Professional Documents
Culture Documents
1 Angina - CDM 2015 Ipd
1 Angina - CDM 2015 Ipd
1 Angina - CDM 2015 Ipd
Pulmonary
Gastrointestinal
Esophageal rupture (Boerhaave), Esophageal tear (MalloryWeiss), Cholecystitis, Pancreatitis, Esophageal spasm, Esophageal
reflux, Peptic ulcer, Biliary colic
Musculoskeletal
Neurologic
Other
Psychologic, Hyperventilation
Chest pain
cardiac
Angina
/ischemic
Non cardiac
Non
Angina
GIT (Gerd, aesophagitis)
Angina
stabil /
Myocarditis
ACS
valvular
Pericarditis
Pulmonal, pleuritis
Neurologic
Psycogenic
Epidemiology
5% of all ED visits CP
Approximately 5 million visits per year
History
Location: Central, left, or right
Associated symptoms: SOB, sweating,
nausea
Timing: Gradual or sudden onset
Provocation: What makes worse or better?
Quality: Visceral vs somatic
Radiation: Back, neck, arm
Severity: Scale of 1-10
Objectives
Establish a differential diagnosis for chest pain
Know what clues to obtain on history to rule-in or
out MI, PE, pneumothorax and aortic dissection
Identify risk factors for MI
Know how to do a focused physical exam, identifying
features that would distinguish between MI, PE,
pneumothorax and aortic dissection.
Identify investigations required in diagnosing MI
Outline management strategy in MI
Kasus
Bapak Sumarno, usia 57 th mengeluh nyeri dada yang hilang
timbul. Nyeri dada dirasakan sejak 1 bulan terakhir. Lama
nyeri kira-kira 5 menit, timbul apabila beraktifitas sedang
seperti jalan cepat atau lari dan saat emosi. Nyeri dada dapat
berkurang dengan istirahat. Bapak Sumarno sudah periksa ke
dokter, dilakukan pemeriksaan elektrokardiografi dan darah.
Oleh dokter disarankan untuk dilakukan pemeriksaan exercise
stress test. Dia seorang penderita hipertensi tidak terkontrol
dan seorang perokok.
Sejak 3 jam terakhir nyeri dada dirasakan semakin memberat
seperti ditindih beban berat dan nyeri tidak hilang meskipun
sudah istirahat, disertai mual dan keringat dingin. Oleh
keluarga segera dibawa ke unit gawat darurat. Pada
pemeriksaan tekanan darah 150/90 mmHg.
Angina
The term angina is from the Latin angere
meaning to strangle.
first described by the English physician William
Heberden in 1768.
Angina pectoris refers to the predictable
occurrence of pain or pressure in the chest or
adjacent areas (jaw, shoulder, arm, back) caused
by myocardial ischemia
Mis - match in the oxygen demandsupply to
the myocardium consequently angina.
Peningkatan kebutuhan
oksigen miokard
Non Kardiak :
- Hipertermi
- Hiperthyroid
- Sympathomimetic toxicity
(penggunaan cocain)
- Hipertensi
- Anxietas
- Fistula arteriovenous
Kardiak
- Kardiomiopathi hipertropi
- Aorta stenosis
- Kardiomiopathi dilatasi
- Takikardia : ventrikular ,
supra ventrikular
Penurunan suplai /
pasokan oksigen
Non kardiak:
- Anemia
- Hipoksemia (pneumonia,
asma bronkhial, PPOK,
hipertensi pulmonal)
- Sympathomimetic toxicity
(penggunaan cocain)
- Hipervskositas
(trombositosis, leukimia,
polisitemia)
Kardiak :
- Stenosis aorta
- Kardiomiopathi hipertropi
Stable Angina
Unstable Angina
Variant Angina
Transient coronary vasospasm that is
associated with a fixed atherosclerotic lesion
(75%)
Pt tends to be younger and in seemingly good
health
Occurs at rest and and associated with
ventrcular dysrhythmias
Nitrates and CCBs are often effective
PTP (dalam %)
Increasing Angina
Physical Examination
Trigerring factors
Electrocardiography
10 Minutes !!!
STEMI
1. ST Elevation with evolution
-
2 mV in V1-V6
2. New LBBB
NON STEMI
ST depression 1 mV
Simetrical T wave inversion > 2 mv
Kasus
Bapak Sumarno, usia 57 th mengeluh nyeri dada yang hilang
timbul. Nyeri dada dirasakan sejak 1 bulan terakhir. Lama
nyeri kira-kira 5 menit, timbul apabila beraktifitas sedang
seperti jalan cepat atau lari dan saat emosi. Nyeri dada dapat
berkurang dengan istirahat. Bapak Sumarno sudah periksa ke
dokter, dilakukan pemeriksaan elektrokardiografi dan darah.
Oleh dokter disarankan untuk dilakukan pemeriksaan exercise
stress test. Dia seorang penderita hipertensi tidak terkontrol
dan seorang perokok.
Sejak 3 jam terakhir nyeri dada dirasakan semakin memberat
seperti ditindih beban berat dan nyeri tidak hilang meskipun
sudah istirahat, disertai mual dan keringat dingin. Oleh
keluarga segera dibawa ke unit gawat darurat. Pada
pemeriksaan tekanan darah 150/90 mmHg.
ECG pertama
ECG kedua