Pleno Nyeri Dada Kel 1

PLENARY MEETING OF
GROUP 1
CARDIOVASCULAR SYSTEM
Muhammadiyah Medical School
CHEST PAIN
SCENARIO
• a men old age 55 year come to clinic with sigh
SCENARIO
DIFFICULT WORD
KEY WORD
of chest pain. men complain last 6 months QUESTION
experience of chest pain of substernal have ANATOMY
the character of intermittent and creep to left PATHOLOGY ANATOMY
HISTOLOGY
arm. pain first time happened when doing HISTOPATHOLOGY
activity and downhill when resting. men deny FISIOLOGY
CHEST PAIN
to experience of short napas, queasy, or MECHANISM of PAIN
puking of diaforesis. he have history disease of REFFERED PAIN
and hypertension of dislipidemia. at family CORONER DISFUNCTION
HYPERTNSION & DYSLIPLD

history obtained by his father boldness die RISK FACTOR
because miokard infark at age 56 year. he WORKING DIAG.
SUPORTING EXAM
finish 50 bale smoke year. physical ANGINA PECTORIS
examination obtained by blood pressure 145 / MYOCARD INFARC
95 mmHg. nadi 75 times permenit and other in H.S.H
TREATMENT
DIFFICULT WORDS SCENARIO
DIFFICULT WORD
KEY WORD
• Chest pain of substernal QUESTION
ANATOMY
• Intermittent PATHOLOGY ANATOMY
HISTOLOGY
• Dyaforesis HISTOPATHOLOGY
FISIOLOGY
• Dislipidemia CHEST PAIN
MECHANISM of PAIN
REFFERED PAIN
CORONER DISFUNCTION
RISK FACTOR
WORKING DIAG.
SUPORTING EXAM
ANGINA PECTORIS
MYOCARD INFARC
H.S.H
TREATMENT
KEY WORD
• A men 55 year
SCENARIO
DIFFICULT WORD
• Chest pain in bone of substernal have the character KEY WORD
of to creep to left arm since last 6 months. QUESTION
ANATOMY
• Pain first time happened when doing activity and PATHOLOGY ANATOMY
downhill when resting. HISTOLOGY
• Men deny to experience of short breath, queasy, or HISTOPATHOLOGY
FISIOLOGY
puking of diaphoresis. CHEST PAIN
• he have history disease of and hypertension of MECHANISM of PAIN
dislipidemia REFFERED PAIN
CORONER DISFUNCTION
• he finish 50 bale smoke year HYPERTNSION & DYSLIPLD
• physical examination obtained by blood pressure 145 RISK FACTOR
WORKING DIAG.
/ 95 mmHg. nadi 75 times permenit and other in
SUPORTING EXAM
normal boundary. ANGINA PECTORIS
MYOCARD INFARC
H.S.H
TREATMENT
QUESTION
1. How anatomy picture and anatomy pathology with
SCENARIO
DIFFICULT WORD
chest pain at KEY WORD
case? QUESTION
2. How and histologi of histopatologi of chest pain ? ANATOMY
PATHOLOGY ANATOMY
3. How and physiology of patofisiologi of chest pain ? HISTOLOGY
4. Explaining chest pain characteristic at disease of CV HISTOPATHOLOGY
and of FISIOLOGY
non-CV! CHEST PAIN
MECHANISM of PAIN
5. Explaining typical chest pain characteristic and atipikal! REFFERED PAIN
6. Why chest pain in bone felt by substenal, and how CORONER DISFUNCTION
mechanism of HYPERTNSION & DYSLIPLD
creep? RISK FACTOR
7. Why pain in bone arise moment of activiti and WORKING DIAG.
decrease rest SUPORTING EXAM
ANGINA PECTORIS
moment? MYOCARD INFARC
H.S.H
TREATMENT
continue……
SCENARIO
8. How relation hypertension and dislipemia at case? 9. Is DIFFICULT WORD
age factor, and gender habit smoke to relate KEY WORD
to griped sigh! QUESTION
ANATOMY
10. How family history bearing ( father PATHOLOGY ANATOMY
dying age 56 year because Infark Miokard) HISTOLOGY
HISTOPATHOLOGY
at incidence this symptom! FISIOLOGY
11. Explaining etiology of chest pain of CHEST PAIN
MECHANISM of PAIN
case this?
REFFERED PAIN
12. Stages;Steps any kind of used to determine to CORONER DISFUNCTION
be diagnosed? HYPERTNSION & DYSLIPLD
RISK FACTOR
13. Explaining DD of this case! WORKING DIAG.
14. Explaining terapy pursuant to DD ! SUPORTING EXAM
ANGINA PECTORIS
MYOCARD INFARC
H.S.H
TREATMENT
ANATOMY
CHEST PAIN
HISTOLOGY Preclinic
PHYSIOLOGY
SHORT BREATH
BIOCHEMISTRY
QUEASY
DIAPHORESIS
HYPERTENSION
DYSLIPIDEMIA
Angina Pectoris
Myocard Infarc
ANATOMY SCENARIO
DIFFICULT WORD
KEY WORD
QUESTION
ANATOMY
PATHOLOGY ANATOMY
HISTOLOGY
HISTOPATHOLOGY
