Tatalaksana Nyeri Dada Akibat PJK
Tatalaksana Nyeri Dada Akibat PJKdr. Hadi Hartono, Sp.JPFakultas KedokteranUniversitas Wijaya Kusuma Surabaya Chest Pain (nyeri dada)
5 juta UGD dengan Chest Pain
1,2 juta PJK2-4% Pulang (?)
Diagnosa salah - dangerous- costlyDifferential diagnosis of chest painSystem InvolvedPathologyCardiacMyocardial InfarctionAngina PectorisPericarditisProlapse of the mitral valveVascularAortic dissectionRespiratory (all tend to give rise to pleuritic pain)Pulmonary embolusPneumoniaPneumothoraxPulmonary neoplasmGastro IntestinalOesophagitis due to gastric refluxOesophageal tearPeptic UlcerBiliary diseaseMusculoskeletalCervical nerve root compression by cervical discCostochondritisFractured ribNeurologicalHerpes Zoster
Characteristics of different types of chest painCharacteristicMyocardial ischemiaPericarditisPleuritic painGastrointestinal painMusculoskeletalAortic DissectionQuality of painCrushing, tight or bandlikeSharp (may be crushing)SharpBurningUsually sharp although can be a dull acheSharp, stabbing, tearingSite of painCentral anterior chestCentral anteriorAnywhere (usually very localized pain)CentralCan be anywhereRetrosternal, interscapularRadiationTo throat, jaw or armsUsually no radiationUsually no radiationTo throatTo arms or around chest to backUsually no radiationExacerbating & relieving factorsExacerbated by exertion, anxiety, cold, relieved by rest & by gliceryl trinitrateExacerbated when lying back; relieved by sitting forwardExacerbated by breathing, coughing or moving; relieid when breathing stopsPeptic ulcer pain often relieved by food & antacids; cholecystitis & oesophageal pain are exacerbated by foodCan be exacerbated by pressing on chest wall or moving neckConstant with no exacerbating or relieving factorsAssociated featurePatient often sweaty, breathless & shocked, might feel nauseatedFever, recent viral illness (e.g. rash, athralgia)Cough, haemoptysis, breathlessness;shock with pulmonary embolusExcessive windOther affected joints; patient otherwise looks very wellUnequal radial & femoral pulse & blood pressure; aortic regurgitant murmur may be heard on auscultationALGORITHM FOR INVESTIGATION OF CHEST PAIN
Test yang harus dilakukan ECG : ST Elevasi, depressi (50%)
Biomarker : CK-MB, TroponinPemeriksaan Lanjutan: Echo
Treadmill / Exercise test
Radionuclide
Coroner AngiografiBILA + PJK Stabil Angina
Unstabil Angina
Acut Myocard InfarkAngina Pectoris Crushing Pain in the Arterian Chest
Radiating to - jaw - left arm
Kurang dari 20 menit, hilang timbulTest yang perlu : ECG : biasanya normal atau non spesifik
Treadmill test (70% spesifitas/sensitifitas)
MS-CT
Angiografi KoronerManagement Controlled Risk Factor- Rokok- Hipertensi- Diabetes Mellitus- Dislipidemia- Obesitas, dll Drug Terapi- Aspirin- Blockers- Calcium Channel Blocker- NitratRevascularisasi- PTCA- Coronary Artery Bypass GraftingUnstabil Angina Nyeri meningkat, lelah sering
Istirahat nyeri +Masuk Kategori Acut Coronary Syndrom ICU
Obat-obat Infark Myocard Nitrat Morphine, Aspirin, Clopidaqued, Heparin.
Angiografi koronerAcut Myocardial 30 menit
Keluhan
Kelainan EKG +
Kelainan Biomarker + (terjadi kematian cell) Tatalaksana ICU, dst
PCITerima kasih
