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UNSTABLE ANGINA PECTORIS

Supervisor :Prof. dr. Peter Kabo Ph.D, Sp.FK, Sp.JP(K), FIHA, FASCC

Department of Cardiology and Vascular Medicine

Faculty of Medicine Hasanuddin University

Makassar

2014

Presented by :

Andi riskayani

C111 09 345

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Name : Mr. AR

Gender : Male

Age : 63 years old

RM : 68-25-19 Date of Admission : October 1st,2014

PATIENT

S IDENTITY

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Chief Complaint : Chest painGuided Anamnesis:

Chest pain felt since 7 hours before admitted to the hospital. It felt

like a heavy-weight pressure at substernal area, passes to the back

and it radiates to the left arm. The duration was about 30 min.Symptoms are triggered by activities and doesnt relieve by resting.

It is usually accompanied by cold sweating. History of chest pain

before (+) about 7 months ago, sometimes feels better after resting.

History of syncope (-). History of shortness of breath (-), paroxysmalnocturnal dispneu (-), ortopneu (-). No nausea and vomit. Epigastric

pain (+), history of epigastric pain (-). Urination and defecation

remains normal.

History Taking

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History of hypertension (+) since 5 years ago,

consuming anti-hypertension drugs, non-adherent.

History of smoking (+) since 20 years ago,

approximately 1 pack for 3 days.

History of DM (-).

History of dyslipidemia unknown.

Family history of cardiovascular disease denied.

Past Illness History

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Risk Factors

ModifiableHypertension

Smoking

Obesity

Non modifiable

Male, 63 years old History of chest pain in

the past

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GENERAL STATE

Moderate illness/overweight/compos mentis

BMI : 26,59 kg/m

2

(obes 1)VITAL SIGN

- Blood pressure : 140/90 mmHg

- Pulse : 72 beats/min

- Breathing : 20 times/min

- Temperature : 36,60C (Axilla)

Clinical Examination

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Head Examination

Eyes : anemia -/-, icterus -/-,

Lip : cyanosis (-)

Neck : JVP R+2 cmH2O (30 degree)

Chest Examination Inspection : symmetric R=L, normochest

Palpation : mass (-), tenderness (-),vocal fremitus right = left

Percussion : sonor left and right Auscultation : breath sound : vesicular

additional sound : ronchi -/-wheezing -/-

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Cardiac Examination

Inspection : IC is not visible

Palpation : IC is not palpable

Percussion : Right heart border in right

parasternal line, left heartborder in left anterior axilla line,

top heart border in left intercostal

II

Auscultation : Regular S1/S2 heart sound,murmur (-)

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Abdominal Examination

Inspection : Flat and follows withbreath movement

Auscultation : Peristaltic sound (+)

Palpation : Liver and spleen not

palpable Percussion : Timpany (+)

Extremities

- Oedema : Pretibial -/-

Dorsum pedis -/-

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ELECTROCARDIOGRAPHY

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ELECTROCARDIOGRAPHY

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LABORATORY FINDINGS

TEST RESULT NORMAL VALUE

WBC 9,5 x 103 /mm3 4,0-10,0 x 103/ mm3

RBC 4,25 x 106 /mm3 4,0-6,0 x 106/ mm3

Hb 14,2 mg/dl 13,0-17,0g/dl

Hct 39,0 % 40,0-54,0 %

GDS 141 mg/dl 140 mg/dl

Ureum 39 mg/dl 10-50 mg/dl

Creatinin 1,0 mg/dl M(

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TEST RESULT NORMAL VALUE

CK 167 U/L L(

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CHEST X-RAY PA

Cardiomegaly, CTI : 0,6

Dilatatio et elongatio

aortae

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WORKING DIAGNOSIS

Unstable Angina Pectoris

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Bed rest

O2 2-4 LPM via Nasal Canule

IVFD NaCl 0,9% 500 cc/24 hrs

Nitrate : ISDNFasorbid 10 mg/8 hr/oral

Fasorbid 5 mg/sublingual Anti-platelet aggregation :

Aspilet 80 mg 1x1

Clopidogrel 75 mg 1x1

Anti-coagulant : Arixtra 2,5mg/24hrs/SC

Anti-Hypertension: Candesartan 16mg/24hrs/oral

Statin: Simvastatin 20 mg (0-0-1)

Anti-anxiety :Alprazolam 0.5 mg (0-0-1)

Laxative:Laxadine syr 0-0-2 cth

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Acute Coronary Syndrome

Unstable Angina Pectoris

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ACUTE CORONARY SYNDROME ?

Spectrum of disease related to myocardial ischemia

ACUTECORONARYSYNDROME

STEMI NSTEMI

UNSTABLEANGINA

PECTORIS

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ACUTE CORONARY SYNDROME

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Pathogenesis of Acute

Coronary Syndromes:The integral role of

platelets

Plaque

Fissure or

Rupture

PlateletAggregation

Platelet

Activation

Platelet

Adhesion

Thrombotic

Occlusion

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Supply DemandImbala

nce

ACUTE CORONARY SYNDROME

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RISK FACTOR

Non-modifiable

Age

Gender

Family History of Heart

Disease

Modifiable

Smoking

Dislipidemia Hypertension

Diabetes mellitus

Lack of exercise

Obesity

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DIAGNOSIS ?

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UNSTABLE ANGINA

Occurring at rest (or withminimal exertion) andusually lasting more than 20minutes (if not interruptedby nitroglycerin)

Being severe and describedas frank pain and of newonset (i.e., within 1 month)

Occurring with a crescendopattern (i.e., more severe,prolonged, or frequent thanpreviously

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EKG LABORATORIUM

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32

Unstable Angina

Therapeutic Goals

Relievingsymptoms

Treatingunderlying

Stabilizeplaque

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THANK YOU