Tatalaksana Nyeri

Dada Akibat PJK

dr. Hadi Hartono, Sp.JP
Fakultas Kedokteran
Universitas Wijaya Kusuma Surabaya

Chest Pain (nyeri dada)

5 juta

UGD dengan Chest Pain

1,2 juta PJK

2-4% Pulang (?)
Diagnosa salah - dangerous
- costly

Differential diagnosis of chest pain

System Involved

Pathology

Cardiac

Myocardial Infarction
Angina Pectoris
Pericarditis
Prolapse of the mitral valve

Vascular

Aortic dissection

Respiratory (all tend to give rise

to pleuritic pain)

Pulmonary embolus
Pneumonia
Pneumothorax
Pulmonary neoplasm

Gastro Intestinal

Oesophagitis due to gastric reflux

Oesophageal tear
Peptic Ulcer
Biliary disease

Musculoskeletal

Cervical nerve root compression

by cervical disc
Costochondritis
Fractured rib

Neurological

Herpes Zoster

Characteristics of different types of chest pain

Characteris
tic

Myocardial
ischemia

Pericarditis

Pleuritic
pain

Gastrointestin
al pain

Musculoskele
tal

Aortic
Dissection

Quality of pain

Crushing, tight or
bandlike

Sharp (may be
crushing)

Sharp

Burning

Usually sharp
although can be
a dull ache

Sharp,
stabbing,
tearing

Site of pain

Central anterior
chest

Central
anterior

Anywhere
(usually very
localized pain)

Central

Can be anywhere

Retrosternal,
interscapular

Radiation

To throat, jaw or
arms

Usually no
radiation

Usually no
radiation

To throat

To arms or
around chest to
back

Usually no
radiation

Exacerbating &
relieving
factors

Exacerbated by
exertion, anxiety,
cold, relieved by
rest & by gliceryl
trinitrate

Exacerbated
when lying
back; relieved
by sitting
forward

Exacerbated by
breathing,
coughing or
moving; relieid
when breathing
stops

Peptic ulcer pain

often relieved by
food & antacids;
cholecystitis &
oesophageal pain
are exacerbated
by food

Can be
exacerbated by
pressing on chest
wall or moving
neck

Constant with
no
exacerbating
or relieving
factors

Associated
feature

Patient often
sweaty, breathless
& shocked, might
feel nauseated

Fever, recent
viral illness
(e.g. rash,
athralgia)

Cough,
haemoptysis,
breathlessness;
shock with
pulmonary
embolus

Excessive wind

Other affected
joints; patient
otherwise looks
very well

Unequal
radial &
femoral pulse
& blood
pressure;
aortic
regurgitant
murmur may
be heard on
auscultation

ALGORITHM FOR INVESTIGATION OF CHEST PAIN

Test yang harus dilakukan

ECG : ST Elevasi, depressi (50%)
Biomarker : CK-MB, Troponin

Pemeriksaan Lanjutan:
Echo
Treadmill / Exercise test
Radionuclide
Coroner Angiograf

BILA + PJK
Stabil Angina
Unstabil Angina
Acut Myocard Infark

Angina Pectoris
Crushing Pain in the Arterian Chest
Radiating to - jaw
- left arm
Kurang dari 20 menit, hilang timbul

Test yang perlu :

ECG : biasanya normal atau non spesifk
Treadmill test (70% spesiftas/sensitiftas)
MS-CT
Angiograf Koroner

Management
Controlled Risk Factor
- Rokok
- Hipertensi
- Diabetes Mellitus
- Dislipidemia
- Obesitas, dll
Drug Terapi
- Aspirin
- Blockers
- Calcium Channel Blocker
- Nitrat
Revascularisasi
- PTCA
- Coronary Artery Bypass Grafting

Unstabil Angina
Nyeri meningkat, lelah sering
Istirahat nyeri +

Masuk Kategori Acut Coronary Syndrom

ICU

Obat-obat Infark Myocard

Nitrat Morphine, Aspirin, Clopidaqued, Heparin
Angiograf koroner

Acut Myocardial
30 menit
Keluhan
Kelainan EKG +
Kelainan Biomarker +
(terjadi kematian cell)

Tatalaksana
ICU, dst
PCI

Terima kasih