FISIOLOGY
CHEST PAIN
MECHANISM of PAIN
REFFERED PAIN
CORONER DISFUNCTION
RISK FACTOR
WORKING DIAG.
SUPORTING EXAM
ANGINA PECTORIS
MYOCARD INFARC
H.S.H
TREATMENT
ANATOMY SCENARIO
DIFFICULT WORD
KEY WORD
QUESTION
ANATOMY
PATHOLOGY ANATOMY
HISTOLOGY
HISTOPATHOLOGY
FISIOLOGY
CHEST PAIN
MECHANISM of PAIN
REFFERED PAIN
CORONER DISFUNCTION
RISK FACTOR
WORKING DIAG.
SUPORTING EXAM
ANGINA PECTORIS
MYOCARD INFARC
H.S.H
TREATMENT
ANATOMY SCENARIO
DIFFICULT WORD
KEY WORD
QUESTION
ANATOMY
PATHOLOGY ANATOMY
HISTOLOGY
HISTOPATHOLOGY
FISIOLOGY
CHEST PAIN
MECHANISM of PAIN
REFFERED PAIN
CORONER DISFUNCTION
RISK FACTOR
WORKING DIAG.
SUPORTING EXAM
ANGINA PECTORIS
MYOCARD INFARC
H.S.H
TREATMENT
ANATOMY SCENARIO
DIFFICULT WORD
KEY WORD
QUESTION
ANATOMY
PATHOLOGY ANATOMY
HISTOLOGY
HISTOPATHOLOGY
FISIOLOGY
CHEST PAIN
MECHANISM of PAIN
REFFERED PAIN
CORONER DISFUNCTION
RISK FACTOR
WORKING DIAG.
SUPORTING EXAM
ANGINA PECTORIS
MYOCARD INFARC
H.S.H
TREATMENT
ANATOMY SCENARIO
DIFFICULT WORD
KEY WORD
QUESTION
ANATOMY
PATHOLOGY ANATOMY
HISTOLOGY
HISTOPATHOLOGY
FISIOLOGY
CHEST PAIN
MECHANISM of PAIN
REFFERED PAIN
CORONER DISFUNCTION
RISK FACTOR
WORKING DIAG.
SUPORTING EXAM
ANGINA PECTORIS
MYOCARD INFARC
H.S.H
TREATMENT
ANATOMY SCENARIO
DIFFICULT WORD
KEY WORD
QUESTION
ANATOMY
PATHOLOGY ANATOMY
HISTOLOGY
HISTOPATHOLOGY
FISIOLOGY
CHEST PAIN
MECHANISM of PAIN
REFFERED PAIN
CORONER DISFUNCTION
RISK FACTOR
WORKING DIAG.
SUPORTING EXAM
ANGINA PECTORIS
MYOCARD INFARC
H.S.H
TREATMENT
ANATOMY SCENARIO
DIFFICULT WORD
KEY WORD
QUESTION
ANATOMY
PATHOLOGY ANATOMY
HISTOLOGY
HISTOPATHOLOGY
FISIOLOGY
CHEST PAIN
MECHANISM of PAIN
REFFERED PAIN
CORONER DISFUNCTION
RISK FACTOR
WORKING DIAG.
SUPORTING EXAM
ANGINA PECTORIS
MYOCARD INFARC
H.S.H
TREATMENT
ANATOMY SCENARIO
DIFFICULT WORD
KEY WORD
QUESTION
ANATOMY
PATHOLOGY ANATOMY
HISTOLOGY
HISTOPATHOLOGY
FISIOLOGY
CHEST PAIN
MECHANISM of PAIN
REFFERED PAIN
CORONER DISFUNCTION
RISK FACTOR
WORKING DIAG.
SUPORTING EXAM
ANGINA PECTORIS
MYOCARD INFARC
H.S.H
TREATMENT
PATOLOGY ANATOMY SCENARIO
DIFFICULT WORD
KEY WORD
QUESTION
ANATOMY
PATHOLOGY ANATOMY
HISTOLOGY
HISTOPATHOLOGY
FISIOLOGY
CHEST PAIN
MECHANISM of PAIN
REFFERED PAIN
CORONER DISFUNCTION
RISK FACTOR
WORKING DIAG.
SUPORTING EXAM
ANGINA PECTORIS
MYOCARD INFARC
H.S.H
TREATMENT
DIFFICULT WORD
KEY WORD
QUESTION
ANATOMY
PATHOLOGY ANATOMY
HISTOLOGY
HISTOPATHOLOGY
FISIOLOGY
CHEST PAIN
MECHANISM of PAIN
REFFERED PAIN
CORONER DISFUNCTION
RISK FACTOR
WORKING DIAG.
SUPORTING EXAM
ANGINA PECTORIS
MYOCARD INFARC
H.S.H
TREATMENT
DIFFICULT WORD
KEY WORD
QUESTION
ANATOMY
PATHOLOGY ANATOMY
HISTOLOGY
HISTOPATHOLOGY
FISIOLOGY
CHEST PAIN
MECHANISM of PAIN
REFFERED PAIN
CORONER DISFUNCTION
RISK FACTOR
WORKING DIAG.
SUPORTING EXAM
ANGINA PECTORIS
MYOCARD INFARC
H.S.H
TREATMENT
HISTOLOGY ( Vasculars) SCENARIO
DIFFICULT WORD
KEY WORD
QUESTION
Medium Artery Medium Vein ANATOMY
PATHOLOGY ANATOMY
HISTOLOGY
HISTOPATHOLOGY
FISIOLOGY
CHEST PAIN
MECHANISM of PAIN
REFFERED PAIN
CORONER DISFUNCTION
Intimae Tunica RISK FACTOR
Internal Elastic Tunica WORKING DIAG.
SUPORTING EXAM
Media Tunica ANGINA PECTORIS
Internal Elastic Tunica MYOCARD INFARC
Adventitia Tunica H.S.H
TREATMENT
HISTOLOGY ( Heart Muscle) SCENARIO
DIFFICULT WORD
KEY WORD
Atrium Ventricle QUESTION
ANATOMY
PATHOLOGY ANATOMY
HISTOLOGY
HISTOPATHOLOGY
FISIOLOGY
CHEST PAIN
MECHANISM of PAIN
REFFERED PAIN
CORONER DISFUNCTION
RISK FACTOR
WORKING DIAG.
SUPORTING EXAM
Endothelial & sub endothelial cell
ANGINA PECTORIS
endocardium
MYOCARD INFARC
miocard
H.S.H
epicardium
TREATMENT
HISTOPATOLOGY (aterogenesis) SCENARIO
DIFFICULT WORD
KEY WORD
QUESTION
ANATOMY
PATHOLOGY ANATOMY
HISTOLOGY
HISTOPATHOLOGY
FISIOLOGY
CHEST PAIN
MECHANISM of PAIN
REFFERED PAIN
CORONER DISFUNCTION
RISK FACTOR
WORKING DIAG.
SUPORTING EXAM
ANGINA PECTORIS
MYOCARD INFARC
H.S.H
TREATMENT
