NSTEMI As A Trigger for Acute Heart Failure

First Author pada Abstrak “NSTEMI As A Trigger for Acute Heart Failure”

 

Ditampilkan sebagai Poster Case Report pada The 18^th Annual Progress In Cardiovascular Disease (APICD) 2019

 

NSTEMI As A Trigger for Acute Heart Failure

Akhmad I. Nurudinulloh¹, Cut A. Rahmi²

¹General Practitioner, Sari Asih Sangiang Hospital

²Cardiologist, Sari Asih Sangiang Hospital

Background

Acute Heart Failure (AHF) is a life-threatening medical condition requiring urgent evaluation and treatment. AHF cases are often found even when patients are hospitalized in the ward. Acute myocardial dysfunction (ischemic, infarction) is the most frequent of acute primary cardiac causes of AHF.

Case Illustration

A 41 years old female came to Emergency Department (ED) with NSTEMI Killip 1 onset 6 hours (Troponin 18.70 ug/L), CAD OMI Anterior, and DM type 2 (blood glucose was 533 mg/dL, blood ketone was negative). Patient had a history of hypertension and DM type 2, but had no history of dyslipidemia and smoked. In the ED, patient had stable hemodynamics with a normal blood pressure and no shortness of breath. The patient has never seen a cardiologist before. First day admission in the ward, patient suddenly had worsening of breath. Upon examination, patient had hypertension (140/90 mmHg), rapid respiratory rate (35 times/minute), low oxygen saturation (84%), increased of JVP, and rales in all lung regions. Chest X-Ray showed Kerley B lines, cardiomegaly, and pleural effusion. Electrocardiogram showed ST-depression at the anterolateral wall, kidney function was normal, and echocardiography showed hypokinetic at midbasal anteroseptal and anterolateral, diskinetic at apicoanterior and apicolateral, reduced LV systolic function, diastolic dysfunction grade II, and LVEF 20%. Patient was diagnosed with AHF Killip 3, and received Guideline-Directed Medical Therapy (GDMT). Patient has refused for early invasive strategy. On Day 4 patient had improvement and on day 5 the patient was discharged.

Conclusion

Acute myocardial dysfunction can trigger AHF. The AHF cases can not only be found in emergency department but also when patients are hospitalized in the ward. It is very important to take immediate treatment for AHF due to high mortality rate in this condition.

Keywords: acute heart failure, NSTEMI, acute myocardial dysfunction