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    RRTM 7 049

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    Fitri
    Ersi Dwi Utami Siregar's curriculum vitae lists her personal details including name, date of birth, address, phone number, and education history. She has presented on the topic of chest pain in the emergency department at a one day symposium on cardiovascular emergencies. Chest pain is one of the most common complaints in the acute care setting and it is important to diagnose potential cardiac causes. The presentation discusses evaluating and diagnosing cardiac and non-cardiac causes of chest pain through history, physical exam, EKG, cardiac enzymes and other tests.

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    RRTM 7 049

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    Fitri
    28 views21 pages
    Ersi Dwi Utami Siregar's curriculum vitae lists her personal details including name, date of birth, address, phone number, and education history. She has presented on the topic of chest pain in the emergency department at a one day symposium on cardiovascular emergencies. Chest pain is one of the most common complaints in the acute care setting and it is important to diagnose potential cardiac causes. The presentation discusses evaluating and diagnosing cardiac and non-cardiac causes of chest pain through history, physical exam, EKG, cardiac enzymes and other tests.

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    Ersi Dwi Utami Siregar's curriculum vitae lists her personal details including name, date of birth, address, phone number, and education history. She has presented on the topic of chest pain in the emergency department at a one day symposium on cardiovascular emergencies. Chest pain is one of the most common complaints in the acute care setting and it is important to diagnose potential cardiac causes. The presentation discusses evaluating and diagnosing cardiac and non-cardiac causes of chest pain through history, physical exam, EKG, cardiac enzymes and other tests.

    Copyright:

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    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    28 views21 pages

    RRTM 7 049

    Uploaded by

    Fitri
    Ersi Dwi Utami Siregar's curriculum vitae lists her personal details including name, date of birth, address, phone number, and education history. She has presented on the topic of chest pain in the emergency department at a one day symposium on cardiovascular emergencies. Chest pain is one of the most common complaints in the acute care setting and it is important to diagnose potential cardiac causes. The presentation discusses evaluating and diagnosing cardiac and non-cardiac causes of chest pain through history, physical exam, EKG, cardiac enzymes and other tests.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 21

    Curiculum Vitae

    • Name : Ersi Dwu Utami Siregar,S.Ked


    • Date of birth : 16th May 1994
    • Home addess : Sidikan, UH V/480, Yogyakarta
    • Phone number : 081393436922
    • Email : ersi.siregar@yahoo.com

    Riwayat Pendidikan
    • SDN 16 P.Sidempuan Sumut
    • SMPN 1 P.Sidempuan Sumut
    • SMAN 1 P.Sidempuan Sumut
    • 2012-2016 FK Universitas
    Muhammasiyah Surakarta
    Overview
    Chest Pain in Emergency Department

    Ersi Dwi Utami Siregar, S.Ked

    One Day Symposium


    Clinical Update Of Cardiovascular Emergency
    Fakultas Kedokteran
    Universitas Muhammadiyah Surakarta
    CHEST PAIN

    Chest pain is one of the most common


    plaints in the acute cure setting.
    Heart disease is the leading cause of
    death in the United States, it is important to
    diagnose a cardiac etiology in patients
    presenting with acute chest pain. In addition,
    non cardiac causes of chest paint may be
    serious.
    KUNJUNGAN DI RUANG RESUSITASI
    UGD RSUP DR SARDJITO

    ACS

    HEART FAIURE
    ARITMIA
    SYOK

    63% kasus Cardiac


    Pelaksanaan
    Anamnesis :
    Rencana, Data Klinis
    Pemantauan Subjektif
    , Edukasi

    Pmx.fisik :
    Komunikasi Data Klinis
    Objektif

    Rencana Perumusan
    (Dx/Tx) Masalah

    Diagnosis
    (Dx/Wdx/Dd
    x
    TYPES OF CHEST PAIN

    Cardiac • ISCHEMIC
    causes • NON-ISCHEMIC

    • Gastroesophageal
    Noncardiac • Pulmonary
    causes • Musculoskeletal
    • Herpes Zoster
    ISCHEMIC
    • Angina
    • Acute Coronary Syndrome
    • Aortic stenosis
    • Hyperthrophic cardiomyopathy
    • Coronary vasospasm

    Non ISCHEMIC
    • Perikarditis
    • Aortic dissection
    • Mitral valve prolapse
    HISTORY

     Onset
     Provocation /palliation
     Quality/quantity
     Region/radiation
     Severity/scale
     Timing/time of onset
    Typical Chest Pain
    Gambaran khas - Levine’sign*.

