REFERAT

“Nyeri Dada”
Disusun oleh
Rakha Munggaran (406171036)
KEPANITERAN KLINIK ILMU PENYAKIT
DALAM
UNIVERSITAS TARUMANAGARA
RSUD CIAWI
PERIODE 30 OKTOBER – 06 JANUARI 2018
Anamesis

• What is the location, quality, and severity of the pain?

• Location (substernal, epigastric); radiation (jaw, arms, back);
• quality (burning, crushing, tearing, stabbing, sharp); and
• severity of pain are features that may suggest a particular diagnosis.
• any recent trauma, fall, or thoracic procedure?
• Fractured ribs, chest wall contusions, excessive physical activity  chest pain
• Are there any factors that are known to precipitate or relieve the
pain?
• Sharp pain  coughing or deep inspiration  pleuritis, pericarditis,
pneumothorax.
• Angina  Activity, acute myocardial infarction  at rest, especially in the
early morning.
• Movement of the arms or trunk  musculoskeletal, pericarditis(trunk).
• esophagitis  exacerbated by recumbency.
• Relief of chest pain with sublingual nitroglycerin  myocardial ischemia,
esophageal spasm and gallbladder colic may also be relieved.
Diferent diagnose of chest pain
• Cardiovascular
• Respiratory
• GI
• Musculoskeletal
• Psyciatric
Cardiovascular
• Stable Angina = reda saat beristirahat . The pain of angina is similar to
that of MI, although it generally lasts less than 20 minutes and is not
nearly as severe. Relief can generally be obtained with sublingual
nitroglycerin.
• Unstabel angina = tetap nyeri saat istirahat
• Acute Mi= severe, crushing, radiate  arms and neck. persists 30
minutes or longer. relieves it with 1 or 2 nitroglycerin tablet.
• Myocarditis = demam, kronik,
• Pericarditis = sharp, but may be dull, sakit saat terlentang, membaik
saat duduk kedepan, nyeri saat batuk, inspirasi.
• Acute aortic dissection  severe pain, may radiate to the back .
history of hypertension, chest trauma.
• Primary pulmonary hypertension pain similar to angina, mild,
syncope or dyspnea.
Respiratroy
• Pulmorany embolism : kaki bengkak, dispnue, nyeri saat bernafas
• Pleuritis : nyeri saat bernafas, demam,
• Pnemothorax: riw Trauma, Suara nafas hilang/melemah pada satu sisi
• Pnemonia : demam, rongki,
GI
• Grantroesophageal reflux Disease: nyeri setelah makan, worse with
recumbency, membaik setelah pemberian antacid, rasa seperti
terbakar, mual muntah, pahit dalam mulut .
• Peptic ulcer disease: nyeri epigastrium, pengunaan NSAID (jamu),
perut kembung. Pain may be either relieved or exacerbated by eating.
Antacids frequently relieve it.
• Cholcystitis: nyeri pada RUQ
• Esophageal spasm. This condition is easily confused with angina
pectoris. conditions may occur together.
Muculoskeletal
• Costochondritis : nyeri saat dilakukan penekanan
• Muscle spasm  aktifitas berat
• Fraktur iga
PEMERIKSAAN FISIK
TTV
• hipotensi  massive MI, cardiac tamponade, tension pneumothorax,
acute massive PE, rupture of a dissecting aneurysm, or gastritis or
peptic ulcer disease with hemorrhage

• Hypertension  any painful condition, acute MI

•
• Tachycardia  sinus tachycardia associated with pain, ventricular
tachycardia cause myocardial ischemia, PE

• Bradycardia  inferior MI, result from either sinus node dysfunction or

atrioventricular heart block
Leher
• Pnemothorax  deviasi trakesa
• Distensi vena jugularis  acute tension pnemotorax, cardiac
tamponade
• Nyeri saat hyperektensi leher  masalah di cervical nerve/tulang
cervical  referred shoulder and chest pain
Dada dan paru
• Nyeri lokal pada dinding dada  contusion, costochondritis, fraktur
iga.
• Pergerakan Asimetris  pnemothorax
• Absent breath sounds dan hipersonor  pnemotroax
• Pnemonia  cracles dan kelainan di stem fremitus
• Pleuritis  friction rub
• Bibasilar cracles , wheezing  bisa muncul dari kompensasi CHF
Jantung
• Pericarditis  friction rub
• Pada MI/ Angina pectoris  sering tidak terdapat kelainan pada
periksaan fisik
• Left ventricular dysfunction  S3 gallop
• Aortic stenosis  murmur
Perut
• Terdapat nyeri pada epigastrium  suspek lambung
• Abdominal pain / discomfort  mesenteric ischemia
Ektremitas
• Pada pasien suspek PE, heart diseae  udem pada ekstremitas
• Pada pasien suspek dissection aorta, pulsasi nadi pada ekstremitas
bawah lebih lemah