PLENARY DISCUSSION 3.

2nd Week

By. Group 8B

SCENARIO
SCENARIO 2: OH my chest Mr. Angin, 56 years old was rushed to the health center complaining chest feeling squeezed from hours ago. RPS obtained from the left chest feeling squeezed from hour ago, then Tn. Angin was playing tennis. The pain spreads to the neck and followed vomitting. It was the first time such a pain. Mr. Angin previously known hypertension and high cholesterol. From the examination, the doctor get a TD 160/100 mmHg, pulse 100 x , breath 26 x . Not found abnormalities of the heart and lung examination. From the get EKG HR 100 beats / min, there were no signs of ischemia / infarction of the heart. Doctors give oxygen and isosorbid dinitrate sublingual. Doctors explained to Mr..Angin and families to be referred to the department of, because necessary laboratory tests to confirm the diagnosis. In the department of inspection Troponin T and CKMB with increased yields. Then Mr. Angin admitted CVCU, in order to get management of the maximal to avoid complications that may occur. How you explain what happened to Mr. Angin?

TERMINOLOGY
1.

2. 3.

4.

5.

6.

Isosorbit dinitrate Nitrates organic that indicate relaxation of vascular smooth muscle causing dilatation of peripheral arteries and veins. Ischemia State of decreased supply oxygen to the heart. Infarct Total blockage of the heart blood vessels cause of death in the surrounding tissue. Troponin T Protein structural of transverse muscle fibers were found in heart muscle. CKMB (Creatine kinase MB isoenzyme) Increased is the sign of the death of heart muscle. CVCU (Cardio Vascular Care Unit) The room to care the patients with cardiovascular disorder.

PROBLEMS IDENTIFICATION

Why chest of Tn. Angin felt squeezed from hour ago, when he played tennis? What is the relation between age and gender with complaints experienced of Tn. Angin? How the relation of high cholesterol and hypertension with the complaints of the Tn. Angin? Why pain radiated to neck and accompanied by vomiting? What interpretation of physical examination and ECG? Why doctor gave Isosirbat dinitrate sublingual and Oxygen? What is interpretation of CKMB and Troponin T? Normal Value ? What is complications if slowly be managed?

PROBLEMS SOLVING
1.

Playing tennis is a tough activity that increases the heart load, work of heart muscle increases, the oxygen supply needed high on Tn. angin narrow coronary arteries, the blood supply to the heart muscle down, there was anaerobic metabolism, reproduced lactic acid, lactic acid stimulates pain.

2.

Age At the beginning of the birth there is no plaque in blood vessels. 1015 years There is plaque - plaque in blood vessels, but still thin. Age> 40 Plaques and thickened, clinical manifestation arises. Prevalence : Male > Female Women had higher HDL number than men, because estrogen women is higher. If the woman had monopose, it will be 1 : 1 for Man : Woman

PROBLEMS SOLVING
3.

4.

Cholesterol plaques worsen the impact to the blood vessels. Hypertension occurs because of the resistance of blood vessels. In the condition Tn. Angin , many Fasoactive substances work, so it make more worse Tn. Angin hypertension. a. Pain radiating a systemic compensation, pain in the chest due innervated by thoracic I V, which raised the sense of choking, vomiting trigger. b. Vomiting due to anxiety Tn. Angin affects the autonomic nervous give effek Gastro Intestinal

PROBLEMS SOLVING
5.

Interpretation of the physical examination TD 160/100 mmHg is a sign of Hypertension 100x pulse per minute = high Breaths per minute = 26 x reads fast (tachypnea) Heart murmur (-) No cardiac abnormalities. At ECG (-) and an increase in troponin T and CKMB possible non - STEMI. And examination should be repeat. On examination use EKG can detect myocardial scar tissue that has apears.

PROBLEMS SOLVING
6.

Giving oxygen is to increase the concentration of O2 in the blood, and to determine that a heart or lung disorder. Iso sorbit dinitrate is given to relax the blood vessels, give sublingual to quickly dissolve in the blood vessels, itsdose-4mg/hour. Troponin T and CKMB Bookmarks have heart muscle damage. Troponin T is generally not found in the blood, if the rise in 4-6 hours occurred IMA (Infarct Miocard Acute), as well as to follow up the treatment.

7.

PROBLEMS SOLVING
8.

Complications that would arise if the recurrent pain without good treatment. Thrombus and embolus in blood vessels can be loose and embolism can occur in the blood vessels of the brain and it will be get a stroke.

9.

Angina pectoralis non-STEMI, DD unstable angina pectoralis.

SCHEME
Hipertensi Hiperkolesterol Angina (nyeri dada) Prognosis

Nutrisi ISDN Usia Lanjut Iskemik koroner Derajat oklusi Pemeriksaan fisik

Jantung rusak

Infark miokard

Trauma akibat kerusakan vaskuler Troponin T CKMB

SKA

EKG

PJK CVCU

arterosklerosis

LEARNING OBJECTIVES
Student are able to : Classifications, Epidemiology, Etiology, Risk Factor, Pathophysiology, Pathogenesis, Clinical Manifestation, Examination, and Treatment of coronary heart disease. Pathophysiology of artheroskleorsis.

SOURCES

Guyton & Hall.2008.Buku ajar fisiologi kedokteran. Jakarta: Penerbit Buku kedokteran EGC Ismudiati Rilantono et al, Lily. Buku Ajar Kardiologi. 2003. Jakarta:FKUI. Thaler, Malcolm S. satu-satunya buku EKG yanganda perlukan. ed. 5.Jakarta : EGC, 2009.