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    Unstable Angina Pectoris

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    Akbar Iskandar
    Mrs. N, a 60-year-old woman, presented with worsening chest pain. She had a history of hypertension but no other significant medical history. Her chest pain was described as a pin and needle sensation in her left chest radiating to her left arm, lasting up to 20 minutes. Testing showed signs of ischemia and hyperlipidemia. She was diagnosed with unstable angina pectoris and hypertension. Her treatment included bed rest, oxygen, nitroglycerin, antiplatelet therapy, beta blockers, statins, and lifestyle modifications to control her risk factors.

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    Unstable Angina Pectoris

    Uploaded by

    Akbar Iskandar
    252 views24 pages
    Mrs. N, a 60-year-old woman, presented with worsening chest pain. She had a history of hypertension but no other significant medical history. Her chest pain was described as a pin and needle sensation in her left chest radiating to her left arm, lasting up to 20 minutes. Testing showed signs of ischemia and hyperlipidemia. She was diagnosed with unstable angina pectoris and hypertension. Her treatment included bed rest, oxygen, nitroglycerin, antiplatelet therapy, beta blockers, statins, and lifestyle modifications to control her risk factors.

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    UAP

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    Mrs. N, a 60-year-old woman, presented with worsening chest pain. She had a history of hypertension but no other significant medical history. Her chest pain was described as a pin and needle sensation in her left chest radiating to her left arm, lasting up to 20 minutes. Testing showed signs of ischemia and hyperlipidemia. She was diagnosed with unstable angina pectoris and hypertension. Her treatment included bed rest, oxygen, nitroglycerin, antiplatelet therapy, beta blockers, statins, and lifestyle modifications to control her risk factors.

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    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    252 views24 pages

    Unstable Angina Pectoris

    Uploaded by

    Akbar Iskandar
    Mrs. N, a 60-year-old woman, presented with worsening chest pain. She had a history of hypertension but no other significant medical history. Her chest pain was described as a pin and needle sensation in her left chest radiating to her left arm, lasting up to 20 minutes. Testing showed signs of ischemia and hyperlipidemia. She was diagnosed with unstable angina pectoris and hypertension. Her treatment included bed rest, oxygen, nitroglycerin, antiplatelet therapy, beta blockers, statins, and lifestyle modifications to control her risk factors.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 24

    Case Presentation

    Unstable Angina Pectoris


    By : Muhammad Junaid
    Supervisor :
    Prof. DR. dr. Ali Aspar Mappahya, Sp.PD,Sp.JP,FIHA, FACCS

    Patient ID

    Name : Mrs. N
    Age : 60 years old
    Address : Jln. Badaruddin dg.Lira
    Medical Record : 251166
    Date of Admittance : 14th April 2009

    History Taking
    Chief Complaint :Chest Pain
    History Taking :

    Experienced by the patient since 2 weeks ago and


    worsen a few days before she was admitted to the
    hospital. The pain was felt in the left chest and
    referred to the left arm which characterized by pin
    & needle feeling. The attacks lasted for 5 minutes
    and later progressed up to 20 minutes. The
    frequency increased from once a day to four times a
    day. At first, the pain lessen with rest but now the
    pain persists even while resting. Lately, she was
    worried about her childrens problem. She
    experienced no fever, no cough, no nausea, and no
    vomiting. Patient also complaints of sleeping
    difficulty. Micturity and defecation were normal.

    Risk Factor

    Female 60 years old (> 55 years old)


    Hypertension (+) since age 32 years old.
    Family history (-)
    Smoking history (-)
    Alcohol (-)
    Obesity (-)
    Diabetes Mellitus (-)
    Dislipidemia (-)

    Past Illness History


    Diabetes mellitus (-)
    Hypertension (+)
    Heart disease (-)
    Family history of heart disease (-)

    Physical Examination
    General Appearance :

    Moderate-illnes/Normal weight/conscious

    Vital Sign :

    Pulse : 65 tpm
    Blood Pressure : 180/100 mmHg
    Inspiratory rate : 20 tpm
    Body temperature : 36.6 C

    Head Examination :

    Eyes : no anemia, no jaundice, no cyanosis


    Neck : JVP R-1 cmH20

    Thoracic Examination :

    Inspection : Symmetric sinistra et dextra


    Palpation : no mass, no tenderness
    Percussion : Sonor
    Auscultation : Breath Sound was vesicular, no extra sound

    Physical Examination
    Cardiac Examination :
    Inspection : Ictus Cordis wasnt visible
    Palpation : Ictus Cordis wasnt palpable
    Percussion : dullness
    Auscultation : regular of I/II Heart Sound, no murmur

    Abdominal Examination :
    Inspection : Normal
    Palpation : No mass palpable, No tenderness
    Percussion : tympani
    Auscultation : peristaltic sound (+), normal

    Extremities :
    No limbs edema

    Laboratory Examination
    Complete blood
    WBC : 8,7 x 103 /mm3
    HGB : 12,1 g/dl
    HCT : 37,4 %
    RBC : 3,93 x 106 /mm3
    PLT : 356 x 103 /mm3

    Cardiac enzyme
    CK
    : 67 (<167)
    CK MB
    : 17 (< 25)

    Blood chemistry
    Random blood sugar
    SGOT
    SGPT
    Total Cholesterol
    HDL
    LDL
    Triglyseride