HISTOPATOLOGY SCENARIO
DIFFICULT WORD
KEY WORD
QUESTION
ANATOMY
PATHOLOGY ANATOMY
HISTOLOGY
HISTOPATHOLOGY
FISIOLOGY
CHEST PAIN
MECHANISM of PAIN
REFFERED PAIN
CORONER DISFUNCTION
RISK FACTOR
WORKING DIAG.
SUPORTING EXAM
ANGINA PECTORIS
MYOCARD INFARC
Component of Ateromatosa Plaque H.S.H
TREATMENT
HISTOPATOLOGY SCENARIO
DIFFICULT WORD
KEY WORD
QUESTION
ANATOMY
PATHOLOGY ANATOMY
HISTOLOGY
HISTOPATHOLOGY
FISIOLOGY
CHEST PAIN
MECHANISM of PAIN
REFFERED PAIN
CORONER DISFUNCTION
RISK FACTOR
WORKING DIAG.
SUPORTING EXAM
ANGINA PECTORIS
MYOCARD INFARC
H.S.H
TREATMENT
FISIOLOGY SCENARIO
DIFFICULT WORD
KEY WORD
QUESTION
ANATOMY
PATHOLOGY ANATOMY
HISTOLOGY
HISTOPATHOLOGY
FISIOLOGY
CHEST PAIN
MECHANISM of PAIN
REFFERED PAIN
CORONER DISFUNCTION
RISK FACTOR
WORKING DIAG.
SUPORTING EXAM
ANGINA PECTORIS
MYOCARD INFARC
H.S.H
TREATMENT
FISIOLOGY
Sino-Atrial
SCENARIO
DIFFICULT WORD
KEY WORD
NodePacemaker QUESTION
ANATOMY
PATHOLOGY ANATOMY
Internodal Pathway HISTOLOGY
HISTOPATHOLOGY
FISIOLOGY
Atrio-Ventricular CHEST PAIN
Node MECHANISM of PAIN
REFFERED PAIN
CORONER DISFUNCTION
AV Bundles HYPERTNSION & DYSLIPLD
RISK FACTOR
WORKING DIAG.
Bundles branches SUPORTING EXAM
ANGINA PECTORIS
MYOCARD INFARC
Purkinje Cells H.S.H
TREATMENT
FISIOLOGY SCENARIO
DIFFICULT WORD
KEY WORD
Contractility QUESTION
ANATOMY
PATHOLOGY ANATOMY
Preload Afterload HISTOLOGY
HISTOPATHOLOGY
FISIOLOGY
FRE-
Stroke QUENCY
CHEST PAIN
MECHANISM of PAIN
Volume REFFERED PAIN
CORONER DISFUNCTION
RISK FACTOR
WORKING DIAG.
CARDIAC SUPORTING EXAM
ANGINA PECTORIS
OUTPUT MYOCARD INFARC
H.S.H
TREATMENT
CHEST PAIN SCENARIO
DIFFICULT WORD
KEY WORD
QUESTION
ANATOMY
• Feel not comfort in retrosternal,As usual in left PATHOLOGY ANATOMY
chest, behind sternum or little space in left
Tipic side of sternum.
• Feel like strangled, fastened, heavy pressure.
HISTOLOGY
HISTOPATHOLOGY
Occurred in physical activity and lose at rest. FISIOLOGY
CHEST PAIN
MECHANISM of PAIN
REFFERED PAIN
• Chest pain that can make confuse CORONER DISFUNCTION
because the characteristic that appeared HYPERTNSION & DYSLIPLD
not complete and can be categorized as
Atipic atypical chest pain and need more
RISK FACTOR
WORKING DIAG.
examine carefully to be categorized as
angina pectoris. SUPORTING EXAM
ANGINA PECTORIS
MYOCARD INFARC
H.S.H
TREATMENT
CHEST PAIN SCENARIO
DIFFICULT WORD
ANGINA PECTORIS KEY WORD
QUESTION
STABLE NOT STABLE PRINZMETAL
ANATOMY
PATHOLOGY ANATOMY
HISTOLOGY
Occure the change in Angina in rest
HISTOPATHOLOGY
( frequency, illness, time) Nothing relation with
Feel pain in rest activity FISIOLOGY
Occurred in long time and Only some week Generally, having CHEST PAIN
permanent  bad Prognosis aterosklerosis MECHANISM of PAIN
In the first, the pain is  lose little with nitrat Lose with nitrogliserin
great feel and then sublingual REFFERED PAIN
ST segment elevation
decrease intensity step CORONER DISFUNCTION
in EKG examination.
by step
Happen because of HYPERTNSION & DYSLIPLD
Have a spark factor
spasm of RISK FACTOR
Lose in rest
coronary arteria.
Chest pain not longer than WORKING DIAG.
15 minute SUPORTING EXAM
reversible
ANGINA PECTORIS
MYOCARD INFARC
H.S.H
TREATMENT
CHEST PAIN MYOCARD
SCENARIO
DIFFICULT WORD
KEY WORD
INFARC QUESTION
ANATOMY
PATHOLOGY ANATOMY
 Chest pain in sternum HISTOLOGY
 Reffed to left chest or right, jaw, HISTOPATHOLOGY
left shoulder or right or both, FISIOLOGY
arm,epigastrium CHEST PAIN
 Feel like strangled, fastened, MECHANISM of PAIN
heavy pressure. REFFERED PAIN
 occurred nmore than 30 minute
CORONER DISFUNCTION
muncul
 After heavy activity or emotional
RISK FACTOR
extremely.
WORKING DIAG.
 Not lose with nitrat and rest.
SUPORTING EXAM
 anxiety, cold sweat, dyspneu,
ANGINA PECTORIS
neusa.
MYOCARD INFARC
H.S.H
TREATMENT
MECHANISM OF PAIN
Stimulus
SCENARIO
DIFFICULT WORD
Center nerfe in Respon reflek KEY WORD

