Anamnesis dan Pemeriksaan Fisik

Penyakit Kardiovaskular
Aditya Agita Sembiring
Pendahuluan
 Anamnesis Penyakit
Kardiovaskular
• Nyeri dada
• Sesak napas
• Berdebar/Pingsan
• Past and family history
• Current medication

Camm AJ, Luscher TF, Serruys PW. The ESC Textbook of Cardiovascular Medicine. 2nd ed. Oxford University Press: 2009
 Nyeri dada
• OPQRST: Onset, Position/Provoked by, Quality,
Radiating, Scale of pain, Time
• Differential diagnosis:
• Angina pectoris
• Pericarditis -> sharp pain, worse when moving, gone
when leaning forward
• Pleuritis -> Pleuritic pain, worse when breathing
• Aortic dissection -> Tearing pain in front and back of the
chest, associated with vascular phenomenon
• Esophageal reflux -> worsen after meal, relieved by
gastroprotector
• Costochondritis -> reproducible by palpation

Camm AJ, Luscher TF, Serruys PW. The ESC Textbook of Cardiovascular Medicine. 2nd ed. Oxford University Press: 2009
• Typical angina:
• Substernal discomfort
• Initiated by exertion or stress
• Relieved with rest or sublingual nitroglycerine
• Atypical angina: 2 out of 3
• Non anginal pain: ≤1 out of 3
• Risk Factors:
• Hypertension
• Diabetes
• Smoking
• Dyslipidemia
• Family history

Camm AJ, Luscher TF, Serruys PW. The ESC Textbook of Cardiovascular Medicine. 2nd ed. Oxford University Press: 2009
Camm AJ, Luscher TF, Serruys PW. The ESC Textbook of Cardiovascular Medicine. 2nd ed. Oxford University Press: 2009
• Angina equivalent (mainly in women, elderly, and
diabetes):
• Indigestion
• Belching
• Dyspnea
• Canadian cardiovascular society classification:
• Class I: No limitation on daily activity
• Class II: Slight limitation on daily activity
• Class III: Marked limitation on daily activity
• Class IV: Inability to carry on any physical activity

Camm AJ, Luscher TF, Serruys PW. The ESC Textbook of Cardiovascular Medicine. 2nd ed. Oxford University Press: 2009
 Sesak napas
• Dyspnea: at rest or on effort, since when?
• Orthopnea -> number of pillow the patient used
• Paroxysmal nocturnal dyspnea -> 2-4 jam setelah
tidur
• New York Heart Association Functional
Classification:
• Class I: No limitation on daily activity
• Class II: Slight limitation on daily activity
• Class III: Marked limitation on daily activity
• Class IV: Inability to carry on any physical activity

Camm AJ, Luscher TF, Serruys PW. The ESC Textbook of Cardiovascular Medicine. 2nd ed. Oxford University Press: 2009
Camm AJ, Luscher TF, Serruys PW. The ESC Textbook of Cardiovascular Medicine. 2nd ed. Oxford University Press: 2009
 Palpitation/Syncope
• Awareness of their heart beat
• Flutters, skip, pounding
• History of previous cardiac disease?
• Duration of palpitation? Factors precipitating?
• Pounding sensation in the neck
• syncope: Cardiogenic or neurogenic?

Camm AJ, Luscher TF, Serruys PW. The ESC Textbook of Cardiovascular Medicine. 2nd ed. Oxford University Press: 2009
Camm AJ, Luscher TF, Serruys PW. The ESC Textbook of Cardiovascular Medicine. 2nd ed. Oxford University Press: 2009
 General examination
• General appearance:
• Look how they enter: gait, mobility, dyspnoeic, diaphoresis, in
pain, sense of doom
• Skeletal deformities
• Congenital syndromes
• Mental Status
• Vital Sign:
• BP
• Respiratory : rate and pattern
• Temperature
• Pulse
• Oxymetry
• BMI

Camm AJ, Luscher TF, Serruys PW. The ESC Textbook of Cardiovascular Medicine. 2nd ed. Oxford University Press: 2009
• Skin:
• Pallor -> Blood loss, IE, Hypothyroid, HF
• Central cyanosis -> Shunting, reduced oxygen
• Lower body cyanosis -> PDA
• Rash/ptechiae -> vasculitis, endocarditis, RF
• Ecchymosis -> drug induced
• Scar -> history of surgery
• Malar rash -> SLE
• Bronze discoloration -> hemochromatosis
• Cafe au lait spots -> Leopard, Lamb syndrome (Carney
complex)

Camm AJ, Luscher TF, Serruys PW. The ESC Textbook of Cardiovascular Medicine. 2nd ed. Oxford University Press: 2009
• Head & neck:
• Facial dysmorphism -> Down, Turner, Noonan
• Mitral facies -> rheumatic MS
• Roth spot
• Blue sclera -> Ehler-danlos, osteogenesis imperfecta
• Xantelasma -> hyperlipidemia
• Cushingoid faces

