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Tatalaksana Nyeri Dada Akibat PJK dr. Hadi Hartono, Sp.JP Fakultas Kedokteran Universitas Wijaya Kusuma Surabaya

Tatalaksana Nyeri Dada Akibat PJK

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

Chest Pain (nyeri dada)
Chest Pain (nyeri dada)
• 5 juta → UGD dengan Chest Pain • 1,2 juta → PJK 2-4% → Pulang
• 5 juta → UGD dengan Chest Pain
• 1,2 juta → PJK
2-4% → Pulang (?)
• Diagnosa salah →
- costly
- dangerous
Differential diagnosis of chest pain System Involved Cardiac Pathology Myocardial Infarction Angina Pectoris Pericarditis Prolapse of
Differential diagnosis of chest pain
System Involved
Cardiac
Pathology
Myocardial Infarction
Angina Pectoris
Pericarditis
Prolapse of the mitral valve
Vascular
Respiratory (all tend to give rise
to pleuritic pain)
Aortic dissection
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 Myocardial Pericarditis Pleuritic Musculoskele Aortic tic ischemia pain
Characteristics of different types of chest pain
Characteris
Myocardial
Pericarditis
Pleuritic
Musculoskele
Aortic
tic
ischemia
pain
Gastrointestin
al pain
tal
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
Anywhere
Central
Can be anywhere
Retrosternal,
anterior
(usually very
interscapular
localized pain)
Radiation
To throat, jaw or
arms
Usually no
Usually no
To throat
Usually no
radiation
radiation
To arms or
around chest to
back
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
ALGORITHM FOR INVESTIGATION OF CHEST PAIN
Test yang harus dilakukan • ECG : ST Elevasi, depressi (50%) • Biomarker : CK-MB, Troponin
Test yang harus dilakukan
• ECG : ST Elevasi, depressi (50%)
• Biomarker : CK-MB, Troponin
Pemeriksaan Lanjutan: • Echo • Treadmill / Exercise test • Radionuclide • Coroner Angiograf
Pemeriksaan Lanjutan:
• Echo
• Treadmill / Exercise test
• Radionuclide
• Coroner Angiograf
BILA + PJK • Stabil Angina • Unstabil Angina •Acut Myocard Infark
BILA + PJK
• Stabil Angina
• Unstabil Angina
•Acut Myocard Infark
Angina Pectoris • Crushing Pain in the Arterian Chest • Radiating to - jaw - left
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%
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,
Management
• Controlled Risk Factor
-
Rokok
-
Hipertensi
-
Diabetes Mellitus
-
Dislipidemia
-
Obesitas, dll
• Drug Terapi
-
Aspirin
-
β Blockers
-
Calcium Channel Blocker
-
Nitrat
•Revascularisasi
-
PTCA
-
Coronary Artery Bypass Grafting
Unstabil Angina • Nyeri meningkat, lelah sering • Istirahat nyeri +
Unstabil Angina
• Nyeri meningkat, lelah sering
• Istirahat nyeri +
Masuk Kategori Acut Coronary Syndrom  ICU  Obat-obat Infark Myocard Nitrat Morphine, Aspirin, Clopidaqued, Heparin
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 +
Acut Myocardial
• 30 menit
• Keluhan ↑
• Kelainan EKG +
• Kelainan Biomarker +
(terjadi kematian cell)
Tatalaksana • ICU, dst • PCI
Tatalaksana
• ICU, dst
• PCI
Terima kasih
Terima kasih