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ALGORITMA NYERI DADA

Nyeri dada

Beri oksigen nasal kanul 4 l/m

Anamnesis
 Pria
 Usia >70tahun
 Terdapat riwayat kencing manis
 Nyeri dada > 15’ dan < 12 jam
 Rasa dada pegal/diremas/ditimpa
 Nyeri menjalar ke lengan kiri dan leher
 Terdapat riwayat sakit jantung

Ya Tidak

Kardiogenik Non kardiogenik

Konsul jantung Anamnesis lebih lanjut

PF:  Sesak
 Hipotensi  Batuk
 Bradi/takikardia  Jenis dahak
 Regurgitasi mitral  Demam
 Murmur  Sifat nyeri dada saat bernapas
 S3 gallop  Riwayat OAT
 Ronki baru/memburuk  Riwayat sakit paru
Evaluasi saturasi O2
Pasang IV line
EKG 12 lead PF lengkap
 Deviasi segmen ST >0,5mm
 Troponin T meningkat
 CK-MB meningkat Buat diagnosis sementara
Foto toraks <30’ (portabel, jika
memungkinkan)
Terapi sementara

STEMI
New LBBB Rencanakan pemeriksaan lanjutan
ACS
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Evaluasi
Differential Diagnosis of Chest Pain

1. Angina Pectoris/Myocardial Infarction

2. Other Cardiovascular Causes

a. Possibly Ischemic Pain Aortic Stenosis


Hypertrophic Cardiomyopathy
Severe Systemic Hypertension
Severe Right Ventricular Hypertension
Aortic Regurgitation
Severe Anemia/hypoxia

Aortic Dissection
b. Non Ischemic in Origin
Pericarditis
Mitral Valve Prolapse

Esophageal Spasm
3. Gastrointestinal
Esophageal Reflux
Esophageal Rupture
Peptic Ulcer Disease

Anxiety
4. Psychogenic Depression
Cardiac Psychosis
Self Gain

Thoracic Outlet syndrome


Lesions of Cervical/Thoracic Spine
5. Neuromusculoskeletal Costochondritis[Tietze’s Syndrome]
Herpes Zoster
Chest wall pain

Pulmonary Embolus/Infarction
Pneumothorax
6. Pulmonary
Pneumonia with pleural involvement

7. Pleurisy
Sources, Types, and Most Common Causes of Chest Pain

Cardiovascular disorders

Myocardial ischemia Angina pectoris


Variant angina
Acute myocardial infarction
Cocaine
Aortic valve disease
Mitral valve prolapse
Hypertrophic cardiomyopathy

Pericardial pain Infection


Dressler’s syndrome
Postcardiotomy syndrome
Idiopathic
Substernal and back pain
Aortic dissection

Musculoskeletal disorders

Costochondral pain
Herpes zoster infection
Disorders of the spine

Neuritis-radiculitis

Shoulder-upper extremity pain Pancoast carcinoma


Thoracic outlet obstruction
Shoulder-hand syndrome

Chest wall pain Rib fracture


Muscle injury (myalgia)
Infection
Malignancy

Pleuropulmonary disorders

Pleuritic pain Infection


Pulmonary embolism
Spontaneous pneumothorax
Collagen vascular disease
Pain of pulmonary hypertension
Pulmonary embolism
Primary pulmonary hypertension
Eisenmenger’s syndrome
Tracheobronchial pain
Infection
Inhalation of irritants
Malignancy

Gastrointestinal disorders
Reflux esophagitis
Esophageal pain Motility disorders

Cholecystitis
Peptic ulcer disease
Epigastric-substernal pain Acute pancreatitis
Disorders of intestinal motility

Psychiatric disorders Neurocirculatory asthenia


Hyperventilation syndrome
Atypical anginal pain Panic disorder

Other
Mediastinal emphysema
Substernal pain

Rujukan
 Handbook of emergency cardiovascular care 2005
 http://www.doctorslounge.com/
 http://www.nlhep.org