Skenario B Blok 10 Tahun 2011

Mr. Yo, 52 years old, comes to MH Hospital because he has been having chest pain since an hour ago at his home while he was watching soccer mtch on TV. The pain was radiated to his back and lower jaw, and it felt like burning . He also complained shortness of breath and nauseous. About 3 months ago he felt pain on his left chest while he was running , then he met his cardiologist and got some medicines. He has no history of hypertension. He is a heavy smoker.

Physical Exam : Dyspnea, Ht : 166 cm, BW : 92 kg, BP : 100/60 mmHg, HR :124 bpm regularly. PR : 124 bpm , regular, unequal. RR : 20x/min . Pallor, diaphoresis, JVP (5+0 ) cmH2O, muffle heart sound, rales (-) , whezzing (-) , liver : not palpable, ankle edema (-)

Laboratory Result : Hemoglobin : 14 g/dl , WBC : 6000/mm , Diff count : 0/2/5/65/22/6 , ESR 20/mm, platelet 200.000/mm. Total cholesterol 320mg%, trigliseride 340 mg %, LDL 192 mg% , HDL 38mg % , blood glucose`158mg % . urine glucose (-). Sediment : no finding. SGOT : 38U/L , SGPT : 43 U/L, Total billirubin 1,0mg/dl. Direct : 0,75mg/dl , Inderect : 0,25mg/dl . CK-NAC :160 U/L , CK-MB : 15 U/L,Troponin I : 0,2 mg/ml.

Additional Exam : Chest X-ray : normal finding ECG : sinus rhytm , normal axis, HR : 124 bpm , regular , normal Q wave , ST elevation in lead V1-V4, ST depression in lead II,III, aVF

Learning Objective 1. Memahami anatomi dan fisiologi jantung dan pembuluh darahnya 2. Memahami patogenesis ahterosklerosis 3. Memahami faktor resiko penyakit jantung koroner

4. Memahami patofisiologi sindrom koroner akut dan penyempitannya 5. Memahami interpretasi hasil pemeriksaan fisik 6. Memahami interpretasi hasil pemeriksaan laboratorium 7. Mengetahui pemeriksaan penunjang diagnostic sindrom koroner akut
8. Memahami kriteria diagnostic sindrom koronar akut 9. Memahami tatalaksana holistik sindrom koroner akut termasuk pencegahan sekunder

10. Memahami komplikasi sindrom koroner akut dan rencana tatalaksananya

1. -

Term Clarification Chest pain Felt like burning Shortness of breath Nauseous Heavy smoker Dyspnea Diaphoresis Muffle heart sound

2.

Problem Identification
a. Mr.Yo, 52 years old, comes to MH Hospital because he has been having chest pain

since an hour at his home while he was watching soccer match on TV. b. The pain was radiated to his back and lower jaw, and it felt like burning. c. He also complained shortness of breath and nauseous. d. About 3 months ago he felt pain on his left chest while he was running, then he met his cardiologist and got some medicine. e. He ies a heay smoker. f. Dyspnea, obese, hypotension. g. Pallor, diaphoresis, JVP (5+0) cmH2O, muffle heart sounds.

h. Total cholesterol 320 mg%, triglyseride 340 mg%, LDL 192 mg%, HDL 38 mg%. i. CK NAC 160 U/L, CK MB 15 U/L, Troponin I: 0,2 mg/ml.

3. -

Problem Analysis Bagaimana anatomi dan fisisologi jantung dan pembuluh darahh koroner? Bagaimana pathogenesis/patofisiologi terjadinya sindrom koroner akut? Apa saja faktor resiko sindrom koroner akut yang terdapat pada pasien ini? Bagaimana karakteristik nyeri pada sindrom koroner akut? Bagaimana interpretasi hasil pemeriksaan fisik pasien ini? Bagaimana interpretasi hasil pemeriksaan laboratorium dan penunjang pada pasien ini? Apa diagnosis banding pasien ini? Apa diagnosis kerja pasien ini? Apa saja komplikasi yang mungkin terjadi pada pasien ini? Bagaimana tatalaksana farmakologi dan non farmakologi pada pasien ini? Bagaimana prognosis pasien ini? Bagaimana pencegah sekunder pasien ini? Bagaimana level kompetensi dokter umum dalam menangani kasus ini?

4.

Hypothesis Mr.Yo, 52 years old, suffered from STEMI antherospetal wall.

5.

Synthesis Risk factors (male, middle age, obese, dislipidemia, prefuse history of chest pain, smoking) disfungsi endhotel atherosclerosis precipitating factr (watch soccer match on TV) coronary plaque rupture thrombosis total coronary occlusion STEMI chest pain, shortness of breath, nausea, pallor, diaphoresis, hypotension, muffle heart sound.