(mekanik,
brain protektif
termal, kimia)
QUESTION
ANATOMY
PATHOLOGY ANATOMY
HISTOLOGY
output histamin, HISTOPATHOLOGY
bradikinin, Pain FISIOLOGY
kalium perifial nerfe CHEST PAIN
fibrous MECHANISM of PAIN
REFFERED PAIN
CORONER DISFUNCTION
Nosiseptor HYPERTNSION & DYSLIPLD
RISK FACTOR
WORKING DIAG.
SUPORTING EXAM
ANGINA PECTORIS
Impulse nerfe Kornu dorsalis MYOCARD INFARC

medula spinalis H.S.H
TREATMENT
REFERRED PAIN SCENARIO
DIFFICULT WORD
KEY WORD
QUESTION
ANATOMY
PATHOLOGY ANATOMY
HISTOLOGY
HISTOPATHOLOGY
FISIOLOGY
CHEST PAIN
MECHANISM of PAIN
REFFERED PAIN
CORONER DISFUNCTION
RISK FACTOR
WORKING DIAG.
SUPORTING EXAM
ANGINA PECTORIS
MYOCARD INFARC
H.S.H
TREATMENT
CORONER FLOW DYSFUNCTION Risk factor
SCENARIO
DIFFICULT WORD
KEY WORD
QUESTION
ANATOMY
Aktivity→ O2↑ Iskemia Miokardium PATHOLOGY ANATOMY
HISTOLOGY
HISTOPATHOLOGY
FISIOLOGY
Reseptor saraf nyeri CHEST PAIN
↑ heart metabolism
terangsang oleh → MECHANISM of PAIN
REFFERED PAIN
CORONER FLOW
DISFUNCTION
Chest pain Hipoksia, energy↓, HYPERTNSION & DYSLIPLD
asidosis ↑ RISK FACTOR
WORKING DIAG.
SUPORTING EXAM
relactation
ANGINA PECTORIS
MYOCARD INFARC
Gangguan fungsi H.S.H
Chest pain↓ ventrikel kiri TREATMENT
HYPERTENSION AND DYSLIPIDEMIA SCENARIO
DIFFICULT WORD
Definision hypertension is as make up of KEY WORD
blood pressure of sistolik at least QUESTION
ANATOMY
140mmHg and diastolik 90mmHg. PATHOLOGY ANATOMY
HISTOLOGY
Definision dyslipidemia is disparity of HISTOPATHOLOGY
metabolism lipid marked with the FISIOLOGY
CHEST PAIN
improvement or degradation of faction MECHANISM of PAIN
REFFERED PAIN
lipid in blood plasma. CORONER DISFUNCTION
RISK FACTOR
WORKING DIAG.
SUPORTING EXAM
ANGINA PECTORIS
MYOCARD INFARC
H.S.H
TREATMENT
RISK FACTOR SCENARIO
DIFFICULT WORD
KEY WORD
QUESTION
ANATOMY
SMOKING PATHOLOGY ANATOMY
HISTOLOGY
HISTOPATHOLOGY
FISIOLOGY
CHEST PAIN
HEART
MECHANISM of PAIN
GENDER REFFERED PAIN
DISEASE
AGE CORONER DISFUNCTION
RISK FACTOR
??? WORKING DIAG.
SUPORTING EXAM
ANGINA PECTORIS
MYOCARD INFARC
H.S.H
TREATMENT
RISK FACTOR SCENARIO
DIFFICULT WORD
KEY WORD
QUESTION
ANATOMY
PATHOLOGY ANATOMY
HISTOLOGY
HISTOPATHOLOGY
FISIOLOGY
CHEST PAIN
MECHANISM of PAIN
REFFERED PAIN
CORONER DISFUNCTION
RISK FACTOR
WORKING DIAG.
SUPORTING EXAM
ANGINA PECTORIS
MYOCARD INFARC
H.S.H
TREATMENT
RISK FACTOR
History of Family
SCENARIO
DIFFICULT WORD
KEY WORD
Father † because infark miokard QUESTION
ANATOMY
PATHOLOGY ANATOMY
RF: Hypertension
HISTOLOGY
HISTOPATHOLOGY
Hypertension Patient + dislipidemia + cigarette FISIOLOGY
CHEST PAIN
MECHANISM of PAIN
Trouble of at heart REFFERED PAIN
CORONER DISFUNCTION
Annoy in Artery Coronary HYPERTNSION & DYSLIPLD
RISK FACTOR
WORKING DIAG.
CAD SUPORTING EXAM
ANGINA PECTORIS
MYOCARD INFARC
H.S.H
TREATMENT
WORKING DIAGNOSE SCENARIO
DIFFICULT WORD
• Dispneu, cough , hemoptisis KEY WORD
• Chest pain QUESTION
• Synkop ANATOMY
ANAMNESIS • Palpitation PATHOLOGY ANATOMY
HISTOLOGY
• Edema ankle joinMalaise
HISTOPATHOLOGY
• Cyanosis
FISIOLOGY
• Claudicasio
CHEST PAIN
MECHANISM of PAIN
REFFERED PAIN
• Clubbing finger CORONER DISFUNCTION
• Blood Pressure HYPERTNSION & DYSLIPLD
• Cyanosis RISK FACTOR
Physical • Throb of vena jugulars WORKING DIAG.
Examination • Heart Impulse

