Professional Documents
Culture Documents
History
sangat penting
Terus menerus/kadang-kadang
Lamanya
Posisi Tubuh
Pemicu : exercise, emosi, Food,
posture, movement, breathing
Penjalaran
Kwalitas : crushing, burning, stabbing
1.
2.
3.
4.
5.
PJK
Gastric problem
Post Operasi Thorax
Pericarditis
Hipertensi, DM
System Involved
Pathology
Cardiac
Myocardial Infarction
Angina Pectoris
Pericarditis
Prolapse of the mitral valve
Vascular
Aortic dissection
Pulmonary embolus
Pneumonia
Pneumothorax
Pulmonary neoplasm
Gastro Intestinal
Musculoskeletal
Neurological
Herpes Zoster
Inspeksi :
myocardial
dissecting
aorta
pulmonal embolism
Nafas tampak berat
heart failure
Mual, muntah
gastric problem
Batuk
heart failure, pneumonia
Characteris
tic
Myocardial
ischemia
Pericarditis
Pleuritic
pain
Gastrointestin
al pain
Musculoskele
tal
Aortic
Dissection
Quality of pain
Crushing, tight or
bandlike
Sharp (may be
crushing)
Sharp
Burning
Usually sharp
although can be
a dull ache
Sharp,
stabbing,
tearing
Site of pain
Central anterior
chest
Central
anterior
Anywhere
(usually very
localized pain)
Central
Can be anywhere
Retrosternal,
interscapular
Radiation
To throat, jaw or
arms
Usually no
radiation
Usually no
radiation
To throat
To arms or
around chest to
back
Usually no
radiation
Exacerbating &
relieving
factors
Exacerbated by
exertion, anxiety,
cold, relieved by
rest & by gliceryl
trinitrate
Exacerbated
when lying
back; relieved
by sitting
forward
Exacerbated by
breathing,
coughing or
moving; relieid
when breathing
stops
Can be
exacerbated by
pressing on chest
wall or moving
neck
Constant with
no
exacerbating
or relieving
factors
Associated
feature
Patient often
sweaty, breathless
& shocked, might
feel nauseated
Fever, recent
viral illness
(e.g. rash,
athralgia)
Cough,
haemoptysis,
breathlessness;
shock with
pulmonary
embolus
Excessive wind
Other affected
joints; patient
otherwise looks
very well
Unequal
radial &
femoral pulse
& blood
pressure;
aortic
regurgitant
murmur may
be heard on
auscultation
Neck
carotiud waveform
elevated JVP
and waveform
BP
hypotension (shock)
hypertension
different between
extremities
Pulse
arrhythmia (tachy- or
brady- )
difference between
extremities
eyes
xanthelasma
(hypercholesterolaemi
a)
Face
pallor
(anaemia)
cyanosis
Heart
murmur of AR (dissection) or AS
(angina)
pericardial rub
audible murmur of MR (MI)
3rd heart sound (MI & LVF)
right ventricular heave &
loud P2 (pulmonary embolus)
displaced apex beat
Lungs
pleural rub
bronchial breathing
reduced breath
sounds
Abdomen
abdominal tenderness or
guarding
reduced bowel sounds
o
o
o
o
o
DL
Cardiac biomarkers : CKMB, Troponin T
Fungsi Renal
Blood Gas
LFT (liver function tests)
EKG
Thorax Foto
Echocardiography
CT Scan
MRI
Exercise tolerance test
Test
Diagnosis
ECG
CXR
Biochemical
markers
May be normal in first 4 hour after MI, but CKMB, cardiac troponins will then increase
Arterial blood
gases
CT scan
Chest
Chest pain
pain
At
At rest
rest
Worse
Worse on
on
exertion
exertion
Investigate
Investigate for
for angina
angina
pectoris
(i.e.
serial
pectoris (i.e. serial
ECG,
ECG, coronary
coronary
angiogram)
angiogram)
Consider
Consider
pulmonary
pulmonary
embolus
embolus in
in all
all
patients
patients
Not
Not worse
worse
in
in
inspiration
inspiration
Pleurisy
Pleurisy scondary
scondary to
to
pneumonia,pneumoth
pneumonia,pneumoth
orax,
orax, pulmonary
pulmonary
embolus,
embolus, dresslers
dresslers
syndrome
syndrome
Raised
Raised
ST
ST
segment
segment
Consider
Consider
MI
MI
Worse
Worse in
in
inspirati
inspirati
on
on
Central
Central
pain
pain
ST
ST depression
depression
T
T Wave
Wave
inversion
inversion
T
T Wave
Wave
flattening
flattening
Consider
Consider unstable
unstable angina
angina
and
investigate
and investigate further
further
(i.e.
(i.e. serial
serial ECGs,
ECGs, serial
serial
biochemical
markers,
biochemical markers,
excersie,
excersie, coronary
coronary
angiogram
angiogram
Widespread
Widespread
concave
concave ST
ST
elevation
elevation
Pericarditi
Pericarditi
s
s
Musculoskele
Musculoskele
tal
tal
oesophagitis
oesophagitis
Lateral
Lateral
Musculoskele
Musculoskele
tal
tal shingles
shingles
(herpes
(herpes
zoster)
zoster)
Thank
you