Supervisor : Prof.Dr.dr.Ali Aspar, M, Sp.PD, Sp.JP, FIHA, FAsCC, FINASIM, FICADepartment of Cardiology and Vascular Medicine Medical Faculty of Hasanuddin UniversityMakassar2014Presented by : Muhammad YunusC11109399

Name: Mrs. KGender: FemaleAge: 45 years oldRM: 624731Date of Admission: August 12nd, 14

Chief Complaint : Chest pain Guided Anamnesis:Symptoms felt since 3 hours before admitted to hospital. Symptoms was triggered by activity, it was felt like heavy pressed at epigastric area and it radiates to the left arm. The duration was >20 min. it wasnt relieved by consuming ISDN 5mg/SL and rest. It usually accompanied by cold sweating. History of chest pain before (+) about 1 year ago and in hospitalized. History in angiography and advised to coronary stent. Regular medical treatment history (+).

SoB (-), history of SoB before(-), DoE (-), PND (-), orthopnea (-)History of HT (+), DM (-)Cigarette Smooking (-)Urination and defecation remains normal

History of hypertension (+)History of dyslipidemia (-)History of DM is deniedHistory of smoking (-)Family history of cardiovascular disease (-)History of chest pain (+), 1 year ago, relieved with rest and consuming ISDN 5mg/SL .

Non modifiableFemale 45 years oldHistory of chest pain 1year ago Modifiable Hypertension

GENERAL STATEModerate illness/well-nourished/conscious

VITAL SIGNBlood pressure : 130/80 mmHgPulse: 108 beats/minBreathing: 20 times/minTemperature: 36,6 degree celcius (Axilla)

Head ExaminationEyes: anemia -/-, icterus -/-, oedema palpebra -/-Lip : cyanosis (-)Neck: JVP R+2 cmH2O (30 degree)

Chest ExaminationInspection : symmetric R=L, normochestPalpation : mass (-), tenderness (-), vocal fremitus right = leftPercussion : sonor left and rightAuscultation : breath sound : vesicular additional sound : ronchi -/- wheezing -/-

Cardiac ExaminationInspection: IC is not visiblePalpation : IC is not palpable Percussion: Right heart border in left parasternal line, left heart border in left midclavicular lineAuscultation: Regular S1/S2 heart sound, murmur (-)

Abdominal Examination Inspection: Flat and follows breath movementAuscultation: Peristaltic sound (+)Palpation: Liver and spleen not palpablePercussion: Timpany (+)

Extremities Oedema: Pretibial -/- Dorsum pedis -/-

Rhythm : sinus rhytmQRS rate: HR 107 bpmP wave: 0.08 secPR interval: 0.16 secQRS complex : 0.08 secAxis : NormoaxisST segment : isoelektricConclusion: Sinus Tachycardi, normoaxis

TESTRESULTNORMAL VALUEWBC7,7 x 103 /uL4,0-10,0 x 103 /lRBC 4,8 x 106 /Ul4,0-6,0 x 106 /lHb14,1mg/dl13,0-17,0 g/dlHct40,1 %40,0-54,0 %GDS105 mg/dl140 mg/dlUreum31 mg/dl10-50 mg/dlCreatinin0,5 mg/dlM(

TESTRESULTNORMAL VALUECK90 U/LL(

CHEST X-RAY PA

Unstable Angina Pectoris

Bed rest O2 2-4 LPM via Nasal Canule IVFD NaCl 0,9% 12 dpm Nitrate : ISDN Fasorbid (10mg/cc) 2mg/hr/SP Anti-platelet aggregation : Aspilet 80 mg 1x2Clopidogrel 75 mg 1x4 Anti-coagulant : Fondaparinux 2,5mg/24hrs/SCAnti-Hypertension : Captopril 25mg 1-1-1 Statin : Simvastatin 20mg (0-0-1)Anti-anxiety : Alprazolam 0.5 mg (0-0-1) Laxative: Laxadyne syr 0-0-2

Acute Coronary Syndrome Unstable Angina Pectoris

Spectrum of disease related to myocardial ischemia

PlaqueFissure or Rupture

Non-modifiable

Age

Gender

Family History of Hearth Disease

Modifiable

SmokingDislipidemiaHypertensionDiabetes mellitusLack of exerciseObesity

Prolonged pain (usually >20 mins) constricting, crushing, squeezingUsually retrosternal location, radiating to left chest, left arm, can be epigastricDyspneaDiaphoresisPalpitationsNausea/vomiting

Occurring at rest (or with minimal exertion) and usually lasting more than 20 minutes (if not interrupted by nitroglycerin) Being severe and described as frank pain and of new onset (i.e., within 1 month)Occurring with a crescendo pattern (i.e., more severe, prolonged, or frequent than previously

DIAGNOSIS

*Unstable Angina Therapeutic Goals

*Shortness of breath*Sinus rhythm , HR 75 x/minute, left axis deviation, P wave 0,08s, PR interval 0,12 s, QRS complex 0,08 s, Conclusion: Sinus rhythm,

*Conclusion:Cardiomegaly, CTI 0,55Dilatatio et elongatio aortae

**And divided into*Out from the base of the aorta and devided into***Platelets are recognized to play an integral role in acute coronary syndromes and arterial thrombosis. After plaque fissure or rupture, there is platelet adhesion and activation. This leads to platelet aggregation within the coronary artery, and ultimately partial or complete occlusion of the coronary artery.Understanding myocardial ischemia*Ischemic symptom*Ischemic symptom**Treatment for unstable angina focuses on three goals: Stabilizing any plaques that may have ruptured in order to prevent a heart attack, Relieving symptoms Treating the underlying coronary artery disease (CAD).