• Auskultasi: Sound of heart (Sound S1,S2,
SUPORTING EXAM
ANGINA PECTORIS
Additional Sound), systole and diastole MYOCARD INFARC
(murmur ) H.S.H
TREATMENT
SUPPORTING EXAMINATION SCENARIO
DIFFICULT WORD
KEY WORD
QUESTION
ANATOMY
PATHOLOGY ANATOMY
HISTOLOGY
HISTOPATHOLOGY
FISIOLOGY
CHEST PAIN
MECHANISM of PAIN
REFFERED PAIN
CORONER DISFUNCTION
RISK FACTOR
WORKING DIAG.
SUPPORTING EXAM
ANGINA PECTORIS
MYOCARD INFARC
H.S.H
TREATMENT
ANGINA PECTORIS
Definition
SCENARIO
DIFFICULT WORD
KEY WORD
QUESTION
A syndrome clinic in the form of ill attack of typical chest, ANATOMY
that is like depressed or felt by weight in chest which PATHOLOGY ANATOMY
frequently spread to left arm. This matter is ordinary of HISTOLOGY
HISTOPATHOLOGY
arise patient moment do the activity and decrease /
FISIOLOGY
disappearing when rest CHEST PAIN
MECHANISM of PAIN
Etiology REFFERED PAIN
CORONER DISFUNCTION

•Atherosclerosis RISK FACTOR
•Spasm of small channel coroner WORKING DIAG.
•Physical practice SUPORTING EXAM
•Exposure to be chilled ANGINA PECTORIS
MYOCARD INFARC
•Eat the heavy meal H.S.H
•Stress TREATMENT
ANGINA PECTORIS
Epidemiology
SCENARIO
DIFFICULT WORD
KEY WORD
QUESTION
ANATOMY
In English, disease KV kill one from two resident in
PATHOLOGY ANATOMY
population,and cause almost equal to 250 thousand death HISTOLOGY
in the year 1998. 1 from 4 men and 1 from 5 woman die HISTOPATHOLOGY
the years of because PJK. FISIOLOGY
CHEST PAIN
MECHANISM of PAIN
Patofisiology REFFERED PAIN
CORONER DISFUNCTION
Mechanism of incidence of angina pectoris relied on by dont RISK FACTOR
adekuat of oxygen supply to cell myocardium resulted by because WORKING DIAG.
stiff of artery and stricture of lumen of coroner artery ( SUPORTING EXAM
atherosclerosis coroner). what Unknown surely is cause ANGINA PECTORIS
atherosclerosis, clear but that there no single factor is which MYOCARD INFARC
H.S.H
responsibility for growth atherosclerosis. Atherosclerosis
TREATMENT
ANGINA PECTORIS SCENARIO
DIFFICULT WORD
KEY WORD
Time of work load of a network mount, hence oxygen QUESTION
requirement also mount. If requirement mount at healthy ANATOMY
heart hence artery of coroner of have dilatation to and PATHOLOGY ANATOMY
conducting of more amount blood and oxygen to heart HISTOLOGY
muscle. But if coroner artery experience of the stiff or HISTOPATHOLOGY
narrow the effect of atherosclerosis and dilatation cannot as FISIOLOGY
respons to make-up of requirement of oxygen, is hence CHEST PAIN
happened by the iskemic ( insuffiency of blood supply) MECHANISM of PAIN
miocardium. REFFERED PAIN
CORONER DISFUNCTION
Symptom clinic RISK FACTOR
WORKING DIAG.
- Pain in bone Chest SUPORTING EXAM
- Disseminating to jaw of under as well as to left arm ANGINA PECTORIS
MYOCARD INFARC
- Pain usually in area sternal & substernal
H.S.H
- Old of attack (between 1-5 minute). TREATMENT
ANGINA PECTORIS
Dipsneu
SCENARIO
DIFFICULT WORD
 Anxietas KEY WORD
 Sweaty QUESTION
 Awareness Trouble ANATOMY
PATHOLOGY ANATOMY
Complication HISTOLOGY
•Unstable Angina HISTOPATHOLOGY
•Infark Miokard FISIOLOGY
•Aritmia CHEST PAIN
MECHANISM of PAIN
REFFERED PAIN
Prognosis CORONER DISFUNCTION
Wide more and more coroner artery incured or more HYPERTNSION & DYSLIPLD
RISK FACTOR
and more ugly [is] its gagging, hence prognosis more and
WORKING DIAG.
more bad.
SUPORTING EXAM
Good Prognosis found at patient of stable angina ANGINA PECTORIS
and patient ably pump normal (normal muscle ventrikel MYOCARD INFARC
function). Decreasing of it ability pump will make worse H.S.H
prognosis. TREATMENT
ANGINA PECTORIS
Therapy
SCENARIO
DIFFICULT WORD
KEY WORD
QUESTION
 Medicamentosa ANATOMY
PATHOLOGY ANATOMY
• Aspirin HISTOLOGY
• Beta Insulator HISTOPATHOLOGY
• Angiotensin Converting enzyme, especially if/when FISIOLOGY
CHEST PAIN
accompanied by the hypertension or dysfunction LV.
MECHANISM of PAIN
• Nitroglycerine spray the / sublingual to control the angina. REFFERED PAIN
• Antagonis of long-range nitrate or Calcium. CORONER DISFUNCTION
• Klopidogrel for the substitution of aspirin which absolute HYPERTNSION & DYSLIPLD
contra indication. RISK FACTOR
WORKING DIAG.
 Non-medicamentosa SUPORTING EXAM
ANGINA PECTORIS
• Rest which enough Diet Adjustment
MYOCARD INFARC
• Desist the cigarette Degrading BB for the things obes H.S.H
• regular Athletic TREATMENT

