LBM 2

STEP 1

1. Diaphoretic : imcreasing the production of sweat

2. Electrocardiogram : the method to record the activity of heart
3. Murmur : occur because of the blood through the valva and make the turbulence
4. Rubs or gallops : sounds like horse step
5. Normal s1 and s2 : S1 : heart beat when the ventricel first contraction

S2 : heart beat when the ventricel last contraction or relaxation

STEP 2

1. Why the patient feel chest pain radiating to his arm and neck?

2. Why the physical examination found reveals faint crackles at the left base?
3. What is the correlation hyperlipidemia, hypertension and cigarette smoking with the chest
pain?
4. Why the production of sweat is increase?
5. Why the symptomps are accompanied with nausea?
6. What is the correlation between lifestyle and pain?
7. What are the relation about the following vital sign with the symptoms?
8. How is the patophysiology of this scenario?
9. What are the etiology of the scenario?
10. What are the classification chest pain?
11. What are the risk factors of the scenario?
12. What are the interpretation of elevation st v1-v4?
13. How is the treatment of the scenario?
14. What are the dd of the scenario?

STEP 3

1. Why the patient feel chest pain radiating to his arm and neck? Tangan yg kanan atau kiri?
Selain lengan dan leher? Embriologi jantung ?
ST elevation V1-V4 : because of the infark myocard while infark means death of cells in the
heart cells in myocard.
The need of oxygen and nutrient is increase compensation tachycardy glikolisis
anaerob asam laktat diaphoretik
Di otak o2 turun mual muntah
Compensation peningkatan CO vasokontriksi
Cigarette NO as vasodilator NO decrease kaku penyempitan arterosklerosis
Peningkatan CO a. Coronaria arteriosklerosis
From the lactat acid the cardiac muscle took conduct the impuls ending and send to
aferen sensorik ke pusat otak kehidupan embriologi jantung tumbuh dari leher
Saraf pada thoraks dan abdomen punya rangsangan yang sama
Embryology : cor and git in cranial so perjalanan nyeri nya sama
 Asam laktat menekan myocard nervus nyeri
n. intercostal brachialis mempersarafi kulit bagian lengan
nyeri penyebaran impuls saraf jadi di leher juga
2. Why the physical examination found reveals faint crackles at the left base?

3. What is the correlation hyperlipidemia, hypertension and cigarette smoking with the chest
pain?

Hyperlipid and hypertensio is the first manifesklinis

Hypertension beban vaskuler berat hipertrofi ventrikel krn arterosklerosis tdk
menerima sebaik nutrisi
Hipertensi kekakuan arterosklerosis butuh usaha yg lebih utk pacu jantung
Hipertensi jdi faktor resiko angina
Beban jantug berat utk kontraksi keluar ke seluruh tubuh kebutuhan o2 meningkat
dikaitkan proses glikolisis anaerob
NB: hiperlipidemia pembuluh darah arterosklerosis?
Hiperlipidemia : LDL, kolesterol meninkat menumpuk , konsentrasi lemak pekat masuk ke
darah yang encer dan akan menimbun di pembuluh darah
...stress kalau air yang melewati kental di pembuluh darah maka akan rusak gsekan
pembuluh darah cidera dan rusak endotel lipid menumpuk inflamasi undang sel2
inflamator
Tromboembolisme -> trombosit menempel dan jika lepas ke saluran yang lebih kecil dan
memperbruk saluran darah
NB kalau infark belum pasti iskemik ? iskemik sudah pasti infark?
Merokok arterosklerosis penyempitan dinding arteri kandungan nikotin buat
mobilisasi dari katekolamin di tembakau menyebabkan hipersensitifitas dari dinding arteri
4. Why the production of sweat is increase?

5. Why the symptomps are accompanied with nausea?

6. What is the correlation between lifestyle and pain?

7. What are the relation about the following vital sign with the symptoms?

8. How is the patophysiology of this scenario?

9. What are the etiology of the scenario?
The most common chest pain caused by cor is atherosklerosis caused by hypertension
hypercolesterol smoke and spasm emboli,kongenital, aorta insufisiensi(early auscultation
diastolic murmur) dan anemia berat
Hipertiroidisme
Kelainan bawaan jantung koroner
10. What are the classification chest pain?
Klasifikasi pain menurut umum dan berdasarkan lokasi
Umum :
-nyeri inflamasi stimulus nosiseptor
 -nyeri neuroatik
Chest pain angina pectoris : nyeri dada diakibatkan proses iskemik disebabkan infark
miokard
Kalau infark : kematian sel otot
Proses iskemik : tubuh butuh 02 pembuluh darah ggg kompensasi : metabolisme anaerob
Bangun siklus koronarius tdk lewat a. Cronaria infark
NB : a. Coronaria dan cabang2 kalau emboli di cabang x menyebabkan apa iskemik dan
infark smpai di cab x
Ada 3
Angina pectoris stabil : setelah kegiatan berat akan berhenti saat istirahat dan pemberian
nitrat terjadi elevasi ST
Angina pectoris tak stabil : tdk berhenti saat istirahat pemberi nitrat
Angina varians : terjadi elevasi
Angina non cardia : nyeri dada pleuritik bsa di pleura posterior dan lateral nyeri spt ditusuk2
bsa di perikardium bsa di cartilao costae
NB : Nyeri dada yg dari jantung bukan dri a coronaria :
Di katup bocor darah tdk bsa smpai ventrikel
NB : ciri masing2 nyeri dada
NB : kalau infark masih ada nyeri atau tidak?
Infark pasti iskemik , iskemik yg lebih dri 35 -40 detik infark
Mengapa seringnya ventrikel?
Sel2 di ventrikel sinistra lebih tebal
Iskemik sifat reversibel,
Nyeri atau tdk apakah ada saraf aferen nya mati atau tidak
NB : infark msuk klasifikasi chest pain?
11. What are the risk factors of the scenario?
- Age : smakin tua elstisitas kurang
- Gender : wanita punya protein aneksin a1 dibantu estrogen yang akan kurangi p. Darah
- Smoking
- Obesity
- DM
- Stress
- Physical activity
- Lifestyle
- Disturbance of koagulation
12. What are the interpretation of elevation st v1-v4?
13. How is the treatment of the scenario?
14. What are the dd of the scenario?
NB :
1. Aktivitas spt apa aja ? NYHA bedain aktivitas?
2. Pemeriksaan kalau pasien nyeri dada? Indikasi apa? Troponin menandakan apa? Kapan
bisa dilakukan?
3. Terapi sesuai diagnosis

MIND MAP