    : 167 mg/dl
    : 19 u/l
    : 14 u/l
    : 208 mg/dl()
    : 37 mg/dl()
    : 137mg/dl ()
    : 176 mg/dl

    Electrocardiogram

    Electrocardiogram

    Sinus Rhythmic
    Heart rate 65 bpm
    Axis : Normoaxis
    T inverted : lead 1,AVL, V1 V6
    Iskemia Miokard Anteroseptolateral

    Echocardiogram

    Echocardiogram

    Hypertension Heart Disease


    Sistolic Function of Left Ventrikel
    Normal
    Diastolic Disfunction
    Pulmonal Hypertension
    EF 85 %

    Suggestion examination
    Thorax radiography
    Coronary angiography

    Diagnosis
    Unstable Angina Pectoris
    Hypertension Grade II

    Management

    Cardiac Diet
    O2 3 4 Lpm
    IVFD NaCl 0,9 % 12 dpm
    Nitroglicerin 10 g/mnt
    Plavix (clopidogrel) 75 mg 1x4 1x1
    Aspilet (aspirin) 80 mg 1x2 1x1
    Captopril (ACE inhibitor) 25 mg 2x1
    Simvastatin 20 mg 0-0-1
    Alprazolam 0,5 mg 0-0-1
    Laxadine syr 3 x 1 cc

    Discussion
    Unstable Angina Pectoris

    Definition
    Angina pectoris is a syndrome characterized by
    chest pain resulting from an imbalance between
    oxygen supply and demand, and is most
    commonly caused by the inability of atherosclerotic
    coronary arteries to perfuse the heart under
    conditions of increased myocardial oxygen
    consumption.
    Classification of Angina Pectoris :
    - Stable angina
    - Unstable angina

    Stable angina is the most common angina, and the type


    most people mean when they refer to angina.
    Stable Angina
    People with stable angina usually have angina symptoms
    on a regular basis. The episodes occur in a pattern and are
    predictable.
    For most people, angina symptoms occur after short bursts
    of exertion.
    Stable angina symptoms usually last less than five minutes.
    They are usually relieved by rest or medication, such as
    nitroglycerin under the tongue.

    Unstable Angina
    Unstable angina is less common. Angina symptoms
    are unpredictable and often occur at rest.
    This may indicate a worsening of stable angina, but
    sometimes the first time a person has angina it is
    already unstable.
    The symptoms are worse in unstable angina - the
    pains are more frequent, more severe, last longer,
    occur at rest, and are not relieved by nitroglycerin
    under the tongue.

    Pathophysiology

    Risk Factors

    Hypertension
    High levels of cholesterol and other fats in the blood
    Diabetes
    Smoking
    Male gender or female > 55 years old
    Inactive (sedentary) lifestyle
    Family history of coronary heart disease
    Aging
    Regular use of stimulants, especially nicotine, cocaine,
    or amphetamines: Other stimulants include
    theophyllines, inhaled beta-agonists, caffeine, diet pills,
    and decongestants.

    Diagnose
    Signs of myocardial ischemia
    ECG
    ST segmen elevation ?

    No

    Acute Myocardial Infarction


    ( Q-wave, non-Q wave )

    Lab

    Biochemical cardiac markers ?

    No

    Yes

    Yes

    NSTEMI
    ( No ST-Segment
    Elevation
    Myocardial Infarction )

    Unstable Angina

    Treatment

    Bed rest
    Diet & Modification of risk factors (smoking, BP, lipids)
    Oxygen
    Nitroglycerin
    Antiplatelet drugs ( aspirin plus clopidogrel )
    -Blockers
    Ca channel blockers
    ACE inhibitors

    Statins
    Revascularization : PCI (eg, angioplasty, stenting) or CABG

    Management

    Bed rest
    Diet
    Oxygen
    Nitroglycerin:
    Beta blockers: Beta blockers lessen the heart's workload. They slow the heart rate,
    decrease blood pressure, and lessen the force of contraction of the heart muscle. This
    decreases the heart's need for oxygen and thus decreases angina symptoms. Beta blockers
    are taken every day, regardless of whether the patient is having symptoms, because they
    are proven to prevent heart attacks and sudden death.

    Clopidogrel

    Calcium channel blockers (CCBs): Calcium channel blockers are used primarily when
    beta blockers cannot be used and/or the patient is still having angina with beta blockers.
    Calcium channel blockers also lower blood pressure and certain ones slow heart rate.
    Calcium channel blockers have to be taken every day.
    Aspirin
    Statins: Statins lower cholesterol and have been shown to stabilize the fatty plaque on the
    inner lining of the coronary artery, even when the blood cholesterol is normal or minimally
    increased. Low density lipoprotein (LDL) or "bad cholesterol" levels should be less than 70
    mg/dL for those at high risk of heart disease. Every person with angina needs to know
    exactly what his or her blood lipids/fats are.
    Miscellaneous anti-anginal drugs : In 2006, the FDA approved ranolazine (Ranexa)
    indicated only after other conventional drug treatments are found to be ineffective.

    Glycoprotein IIb/IIIa antagonists

    ACE inhibitor

    Surgical Care
    : Percutaneus coronary intervention (PCI)

    & coronary artery bypass graft (CABG)

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