Bst unisba

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BED SIDE TEACHING

“Coronary Artery

Disease”

WINDY NURAINI SHUFIAN/12111!"!

Ra#$aniati / 12111!!%

&e$'i$'in( )Dr* +,to-* S.*&D



IDENTITAS &ASIEN



IDENTITAS &ASIEN

Na$a ) I' T Tan((a0 0a#ir/ Usia ) " ta#ne3ar(ane(araan ) In4onesia

A0a$at ) 50* Hanta. no "! Rt /1"&en4i4i6an ) S7AStats $arita0 ) 7eni6a#&e6er8aan ) I' R$a# Tan((aA(a$a ) Is0a$

Tan((a0 $as6 ) 11 7aret 21% Tan((a0 .e$eri6saan ) 1% 7aret 21%



ANA7NESIS



E9UHAN UTA7A

Sesa6 yan( $e$'erat se8a6 1 #ari S7RS



RIWAYAT &ENYAIT SEARANG

Se8a6 1 $in(( S7RS .asien $erasa6an sesa6* Sesa6 4irasa6an $en4a4a6 se.erti tertin4i#* e0#an sesa6 4irasa6an se$a6in 'erat 6eti6a .asien 'era6ti:itas 4an

'er6ran( a.a'i0a .asien 'eristira#at* &asien ti4r 4en(an $en((na6an 4a

'anta0 nt6 $en(ran(i rasa sesa6nya* &asien $enyan(6a0 ter'an(n .a4a

$a0a$ #ari a6i'at sesa6- 4an $enyan(6a0 a4anya 'at6 .a4a $a0a$ #ari*

e0#an 4isertai nyeri 4a4a yan( 4irasa6an se8a6 1 $in(( S7RS* e0#an ini

4irasa6an #i0an( ti$'0* Nyeri 4a4a 4irasa6an se.erti terts6;ts6 4an 4ire$as- ter6a4an( nyeri 4a4a $en8a0ar sa$.ai 6e .n(n( 4an 0en(an 6iri* Nyeri 4a4a

4irasa6an $e$'r6 a.a'i0a .asien 4a0a$ 6ea4aan ,e$as 4an e$osi* &asien 8(a

$erasa6an nyeri .a4a 0 #ati se8a6 1 $in(( S7RS*

Se8a6 1 #ari S7RS sesa6 yan( 4irasa6an se$a6in 'erat- 'a#6an saat istira#at sesa6

4irasa6an ti4a6 ter0a0 'er6ran( se#in((a .asien 4atan( 6e R$a# Sa6it

7#a$$a4iya# Ban4n(*




&asien $enyan(6a0 6e0#an sesa6 #anya ti$'0 saat ,a,a 4in(inata ter6ena 4e'- $enyan(6a0 sesa6 $erasa 0e'i# 'ai6 6eti6a

.asien 'er'arin( 4an $er'a# .osisi 'ai6 6e 6anan $a.n 6e 6iri*&asien 8(a $enyan(6a0 a4anya ri3ayat tra$a- terse4a6*

&asien $enyan(6a0 a4anya sesa6 4isertai 'at6 'er4a#a6 yan(0a$a- 4e$a$- 6erin(at .a4a $a0a$ #ari- 4an .enrnan 'erat

'a4an*e0#an ti4a6 4isertai 4en(an (an((an 'an( air 6e,i0- .asien

$enyan(6a0 <re6ensi 'an( air 6e,i0 $en8a4i 'er6ran(- 3arna rinyan( .e6at ata 'er3arna 6e$era#an* &asien 8(a $enyan(6a0

a4anya 6e0#an nyeri .a4a .in((an(*




Se8a6 = ? ta#n yan( 0a0 .asien $erasa6an serin( a4anya sa6it 6e.a0a* Sa6it

6e.a0a 4irasa6an $en4a4a6 ter8a4i terta$a a.a'i0a .asien $en(a0a$i 'anya6

.i6iran 4an 6ran( istira#at* Saat .asien $en(a0a$i 6e0#an .asien $e0a66an

.en(o'atan 6e 4o6ter $$ ter4e6at* eti6a o'at #a'is 4an 6e0#an ti4a6 0a(i

4irasa6an .asien ti4a6 $e0a66an .en(o'atan 0e'i# 0an8t*

Se8a6 1 ta#n tera6#ir .asien serin( $en(e0#6an a4anya nyeri .a4a 4a4anya*

Nyeri ini 4irasa6an #i0an( ti$'0* Nyeri 'er4rasi se6itar 6ran( 4ari 1 @ 1! 4eti6

setia. seran(an* &asien ti4a6 $en(an((a. 6e0#an ini se'a(ai 6e0#an yan( seris-

se#in((a .asien ti4a6 $e0a66an .en(o'atan 0e'i# 0an8t*



&asien s4a# $en4a.at .era3atan 4i r$a# sa6it 7#a$a4iya#se0a$a % #ari 4an

te0a# 4i'eri6an .en(o'atan* Unt6 se6aran( 6e0#an sesa6- nyeri4a4a 4an 6e0#an nyeri 4i 'a(ian 0 #ati s4a# ti4a6 4irasa6an o0e#

