Unstable Angina Pectoris Edit 56403l

Presented by : Muhammad Yunus C11109399 Supervisor : Prof.Dr.dr.Ali Aspar, M, Sp.PD, Sp.JP, FIHA, FAsCC, FINASIM, FICA Department of Cardiology and Vascular Medicine Medical Faculty of Hasanuddin University Makassar 2014

PATIENT’S IDENTITY     

Name : Mrs. K Gender : Female Age : 45 years old RM : 624731 Date of ission : August 12nd, 14

History Taking Chief Complaint : Chest pain Guided Anamnesis: Symptoms felt since 3 hours before itted 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 wasn’t 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

Past Illness History      

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

 Modifiable  Hypertension

Non modifiable  Female 45 years old  History of chest pain 1year ago

Clinical Examination GENERAL STATE Moderate illness/well-nourished/conscious VITAL SIGN - Blood pressure : 130/80 mmHg - Pulse : 108 beats/min - Breathing : 20 times/min -

Temperature : 36,6 degree celcius (Axilla)

Head Examination  Eyes : anemia -/-, icterus -/-, oedema palpebra -/ 

Lip : cyanosis (-) Neck: JVP R+2 cmH2O (30 degree)

Chest Examination  Inspection : symmetric R=L, normochest  Palpation : mass (-), tenderness (-), fremitus right = left  Percussion : sonor left and right  Auscultation : breath sound : vesicular additional sound : ronchi -/-

vocal

wheezing -/-

Cardiac Examination  Inspection : IC is not visible  Palpation : IC is not palpable  Percussion : Right heart border in left parasternal line, left heart border in left midclavicular line  Auscultation : Regular S1/S2 heart sound, murmur (-)

Abdominal Examination  Inspection : Flat and follows

breath

movement  Auscultation : Peristaltic sound (+)  Palpation : Liver and spleen not palpable  Percussion : Timpany (+)

Extremities - Oedema : Pretibial -/-

Dorsum pedis -/-

       

Rhythm : sinus rhytm QRS rate : HR 107 bpm P wave : 0.08 sec PR interval : 0.16 sec QRS complex : 0.08 sec Axis : Normoaxis ST segment : isoelektric Conclusion: Sinus Tachycardi, normoaxis

TEST

RESULT

NORMAL VALUE

WBC

7,7 x 103 /uL

4,0-10,0 x 103 /l

RBC

4,8 x 106 /Ul

4,0-6,0 x 106 /l

Hb

14,1mg/dl

13,0-17,0 g/dl

Hct

40,1 %

40,0-54,0 %

GDS

105 mg/dl

140 mg/dl

Ureum

31 mg/dl

10-50 mg/dl

Creatinin

0,5 mg/dl

M(<1,3);F(<1,1) mg/dl

PLT

321 x 103 /uL

150-500 x 103 /l

TEST

RESULT

NORMAL VALUE

CK

90 U/L

L(<190) P (<167)

Troponin T

0.01

0.05

SGOT

32 mg/dl

<38 U/l

SGPT

53 mg/dl

<41 U/l

Total Cholesterol

342 mg/dl

200 mg/dl

HDL

51 mg/dl

M(>55);F(>65) mg/dl

LDL

157 mg/dl

<130 mg/dl

TG

267 mg/dl

200 mg/dl

Uric Acid

4.3 mg/dl

2,4-5,7 mg/dl

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 1x2 Clopidogrel 75 mg 1x4 Anti-coagulant : Fondaparinux 2,5mg/24hrs/SC Anti-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

Plaque Fissure or Rupture

Platelet Adhesion Platelet Activation Platelet Aggregation Thrombotic Occlusion

Imbala nce

Non-modifiable Non-modifiable Age Age Gender Gender Family History of Hearth Disease Family History of Hearth Disease

Modifiable Modifiable Smoking •Dislipidemia Smoking •Dislipidemia Hypertension •Hypertension Diabetes mellitus •Diabetes mellitus Lack of exercise •Lack of exercise Obesity •Obesity



Prolonged pain (usually >20 mins) – constricting, crushing, squeezing



Usually retrosternal location, radiating to left chest, left arm, can be epigastric



Dyspnea



Diaphoresis



Palpitations



Nausea/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 ECG Yes

No

Lab Yes

No

Unstable Angina Therapeutic Goals

33