KEMENTERIAN PENDIDIKAN DAN KEBUDAYAAN

UNIVERSITAS SRIWIJAYA
FAKULTAS KEDOKTERAN
PLP. PENDIDIKAN KEDOKTERAN DAN KESEHATAN
Jalan Palembang-Prabumulih, KM 32 Inderalaya Kabupaten Ogan Ilir 30662
Zona F, Telepon (0711) 580227,/Jalan Dr. Moh. Ali Komplek RSMH Palembang 30126
Telpon (0711) 373438 Faksimile (0711) 373438
Laman http://kedokteran@fk.unsri.ac.id

SKENARIO A BLOK 13 TAHUN 2021

Mr. N, 50-year-old, came to Emergency Room with squeezing chest pain and radiated to left shoulder
since 7 hours before, didn’t relieve even after resting. Chest pain emerged when he was about to go to
work, and it was felt more than 20 minutes. It was felt only once and for the first time in his life. VAS
score for the first occuring chest pain was 7/10, with diaphoresis, slight dizziness and palpitation. In ER,
he still felt the chest discomfort with squeezing sensation, with VAS score 3-4/10. He denied coughing,
shortness of breath, syncope, fever or diarrhea. He had hypertension since 10 years ago and he had
stopped smoking since 2 years ago. He didn’t have any history of diabetes, hypercholestrolemia or family
history with heart attack. He never had a regular treatment, the last time he took hypertension medication
was 1 year ago.

Physical Examination
Moderately ill, CM, BH 168 cm, BW 76 kg
BP 177/89 mmHg, HR 89 bpm, RR 20 x/m, SaO2 99%, Temp 36,3 C
Head : Anemic conjunctiva (-), Icteric sclera (-)
Neck : JVP (5-1) cmH20, Lymph node enlargement (-)
Cor : S1-S2 reguler and normal splitting, left cardiac border ICS VI linea axialis anterior sinistra, murmur
/ gallop (-)
Pulmo : Vesiculer (+) normal, rhonki / wheezing (-)
Abdominal : Bowel sound (+) normal, unpalpable liver / spleen, tenderness (-)
Extremity : Warm acral, oedema (-)
ECG (berikan bertahap bila mahasiswa bertanya)

Laboratorium (berikan bertahap bila mahasiswa bertanya)

- Hb 13,7 gr/dl, Ht 40,2%, WBC 12.000/uL, Trombocyte 203.000 /uL, ESR 10 mm/h
- HsTroponin T 75 ng/l, Ureum 18,5 mg/dl, Creatinine, 0,95 mg/dl, eGFR 93 ml/min/1,73m2, GDS
161 mg/dl, Natrium 136 mmol/l, Kalium 3,3 mmol/l, Chlorida 104 mmol/l, Magnesium 2,1
mg/dl, Calcium Total 2,24 mmol/l, CRP 4 mg/l, Rapid Antigen COVID-19 negative
- D-Dimer 220 ug/l, Fibrinogen 102 mg/dl

Rontgen (berikan bertahap bila mahasiswa bertanya)

Emergency Echocardiography (berikan bertahap bila mahasiswa bertanya)

LA Dimension 37 mm, EDD 53 mm, ESD 42 mm, LVMI 131 gr/m2, RWT 0,47
EF 55% (Teich), EF 53% (Simpson), Hipokinetik segmen anteroseptal, segmen lain normokinetik
Efusi Perikard (-), Mild Mitral Regurgitation, katup lain dalam batas normal
PV AccT 130 ms, mPAP 15 mmHg, LVOT VTI 18 cm, MV E/A 1,3, TAPSE 21 mm, IVC 17/12