Camm AJ, Luscher TF, Serruys PW. The ESC Textbook of Cardiovascular Medicine. 2nd ed. Oxford University Press: 2009
• Chest and Abdomen:
• Cutaneous collaterals -> obstruction
• Rales -> pulmonary edema
• Pectur: carinatum/excavatum
• Hepatomegaly, ascites -> HF
• Splenomegaly -> IE
• Abdominal bruit
• Abdominal aortic aneurysm

Camm AJ, Luscher TF, Serruys PW. The ESC Textbook of Cardiovascular Medicine. 2nd ed. Oxford University Press: 2009
• Extremities:
• Clubbing finger -> long standing hypoxia, congenital heart
disease
• Splinter hemorrhage, janeway lesion, osler’s node -> IE
• Peripheral cyanosis -> low cardiac output, vasoconstriction
• Tremor -> hyperthyroid, drug
• Capillary pulsation -> AR (Quincke sign)
• Pitting edema -> overloaded status
• Non pitting edema -> hypothyroid, hypoalbumin, renal failure
• Asymmetrical swelling -> DVT
• Varicosities, medial ulcers -> venous disease
• Arachnodactyly -> Marfan
• Muscular atrophy, absent hair -> chronic arterial insufficiency

Camm AJ, Luscher TF, Serruys PW. The ESC Textbook of Cardiovascular Medicine. 2nd ed. Oxford University Press: 2009
Camm AJ, Luscher TF, Serruys PW. The ESC Textbook of Cardiovascular Medicine. 2nd ed. Oxford University Press: 2009
Camm AJ, Luscher TF, Serruys PW. The ESC Textbook of Cardiovascular Medicine. 2nd ed. Oxford University Press: 2009
 Arterial pulse
• Assess:
• Rate
• Rhythm
• Pulse character
• Nature of vessel wall
• Usually from radial pulse
• Both arms (aortic dissection)

Camm AJ, Luscher TF, Serruys PW. The ESC Textbook of Cardiovascular Medicine. 2nd ed. Oxford University Press: 2009
 Pulse Character
• Ususally assessed in central pulse (carotid):
• A: Normal Pulse
• B: Slow rising pulse
• C: Collapsing pulse
• D: Bisferiens pulse

Camm AJ, Luscher TF, Serruys PW. The ESC Textbook of Cardiovascular Medicine. 2nd ed. Oxford University Press: 2009
• Pulsus paradoxus

• Pulsus alternans
• Pulsus bigeminus

Camm AJ, Luscher TF, Serruys PW. The ESC Textbook of Cardiovascular Medicine. 2nd ed. Oxford University Press: 2009
 Venous System
• Jugular Venous
Pressure (JVP)
• Transmission
of the
pulsation from
the internal
jugular vein to
skin surfaces
• RA pressure ≈
estimates
volume status
• Assess level
and character

Camm AJ, Luscher TF, Serruys PW. The ESC Textbook of Cardiovascular Medicine. 2nd ed. Oxford University Press: 2009
• Assess level:
• Positioned at 45o
• Vertical distance
between the top of the
venous pulsation and
the sternal inflection
point, where the
manubrium sterni meets
the sternum (angle of
Louis)
• A distance of >3 cm is
abnormal

Camm AJ, Luscher TF, Serruys PW. The ESC Textbook of Cardiovascular Medicine. 2nd ed. Oxford University Press: 2009
Camm AJ, Luscher TF, Serruys PW. The ESC Textbook of Cardiovascular Medicine. 2nd ed. Oxford University Press: 2009
• Assess Character

a wave: atrial contraction

X descent: atrial
relaxation, RV systole
c wave: transmitted
carotid pulsation
v wave: Passive filling
atrium
y descent : tricuspid valve
opening

Camm AJ, Luscher TF, Serruys PW. The ESC Textbook of Cardiovascular Medicine. 2nd ed. Oxford University Press: 2009
• TR: Prominent v wave
• Constrictive pericarditis: prominent y wave
• AV dissociation: Cannon a wave
• RF infarct/pulmonary embolism: Kussmaul sign
• Heart failure: abdominojugular reflux

Camm AJ, Luscher TF, Serruys PW. The ESC Textbook of Cardiovascular Medicine. 2nd ed. Oxford University Press: 2009
 Cardiac Palpation
• Precordial thrill -> palpable murmur
• Apical impulse -> 5th ICS LMCS
• Abnormality:
• Forceful apex -> concentric LVH
• Displaced to the left -> eccentric LVH
• Left parasternal heave -> RVH

Camm AJ, Luscher TF, Serruys PW. The ESC Textbook of Cardiovascular Medicine. 2nd ed. Oxford University Press: 2009