GROUP 15

NINIEK IIN FITRIANI : 110 2015 0015

AYU MUSTIKA : 110 2015 0029
WIALDA DWI RODYAH S: 110 2015 0048
RIQAH NEFIYANTI PUTRI : 110 2015 0060
AFRILIA CHAERUNNISA : 110 2015 0065
RISKA DWIYANSARI : 110 2015 0071
ZARA QAYLA ARIF MARICAR : 110 2015 0085
A. ST. ZURAIDHA P.A : 110 2015 0081
MUH. FUAD ALAMSYAH : 110 2015 0113
RIFQI ADITYA : 110 2015 0078

TUTOR : dr. WISUDAWAN, M.Kes, Sp.JP

A 45 years old man came to the clinic with chief
complaints of the chest pain that is felt was advancing
from one week prior. Chest pain felt substernal, not
continuous and not radiated. Pain occurs when doing
strenuous activity and relieved with rest. He denies
have any complaints of nausea, vomiting and
diaphoresis. He had a history of hypertension and
dyslipidemia. History as an active smokers since high
senior and spent about 2 packs/day. On examination
his blood pressure 150/90 mmHg. Pulse 100 beats per
minutes and others within normal limits.
1. A 45 years old man
2. Chest pain that is felt was advancing from one week
prior
3. Chest pain substernal, not continuous and not
radiated
4. Pain occurs when doing strenuous activity and
relieved with rest
5. History as an hypertension and dyslipidemia
6. History as an active smokers since high school
7. Blood pressure 150/90 mmHg
8. Pulse 100 beats / minutes.
Diaphoresis: Axcessive sweating, can be
symptoms of various condition.
Dyslipidemia: Dyslipidemia was defined as
a disorder of lipid metabolism
characterized by an increase or decrease
in the plasma lipid fraction. Abnormalities
of lipid fractions the main one is the
increase in total cholesterol (total K), LDL
cholesterol (LDL-C), triglycerides (TG), and
a decrease in HDL cholesterol (HDL-C).
1. How to differentiate chest pain caused by cardiovascular
disease and non cardiovascular disease?
2. What the causes of chest pain from the scenario above?
3. How is the relation with smoking history of chest pain?
4. How is the relation between smoking, hypertension and
dyslipidemia?
5. How to diagnose the disease base on the scenario?
6. What are the differential diagnose base on the scenario?
7. Islams perspective based on the scenario?
 Stable Angina
(Angina classic, Angina of Effort)

Attacks typical chest pain that arises

when working. Lasted only a few
minutes and disappear with
nitroglycerin or rest. Chest pain can
occur after meals, in cold air, simfatis
excessive reaction or emotional
distress.
 Unstable Angina
(Angina preinfark, acute coronary insufficiency)
This type of angina is suspected if the patient has
often repeatedly complained of chest pain that arises
when a break or working light and lasts longer.

Myocardial ischemia lasting more than 20-30 minutes

Myocardial
can lead to myocardial
infarctioninfarction. Chest pain lasts
longer, radiating to the left shoulder, arm and jaw.
In contrast with angina pectoris, the onset of chest
pain has nothing to do with physical activity and if
not treated took place within a few hours. Besides,
patients also complain dispea, palpitations and
sweating. Diagnosis is upheld by the examiner
serioal ECG and cardiac enzymes.
Smoke contains many harmful substaces, one of which
is the CO gas. CO gas has the ability to bind to Hb
higher than oxygen. So, if there is smoke inhaled, Hb
bring more CO than oxygen. O2 deficient cells will do
compenstate by way of spasm. When the spasm lasts
long, the blood vessels will be damaged and it can be
atherosclerosis. Atherosclerosis can cause
hypertension, if hypertension lasts long, it can be
grafting blood vessels in the heart (coronary arteries),
and ultimately lead to myocardial infarction. One of the
symptoms of myocardial infarction is chest pain.
Anamnase
1.Onset and duration of chest pain
2.Characteristic of chest pain
3.Radiated of chest pain
4.Ask the others symptom that has a related
5.History of the same disease before
6.Ask the same disease from the family
Inspection Percussion

Palpation Heart sounds

Coronary heart disease (CHD)
is a disease in which a waxy
substance called plaque builds
up inside the coronary arteries.
These arteries supply oxygen-
rich blood to heart muscle.
When plaque builds up in the
arteries, the condition is
called atherosclerosis. The
buildup of plaque occurs over
many years.
Etiology
Research suggests that coronary heart disease
(CHD) starts when certain factors damage the inner
layers of the coronary arteries. These factors
include:
Atherosclerosis
High levels of certain fats andcholesterol
High blood pressure
High levels of sugar in the blood due toinsulin
resistanceordiabetes
Blood vessel inflammation
Sign and Symptoms
Chest pain like pressure or squeezing in your
chest. May radiated to shoulders, arms, neck,
jaw, or back.
The pain tends to get worse with activity and
go away with rest.
Shortness of breath.
Emotional stress also can trigger the pain.
They may get more severe as the buildup
of plaque continues to narrow the
coronary arteries.
 Treatment
Non Farmacology:
Heart-healthy Managing Maintaining a healthy
eating stress weight

Physical activity Quitting smoking

Farmacology:
Cholesterol-modifying medication
Aspirin
Beta blockers
Nitroglycerin
Angiotensin-converting enzyme (ACE)
inhibitors and angiotensin II receptor blockers
(ARBs)
Surgical:

Coronary Artery Percutaneous

Bypass Grafting Coronary Intervention
 Still a lot of opinions about haram or
not to smoke, but it was clear that smoking
has many negative effects.
Smoking can bring the perpetrators to
destruction and dangerous disease, death,
cancer, heart attacks, impotence, and
various other serious illnesses. While we are
not to lead us to actions that could harm us.
(Q.S. Al-Baqarah
[2:195])

And spend in the way of Allah and do not
throw [yourselves] with your [own] hands
into destruction [by refraining]. And do
good; indeed, Allah loves the doers of good.
THANK YOU