     Kepalan tangan
    mencekeram didepan
    tulang dada dengan
    ekspresi perasaan
    kesakitan, cemas
    indikasi kuat
    nyeri dada angina
    akibat iskemia
    miokard atau infark
    miokard
    Karasteristik simptom
    Angina pektoris
     Lokasi
    Retrosternal, radiasi ke leher, bahu, lengan,
    mandibula, epigastrium, punggung. Beberapa
    kasus tidak retrosternal.
     Trigger
    Aktifitas fisik, stres emosi, merokok.
     Karakter nyeri.
    Kurang jelas, Rasa tertekan, terjepit, sesak,
    tercekik, tertimpa beban berat , perasaan panas
    atau dingin.
    Radiation Typical Chest
    Pain

     GAMBAR
    Cardiovascular risk factors

    1. HYPERTENSION
    2. CIGARETTE SMOKING
    3. PHYSICAL INACTIVITY
    4. DYSLIPIDEMIA
    5. DIABETES MELLITUS
    6. MICROALBUMINURIA or ESTIMATED GFR<60mL
    7. AGE (Older than 55 for men, 65 for women)
    8. FAMILY HISTORY OF PREMATURE CVD (men
    under age 55 or women under age 65)
    9. OBESITY (BODY MASS INDEX ≥ 30kg/m2

    JNC VII. 2003. The Sevent report of the Joint National Committee on prevention,
    detection, evaluation, and treatment of high blood pressure. Hypertension. 6.
    Gradasi angina pektoris
    CCS*
     I. Aktifitas fisik biasa, jalan, menaiki tangga,
    tidak menimbulkan angina.
     II. Terdapat pembatasan ringan aktifitas fisik.
    Jalan,menaiki tangga dengan cepat, jalan
    atau menaiki tangga setelah makan, pada
    suhu dingin, bila karena stres emosional,
    jalan lebih dari 2 blok  angina
     III. Keterbatasan nyata dari aktifitas fisik
    sehari-hari. Jalan 1-2 blok atau naik > 1
    tangga angina
     IV. Tidak mampu melakukan berbagai aktifitas
    fisik, bahkan angina timbul sewaktu
    istirahat.

    *Braunwald E. Heart Disease A Text Book of Cardiovascular


    Medicine 6th e.2001:30-42.
    Diagnosis
     Diagnosis AP berdasarkan anamnesis
    teliti.

     Adanya FR PJK: HT,


    DM,
    merokok,
    dislipidemia,
    usia,
    Family history.
     kemungkinan nyeri dada ok
    Iskemia miokard.
    Pemeriksaan EKG
     Skrining awal PJK:
    60% pasien nyeri dada EKG normal.
    40-50% kasus iskemia miokard
    (depresi ST horisontal/upsloping).
     EKG normalbelum singkirkan iskemia
     Sebaliknya EKG menyerupai iskemia:LVH,
    kelainan elektrolit ,intoksikasi digitalis.
     EKG menilai stratifikasi resiko pasien
    nyeri dada.
    Test diagnostik
     Cardiac Enzyme (CKMB,Troponin)
     Stress EKG
     Echokardiografi
     Radionuclide imaging dengan Thallium
    Scintigraphy
     Multi Slice CT Scan
     Coronary angiography
    Kausa nyeri dada non kardiak

     Penyakit gastroesofageal ( Refluk


    gastroesofageal, ulkus peptikum, batu
    empedu)
     Penyakit neuromuskular (Cervical disc
    disease, kostochondroitis/sindrome Tietze)
     Pleuritis / pneumonia
     Emboli paru
     Kanker paru
     Herpes Zoster
     Gangguan emosional atau psikiatrik.
    Chest pain

    ST elevation ST depression
    ECG ST segment

    Bio- Troponin Troponin


    chemistry rise / fall normal

    Diagnosis

    STEMI NSTEMI UA
    Adapted from Hamm CW et al. Eur Heart J 2011;32:2999 – 3054, Davies MJ. Heart 2000;83:361–366
    Kesimpulan
     Chest pain: 1) Kardiak
    2) Nonkardiak
     Penting :
    1)Anamnesis Cermat-Cepat
    2) Pemeriksaan fisik
    3) Pemeriksaan penunjang
     ACS:
    1) Angina Pektoris Tidak Stabil
    2) Infark Miokard –Elevasi ST
    3) Infark Miokard –Tanpa Elevasi ST

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