SOAL KASUS CICU 5 Pasien ThA dirawat di ruang CICU dalam kendisi sesak dengan diagnosa CAD OMI Anteroseptal Decomeordis Kika Fe IV. Pasien mengeluh sesak sejak | minggu dan memberat dalam 3 hari terekhir hingga pesien nyaman tidur dengan 4 bantal ditumpuk untuk mangurangi sesak, dan bengkak pada kedua tungkal yang makin lama makin membeser dalam 3 hari, ryerl dada kiri berlangsung selama 4 jam seperti ditusuk-tusuk dan menembus punggung. Myeri dada tidak hilang walaupun dengan istirahat dan minum obat dibawah lidah. Pemeriksaan fistk didapatkan Kesadaran Compes Mentis, GCS E46ns, pupil bulat isokor RR 34 x/mnt, Saturasi oksigen 99% dengan o2 NG Zlpm, Pasion merasa nyaman dengan posisi setengah duduk. Thoraks: bentuk simatris, gerakan dada simetris, ratraksi supra stemal (-), retraksl inter costa {-), secret (-), ronkhi basah halus di basal paru, wheezing tidak ada, nyeri tekan (-).Akral hangat, CRT = 2 detik, pasien tampak pucat, TD 110/70 meng, HR 110 x/mnt reguler, saturasi oksigen 99%, suhu 37,6 C, JVP 5+4 cm H20, terpasang infuse Nacl 0,9 % SO0Dec/24 jam, dobutamin 6 meg/KgGB/min, Pemeriksaan diagnostic 1, Foto Thorax Klinis : Acute decomp HF Kesan ; Cardiomegali dengan edema paru, efusi pleura bilateral 2. Echocardiography Dilatasi LA, LY systolic disfunction, regional will mation abnormality, EF 26 %. Diastolic disfunction grade II AR mila Reduced RV kontractility 3. 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