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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

PATIENTS IDENTITY

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

History Taking
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

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

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