 3,1 cm, RA Mayor 4,6 cm, RA Minor 3,3 cm, RVDB 2,4 cm, Ao 3,3 cm, LA 3,2 cm, LA/Ao
0,97)
• Left Ventricular Hypertrophy: concentric (LVMI 119 g/m2, RWT 0,56)
• Myocard movement: Hypokinetic basal inferoseptal, akinetik anteroseptal, anterior, anterolateral,
akinetik apicoseptal, apicoanterior, apikolateral.
• Normal RV systolic function, TAPSE 1,9 cm
• Valves :
o Mitral : Good function and movement
o Aorta : 3 cuspis, Calcificatio (+) NCC, RCC
o Tricuspid : Good function and movement
o Pulmonal : Good function and movement
o E/A < 1, eRAP 8 mmHg (IVC Exp 1.2 cm, Insp 0.8 cm)
o LVSV 66 ml, LVCO 5,0 L/min, SVR 1204,8 dynes/sec/cm5
Conclusion :
• Decreased LV systolic function, EF 35.1% (Biplane)
• LVH Concentric
• Hypokinetic and akinetic segmental
• Mild Degree Diastolic Disfunction LV
 5nd Patient

Name : Mr. AH
Age : 50 years old
Address : Makassar
MR : 609831
Date of Admission: September 14nd, 2019
DPJP : dr. ZD
The patient was referred from Maros Hospital with
diagnosis STEMI Anterioseptal
 Echocardiography (14/09/2019)
• Decreased LV systolic function, EF 33,6% by TEICH, 32,9% by Biplane
• Dimension of heart chambers : No. chamber dilatation (LVEDd 3,43 cm, LVEDs 2,9 cm, LA Mayor
5,6 cm, LA Minor 4,0 cm, RA Mayor 4,6 cm, RA Minor 3,0 cm, RVDB 2,4 cm)
• Left Ventricular Hypertrophy: positive concentric (LVMI 118 g/m2, RWT 0,91)
• Myocard movement: Akinetic basal-mid anterior, anteroseptal, hipokinetik anterolateral, apicoseptal,
apicoanterior, apicolateral
• Normal RV systolic function, TAPSE 1,8 cm
• Valves :
o Mitral : Normal Function and Movement
o Aorta : 3 cuspis, Calcificatio (+) RCC
o Tricuspid : Normal Function and Movement
o Pulmonal : Normal Function and Movement
• E/A > 1 (pseudonormal), eRAP 8 mmHg (IVC Exp 2.0 cm, Insp 1.4 cm)
• LVSV 66 ml, LVCO 5,0 I/ml, SVR 1739,2 dynes/sec/cm5
Conclusion :
• Poor echo window
• Decreased LV & RV systolic function, EF 32.9% (Biplane)
• LVH Concentric
• Hypokinetic and akinetic segmental
• Mioderate Diastolic Disfunction LV