Right Heart Failure (RHF) as a rapidly progressive syndrome with systemic congestion in the setting of impaired RV filling and/or decreased RV outflow output. A 28-year-old male patient, a photographer, lived in North Aceh was admitted to the ED of Cut Meutia Hospital. He was admitted with worsening dyspnea since 2 days before, initiated after a periode of fever. He also complained of fatigue, palpitations in ordinary activities and chest pain occasionally. He had history of presyncope and syncope. He denied any history of hypertension, type 2 diabetes, allergies, and active smoking. He had no congenital or family history of heart disease. Physical examination revealed full of conciousness with slightly abnormal vital sign. He had malar rash, dilated jugular vein. The apex of the heart shifts to the axilla anterior line, S1>S2 with systolic murmur (+). ECG showed complete RBBB with RAD and chest x-ray showed cardiomegaly. The transthoracic echocardiogram revealed severe TR (Tricuspid Regurgitation), dilatation of RARV (Right Atrium Right Ventricle), with severe PH (Pulmonary Hypertension). The patient was diagnosed with RHF (Right Heart Failure) caused by primary PH. The patient was placed on intravenous furosemide, spironolacton, digoxin, and sildenafil. Treatment and lifestyle modification were expected to improve the quality of life.

Rheumatic heart disease (RHD) is damage of the heart valves due to acute rheumatic fever (ARF) which results from the body’s autoimmune response to Streptococcus pyogenes (group A Streptococcus bacteria) infection which is a throat infection. Acute rheumatic fever is one of the most important causes of cardiovascular morbidity and mortality in the developing countries. A 25-years-old male patient, domiciled in Alue Dalam, Darul Aman, East Aceh, admitted to emergency department of Cut Mutia hospital, the patient was brought to the hospital by his family at 05.0o pm on January 27th, 2022. Patient referred from Graha Bunda hospital. Patient was admitted to the hospital with complaints shortness of breath. Shortness of breath is felt during activity and worsens at night. Shortness of breath since yesterday. The patient also complained of pounding. The pounding has been felt for five days before arriving at the hospital. The patient also has chest pain, and tired easily. Past medical history such hypertension and diabetes mellitus are denied. Physical examination before treatment was obtained: the patient looked restless, weakness, and akker. Echocardiography examination showed the MR Severe, MS moderate, AR moderate, TR moderate, PH mild, AML calsification, all chamber dilatation, and thrombus LV. The patient was given initial treatment in Cut Mutia General Hospital.

Fistula is an abnormal connection between a channel with another channel (internal fistula), or a channel with the outside through the skin (externa fistula). A male, 48 years old, came to the RSUCM Hospital with complaints of discharge from the wound after a hernia operation on the left hip since 1 month at the SMRS. The liquid comes out in small increments, spontaneously, in lumps the size of corn kernels, blackish brown and sometimes greenish yellow, and smells bad. Surgical scars are often inflamed since 6 months after hernia surgery and have often been constipated since the operation. History of hypertension and diabetes mellitus since 4 years ago, not in control and not taking medication regularly. On physical examination, vital signs revealed hypertension. On physical examination, the status of the left iliac a/rillois was seen, an open wound measuring 1x1.5 cm, smelly discharge (+), felt warm, edema (+), NT (+). On complete blood laboratory examination, found within normal limits. At the time of colonoscopy.