MYOCARDIUM INFARC
Definition
SCENARIO
DIFFICULT WORD
KEY WORD
QUESTION
ANATOMY
Miokardium Infark is miokard nekrosis effect of blood stream PATHOLOGY ANATOMY
trouble to heart muscle.The happening of because of flak HISTOLOGY
ruptur which is later, then followed by forming of trombus HISTOPATHOLOGY
by trombosite. FISIOLOGY
CHEST PAIN
MECHANISM of PAIN
Etiology REFFERED PAIN
CORONER DISFUNCTION
RISK FACTOR
Miokard Infark usually because of its process coroner artery WORKING DIAG.
trombus originally early from its it plaque which is later SUPORTING EXAM
then followed by forming of trombus by trombosite. ANGINA PECTORIS
Location and broadness of infark miokard depend on artery MYOCARD INFARC
type which is collateral blood stream and occlusion. H.S.H
TREATMENT
MYOCARDIUM INFARC
Epidemiology
SCENARIO
DIFFICULT WORD
KEY WORD
• Death because acute attack mount along increase age. QUESTION
• Death about 10% age below/under 50 year, 20% above age ANATOMY
PATHOLOGY ANATOMY
50 year
HISTOLOGY
HISTOPATHOLOGY
Patofisiology FISIOLOGY
CHEST PAIN
Damage of miokard which because of coroner occlusion MECHANISM of PAIN
depended from area which is supply by hit vein. Whether REFFERED PAIN
CORONER DISFUNCTION
closed entirely or do not, original factor able to off the cuff
lisis early from oklusif trombus, amount of blood which is RISK FACTOR
supply by collateral small channel to hit network, and level WORKING DIAG.
of requirement of oxygen of miokard which is its sudden SUPORTING EXAM
blood supply become limitedly. ANGINA PECTORIS
MYOCARD INFARC
H.S.H
TREATMENT
MYOCARDIUM INFARC
Clinic symptom
SCENARIO
DIFFICULT WORD
KEY WORD
• felt by Chest pain is area of sternum.
QUESTION
• Menjalar to left and to right, rahang, to left shoulder and right ANATOMY
shoulder, till second spliting arm. PATHOLOGY ANATOMY
• Com under pressure, oppressed, diremas-remas, feel heat or HISTOLOGY
weight. HISTOPATHOLOGY
• Take place about more than half hour Do not lose with rest FISIOLOGY
CHEST PAIN
• old and also do not fully lose with rest MECHANISM of PAIN
• Chest com under pressure like overlaped by heavy object, neck REFFERED PAIN
feel CORONER DISFUNCTION
• choke HYPERTNSION & DYSLIPLD
• Feel pain in bone sometime in area of epigastrikum and can RISK FACTOR
• creed to back WORKING DIAG.
• Feel super pain in bone once so that jumpy SUPORTING EXAM
ANGINA PECTORIS
• patient, fear MYOCARD INFARC
• sweating out and weaken H.S.H
TREATMENT
MYOCARDIUM INFARC
Complication
SCENARIO
DIFFICULT WORD
• Rhythm trouble and conduction KEY WORD
QUESTION
• Kardiogenik Renjatan ANATOMY
• Fail left heart PATHOLOGY ANATOMY
• Fail right ventrikel HISTOLOGY
HISTOPATHOLOGY
• Paru Emboli and of infark paru FISIOLOGY
• systematical Artery Emboli CHEST PAIN
• Venous cork to brain MECHANISM of PAIN
• Heart Ruptur REFFERED PAIN
CORONER DISFUNCTION
• Disfungsi and of ruptur papilaris muskulus HYPERTNSION & DYSLIPLD
RISK FACTOR
Prognosis WORKING DIAG.
SUPORTING EXAM
• Happened aritmia which [is] serious condition ANGINA PECTORIS
• Attack potency of iskemik higher MYOCARD INFARC
H.S.H
• Potency worsening of trouble of hemodinamika farther TREATMENT
HEART SICKNESS OF HYPERTENSION
Definition
SCENARIO
DIFFICULT WORD
KEY WORD
Hypertension is high of blood pressure above is normal. If QUESTION
hypertension [do] not be controlled will cause disparity [at] ANATOMY
heart muscle, kidney, aorta eye and vein PATHOLOGY ANATOMY
HISTOLOGY
HISTOPATHOLOGY
Patofisiology FISIOLOGY
• especial resistor [at] heart sickness of hypertension [is] left CHEST PAIN
MECHANISM of PAIN
ventrikel hipertrofi that happened as direct effect of REFFERED PAIN
improvement in phases prisoner small channel of final CORONER DISFUNCTION
burden and perifer [of] ventrikel HYPERTNSION & DYSLIPLD
• At stadium start of hypertension, hipertrofi that happened RISK FACTOR
at difus ( konsentrik). Ratio a period of/to and final volume WORKING DIAG.
[of] left ventrikel diastolik mount unchanged which mean SUPORTING EXAM
[at] effective pump function [of] left ventrikel ANGINA PECTORIS
• At next stadium because disease continue to continue, MYOCARD INFARC
H.S.H
regular hipertropi becoming not, and eccentric finally,
TREATMENT
Primary factor
SCENARIO
DIFFICULT WORD
KEY WORD
QUESTION
1.Thick [of] coroner arteriol ANATOMY
part of artless muscle hipertrofi [of] vein of arteriol PATHOLOGY ANATOMY
resistensi from head to foot. Later;Then happened salt HISTOLOGY
resistensi and water, resulting decreasing [him/ it] of HISTOPATHOLOGY
complience this small channels and mount prisoner of FISIOLOGY
CHEST PAIN
perifer.
MECHANISM of PAIN
Make Up of hipertrofi resulting decreasing REFFERED PAIN
capillary density him of perunit of heart muscle CORONER DISFUNCTION
if/when arising eccentric hipertrofi. Make Up of HYPERTNSION & DYSLIPLD
RISK FACTOR
diffusion distance among capillary and muscle fibre WORKING DIAG.
which is hipertropi become primary factor at stadium SUPORTING EXAM
continue ANGINA PECTORIS
MYOCARD INFARC
H.S.H
TREATMENT
Clinic symptom
SCENARIO
DIFFICULT WORD
KEY WORD
• Make-Up of blood pressure, palpitating to feel to float ( QUESTION
dizzy) and is impotent ANATOMY
• Weary quickly is, out of breath, chest pain, bloated both PATHOLOGY ANATOMY
HISTOLOGY
stomach and foot/feet.
HISTOPATHOLOGY
• Epistaksis, hematuria, blurry view because blood of retina FISIOLOGY
CHEST PAIN
MECHANISM of PAIN
REFFERED PAIN
CORONER DISFUNCTION
RISK FACTOR
WORKING DIAG.
SUPORTING EXAM
ANGINA PECTORIS
MYOCARD INFARC
H.S.H
TREATMENT
TREATMENT
1. Diuretika
a. Tiazid: bendroflumetiazid (bendrofluazid)= 2.5-10 mg/hari
SCENARIO
DIFFICULT WORD
KEY WORD
b. loop diuretic:furosemid (frusemid)= 20-120 mg/hari. QUESTION
- side effect: caused of hipokalemia, aritmia ventrikel ANATOMY
- KI : pregnant women
PATHOLOGY ANATOMY
HISTOLOGY
2. Vasodilator
- decrease preload HISTOPATHOLOGY
- often used: nitrat (nitrogliserin) FISIOLOGY
- give sublingual way, can be repeated 3-4x with interval CHEST PAIN
5 second MECHANISM of PAIN
- dose : 0.1-0.5 mg REFFERED PAIN

