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Presentation By
Saidah Mafisah
Supervisor
Dr. Dr. Khalid Saleh, Sp.PD-KKV, FINASIM
NAME : Ms. K
AGE : 21 years old
ADDRESS : Andi Caco Pangkep
MEDICAL RECORD NUM :479121
Vital Status
Blood pressure : 100/70 mmHg
Temperature : 36,5 oC
HEAD AND NECK
• No anemic, no icteric
• No cyanosis
• JVP R+ 1cmH20
LUNG
• Inspection : Symmetry left=right
• Palpation : Mass (-), no tenderness
• Percussion : Sonor
• Auscultation : Vesicular
Rhonchi -/-, wheezing -/-
HEART
• Inspection : Ictus cordis visible linea axillaris anterior sinistra
• Palpation : Ictus cordis palpable linea axillaris anterior sinistra
• Percussion : normal heart size
• Upper border 2nd ICS sinistra
• Right border 4th ICS linea parasternalis dextra
• Left border 5th ICS linea axillaris anterior sinistra
• Auscultation : Heart sound I/II regular, murmur (+) sistolik gr 4/6
LLSB
ABDOMEN
• Inspection : flat, follows breath movement
• Auscultation : peristaltic (+), normal
• Palpation : liver and spleen not palpable
• Percussion : tympani, ascites (-)
EXTREMITIES
• No edema
Heart rate : 87 bpm, reguler
P wave : 0.08’
PR interval : 0.16’
Axis : normoaxis
QRS complex
Duration : 0.08’
ST segment : Normal
T wave : T-inverted di V1
conclusion :
Sinus rhythm , HR 87 bpm, normoaxis
Prominent parahiler
Cardiomegaly (cti 0.54 ) with
left to right shunt
Result Normal Values
Moderate VSD :
- defect ½ of annulus aorta.
Large VSD :
-defect more equal to annulus aorta
At present, a multifactorial etiology
based on an interaction between
hereditary predisposition and
environmental influences is
assumed to cause the defects.
Maternal Genetic risk
factors factors
A family history of a cardiac
Maternal diabetes
or noncardiac defect
Increase RV vol
LV pressure > Left to right
VSD (hipertrophy,dil
RV pressure shunt
atation)
Increase
RV pressure > Pulmonary Increase vessel
pulmonary
LV pressure hipertension resistance
blood flow
cyanosis
Right to left
shunt LV volume
(esenmenger overload
syndrome)
Small defects
• asymptomatic
Magnetic
Echocardiograph resonance
y imaging (MRI)
Additional
Examinatio
n
Cardiac
Electrocardiograph
catheterizati
y (ECG)
on
Observation & follow up
• Small VSDs
Medical management
• Medium sized vsd
• CHF- treat with diuretics, ACEI
• 2-3 months follow up
• RV & PAH pressures assessed
Surgical
• Large vsd
DSV
Anti failure
Aortic valve Infundibular PH Spontaneous Smaller
prolaps stenosis closure
Conservative
Surgical closure/Transcatheter closure
Large VSD with pulmonary hypertension
VSD with aortic regurgitation
VSD with associated defects
Failure of congestive cardiac failure to respond to
medications