Nyeri Dada

Arhyatus Sa’adiyah
Epidemiologi
• +1 % kunjungan pelayanan primer adalah untuk nyeri dada, 1,5%
diantaranya adalah unstable angina atau AMI
• Di US >5juta pasien datang ke IGD dengan keluhan nyeri dada, >55%
diantaranya disebabkan penyakit nonkardiak
• 15-25% kunjungan IGD dengan nyeri dada terbukti ACS
Anatomi
Anamnesa
• Onset?
• Location? Substernal/salah satu sisi dada
• Duration?
• Characteristics? Tumpul/tajam/dirobek2/kesemutan/terbakar
• Aggravating/Alleviating factor(s)? Saat berubah posisi/menarik nafas
• Radiating? Tangan/punggung/leher/dagu
• Timing and Severity?
Anamnesa
• Gejala lain? Sesak/bengkak/mual muntah
• Riwayat Penyakit Dahulu? Diabetes/dislipidemia/varicella/marfan
syndrome/post op
• Riwayat Keluarga?
• Riwayat Pengobatan?
• Riwayat sosial? Merokok/Alkohol/IDU
DDx Clinical Findings SKDI
Acute myocardial Chest pain radiates to both arms 3B
infarction Third heart sound on auscultation
Hypotension
Tension Progressive dyspnea, hypotension, hypersonor on 3A
Pneumothorax percussion
Pulmonary Wells criteria (History of DVT/PE/immobilization/surgery, 1
embolism hemoptysis, dyspnea, malignancy)
Acute thoracic aortic severe chest or back pain, and a pulse differential in the 1
dissection upper extremities
Boerhaave vomiting, lower thoracic pain, and subcutaneous 1
syndrome emphysema
DDx Clinical FIndings SKDI
Postherpetic History of VZV infection 3A
neuralgia
Chest wall At least two of the following findings: localized muscle tension; -
pain stinging pain; pain reproducible by palpation; absence of cough

Pericarditis Clinical triad of pleuritic chest pain (increases with inspiration or 2

when reclining, and is lessened by leaning forward), pericardial
friction rub, and electrocardiographic changes (diffuse ST segment
elevation and PR interval depression without T wave inversion)
Heart failure History of heart failure/AMI, Pulmonary edema on chest radiography, 3B
Clinical impression
Pneumonia Pleuritic chest pain, fever, cough, dyspnea, Egophony, dullness to 4A
percussion, rhonchi
DDx Clinical Findings SKDI
Gastroesophageal Burning retrosternal pain, acid regurgitation, sour or bitter 3A
reflux disease taste in the mouth; one-week trial of high-dose proton
pump inhibitor relieves symptoms
Panic Single question: In the past four weeks, have you had an 3A
disorder/anxiety anxiety attack (suddenly feeling fear or panic)?
state
Tatalaksana

ABC
Tatalaksana
Daftar Pustaka
• Bruno, R., Donner-Banzhoff, N., Söllner, W., Frieling, T., Müller, C. and Christ, M. (2015). The Interdisciplinary
Management of Acute Chest Pain. doi: 10.3238/arztebl.2015.0768
• Corvera JS, Acute aortic syndrome, (2016) Ann Cardiothorac Surg. May; 5(3): 188–193.
• Johnson RW and Andrew S.C. Postherpetic Neuralgia, (2014), RiceN Engl J Med; 371:1526-1533 DOI:
10.1056/NEJMcp1403062
• Malik MA, Khan SA, Safdar S, Taseer IUH, Chest Pain as a presenting complaint in patients with acute
myocardial infarction (AMI), Pak J Med Sci. 2013 Apr; 29(2): 565–568.
• Mcconaghy JR and Oza RS, Outpatient Diagnosis of Acute Chest Pain in Adults, (2013) Ohio Am Fam
Physician. Feb 1;87(3):177-182.
• PERKI, 2018, Pedoman Tatalaksana Sindrom Koroner Akut, Indonesia, hlm 14
• Pollack CV, 2013, Perman SM, Chest Pain in the Emergency Department: Differential Diagnosis, (Online)
Decision Support in Medicine, LLC (https://www.thecardiologyadvisor.com/cardiology/chest-pain-in-the-
emergency-department-differential-diagnosis/article/584106/, diakses 9 Agustus 2018)
• Turner AR, Turner SD. Boerhaave Syndrome. [Updated 2017 Apr 19]. In: StatPearls [Internet]. Treasure Island
(FL): StatPearls Publishing; 2018 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430808/
• Zarogoulidis P, Kioumis L, Pitsiou G, Porpodis K,Lampaki S, Papaiwannou A, et al, Pneumothorax: from
definition to diagnosis and treatment, (2014) J Thorac Dis. 6(Suppl 4): S372–S376. doi: 10.3978/j.issn.2072-
1439.2014.09.24
Terima Kasih