- effect : vasodilatasi vena kapasitan that caused of CORONER DISFUNCTION
preload decrease and decend of left ventricle filling up HYPERTNSION & DYSLIPLD
pressure. RISK FACTOR
- side effect : muka merah, palpitation, ortostatik WORKING DIAG.
hipotention, head pain. SUPORTING EXAM
ANGINA PECTORIS
MYOCARD INFARC
H.S.H
TREATMENT
TREATMENT
3. Vasodilator
SCENARIO
DIFFICULT WORD
- Decrease afterload KEY WORD
QUESTION
- Usefull in acute or chronic heart failure
ANATOMY
- Often used: ACE inhibitor (captropril 6,25mg 3 dd 1), PATHOLOGY ANATOMY
nitrat long acting, prazosin and hidralazin. HISTOLOGY
HISTOPATHOLOGY
4. Inotropik FISIOLOGY
CHEST PAIN
- Strengthen contractility of miocard MECHANISM of PAIN
- preparat : digitalis (0,75-1mg iv/ digoksin oral 0.25mg 2 REFFERED PAIN
dd 1), aminsimpatomimetik (dopamin dan dobutamin, CORONER DISFUNCTION
amrinon) HYPERTNSION & DYSLIPLD
RISK FACTOR
WORKING DIAG.
SUPORTING EXAM
ANGINA PECTORIS
MYOCARD INFARC
H.S.H
TREATMENT
TREATMENT
Functional clasification of heart failure (NYHA)
SCENARIO
DIFFICULT WORD
KEY WORD
• class I: dont have limited in physical activity QUESTION
ANATOMY
PATHOLOGY ANATOMY
• Kelas II: a little limited in activity HISTOLOGY
HISTOPATHOLOGY
* that have been getting heart failure with ejection fraction FISIOLOGY
less or same with 35%. CHEST PAIN
MECHANISM of PAIN
REFFERED PAIN
combination from:
CORONER DISFUNCTION
- diuretik: low and middle dose (furosemide 40-80mg) HYPERTNSION & DYSLIPLD
- digoxin with atrium fibrilation or rytme of sinus RISK FACTOR
- ACE inhibitor: captropril 25-75mg or enalapril 5mg-20mg/hr WORKING DIAG.
- ISDN: step by step from low dose 10-15mg 3x/hr SUPORTING EXAM
ANGINA PECTORIS
MYOCARD INFARC
H.S.H
TREATMENT
TREATMENT
• Kelas III: serious level activity ( comfort at rest and a little
activity can cause the symptom)
SCENARIO
DIFFICULT WORD
KEY WORD
QUESTION
• In inus rytme with eject fraction less of 35% ANATOMY
PATHOLOGY ANATOMY
- diuretik: low-middle dose(furosemide 40-80mg) HISTOLOGY
HISTOPATHOLOGY
- digoxin with atrium fibrilation or sinus rytme
FISIOLOGY
- ACE inhibitor: captropril 25-75mg or enalapril 5mg-20mg/hr CHEST PAIN
-ISDN: step by step from low dose 10-15mg 3x/hr. MECHANISM of PAIN
• class IV: the symptom at rest REFFERED PAIN
CORONER DISFUNCTION
- diuretik HYPERTNSION & DYSLIPLD
- digoxin RISK FACTOR
WORKING DIAG.
- inhibitor ACE
SUPORTING EXAM
ANGINA PECTORIS
• All of that medicines must be titrated step by step. MYOCARD INFARC
H.S.H
TREATMENT
TREATMENT SCENARIO
DIFFICULT WORD
KEY WORD
Non medikamentosa QUESTION
ANATOMY
PATHOLOGY ANATOMY
HISTOLOGY
• Physical activities HISTOPATHOLOGY
FISIOLOGY
• Oxygen treatment CHEST PAIN
MECHANISM of PAIN
• Stop smoking REFFERED PAIN
CORONER DISFUNCTION
• Avoid alcohol HYPERTNSION & DYSLIPLD
RISK FACTOR
• Vaccinaci WORKING DIAG.
SUPORTING EXAM
• Increase nutrition ANGINA PECTORIS
MYOCARD INFARC
H.S.H
TREATMENT
Dwi rasti M.
Budi Pratama
Thank you for the
Vidya R.
Ari a.
Kelompok 7 attention
Ikrimah N.
Ade T.
Intan o.
Chyndhia h.
Faridah
Wassalam Arisyah R.
Rini

Pleno Nyeri Dada Kel 1

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PLENARY MEETING OF

experience of chest pain of substernal have ANATOMY

the character of intermittent and creep to left PATHOLOGY ANATOMY

activity and downhill when resting. men deny FISIOLOGY

puking of diaforesis. he have history disease of REFFERED PAIN

and hypertension of dislipidemia. at family CORONER DISFUNCTION

HYPERTNSION & DYSLIPLD

because miokard infark at age 56 year. he WORKING DIAG.

95 mmHg. nadi 75 times permenit and other in H.S.H

• Chest pain of substernal QUESTION

• Intermittent PATHOLOGY ANATOMY

• Dislipidemia CHEST PAIN

HYPERTNSION & DYSLIPLD

• Chest pain in bone of substernal have the character KEY WORD

of to creep to left arm since last 6 months. QUESTION

downhill when resting. HISTOLOGY

• Men deny to experience of short breath, queasy, or HISTOPATHOLOGY

dislipidemia REFFERED PAIN

• physical examination obtained by blood pressure 145 RISK FACTOR

2. How and histologi of histopatologi of chest pain ? ANATOMY

non-CV! CHEST PAIN

creep? RISK FACTOR

7. Why pain in bone arise moment of activiti and WORKING DIAG.

decrease rest SUPORTING EXAM

age factor, and gender habit smoke to relate KEY WORD

to griped sigh! QUESTION

dying age 56 year because Infark Miokard) HISTOLOGY

11. Explaining etiology of chest pain of CHEST PAIN

be diagnosed? HYPERTNSION & DYSLIPLD

14. Explaining terapy pursuant to DD ! SUPORTING EXAM

HYPERTNSION & DYSLIPLD

HYPERTNSION & DYSLIPLD

HYPERTNSION & DYSLIPLD

HYPERTNSION & DYSLIPLD

HYPERTNSION & DYSLIPLD

HYPERTNSION & DYSLIPLD

HYPERTNSION & DYSLIPLD

HYPERTNSION & DYSLIPLD

HYPERTNSION & DYSLIPLD

HYPERTNSION & DYSLIPLD

HYPERTNSION & DYSLIPLD

HYPERTNSION & DYSLIPLD

Intimae Tunica RISK FACTOR

Internal Elastic Tunica WORKING DIAG.

Adventitia Tunica H.S.H

HYPERTNSION & DYSLIPLD

HYPERTNSION & DYSLIPLD

HYPERTNSION & DYSLIPLD

HYPERTNSION & DYSLIPLD

HYPERTNSION & DYSLIPLD

Node MECHANISM of PAIN

AV Bundles HYPERTNSION & DYSLIPLD

Bundles branches SUPORTING EXAM

Purkinje Cells H.S.H

HYPERTNSION & DYSLIPLD

CARDIAC SUPORTING EXAM

Occurred in physical activity and lose at rest. FISIOLOGY

Center nerfe in Respon reflek KEY WORD

Impulse nerfe Kornu dorsalis MYOCARD INFARC

HYPERTNSION & DYSLIPLD

Aktivity→ O2↑ Iskemia Miokardium PATHOLOGY ANATOMY

asidosis ↑ RISK FACTOR

Definision hypertension is as make up of KEY WORD

blood pressure of sistolik at least QUESTION