.asien*

ETERANGAN TA7BAHAN



RIWAYAT &ENYAIT DAHU9U

Ri3ayat #i.ertensi se8a6 ? ta#n yan( 0a0Ri3ayat as$a 4isan(6a0Ri3ayat .enya6it .ar 2 ta#n 0a0 ,o$$nity a,ire4 .ne$oniaRi3ayat .enya6it #ati 4isan(6a0Ri3ayat .enya6it (in8a0 4isan(6a0Ri3ayat o.erasi 2 ta#n 0a0 ,#o0e,ystitisRi3ayat 4ira3at 4i r$a# sa6it 2 ta#n 0a0



RIWAYAT E9UARGA

Ri3ayat .enya6it D7- 8antn(- .enya6it .ar- a0er(i/atoi$n4a0a$ 6e0ar(a 4isan(6a0



RIWAYAT S+SIA9 E+N+7I

&asien 'erasa0 4ari 6e0ar(a 4en(an .en4i4i6an 4an 6ea4aane6ono$i $enen(a#* &asien $er.a6an seoran( i' r$a# tan((a4an $e$'ant sa$inya nt6 'er8a0an 4i .asar*



EBIASAAN

&asien ti4a6 $e$.er#ati6an $a6anan yan( 4i6ons$si*&asien 8(a 8aran( nt6 $e0a66an o0a#ra(a*Ri3ayat $ero6o6 4isan(6a0Ri3ayat $in$ a06o#o0 4isan(6a0Ri3ayat 6ons$si 8a$- 4an o'at;o'atan 0ainnya 4a0a$

8an(6a 3a6t 0a$a 4isan(6a0



&E7ERISAAN FISI



PEMERIKSAAN FISIK

• esan sa6it ) Ta$.a6 sa6it se4an(

• ea4aan $$ ) Co$.os $entis

• Tan4a :ita0

Te6anan Dara# )1"/ $$H(Na4i )% /$enit- re(0ar- ea0- isi

,6.

Res.irasi

)2/$enit-a'4o$inot#ora,a0*S# )?%-!C

&E7ERISAAN FISI



KEPALA• Ra$'t ) Hita$- 'er'an- 0rs- ti4a6 $4a# 4i,a't-

ti4a6 $4a# ronto6• 0it 3a8a# ) &i($entasi ;- 8ar .art ;- i,teri, ;-

0e$'a'- e4e$a ;• 7ata )- 9eta6 ) Si$etris- &a0.e'rae ) E4e$a ;/;- ornea ) er# ;/;-

&.i0 ) '0at iso6or- S60era ) i6teri6 ;/;- on8n(ti:a ) ane$is ;/;- &er(era6an ) ;/;- Ree6 ,a#aya ) /- Ree6 6ornea ) /- atara6 Dia'eti6 ) ;/;

&E7ERISAAN FISI



• Hi4n( ) Si$etris- 4e:iasi se.t$ ;- $assa ;/;-

se6ret ;/;- &CH ;

•

Te0in(a ) De<or$itas ;/;- otorr#ea ;/;• 70t ) Bi'ir 0e$'a'- .er4ara#an (si ;- 9i4a#

6otor ;- sianosis ;

• Gi(i ) aries ;

&E7ERISAAN FISI



• Lidah:- &er(era6an ) si$etris

- Tre$or ) ;

- Fren0$ 0in(ae ) i6teri6 ;

•Rongga leher :

- &#arin( ) $6osa 0e$'a'- #i.ere$is ;

- Tonsi0 ) T1/T1- #i.re$is ;

• Kelenjar parotis ) ti4a6 a4a .e$'esaran

&E7ERISAAN FISI



• Leher : – 5& ) !,$ 2 - ti4a6 $enin(6at – GB ) .e$'esaran ;/; – Tra6ea ) 4e:iasi ; –

Tiroi4 ) .e$'esaran ;• Thoraks :Thorax anterior

– Bent6 ) si$etris – Se0a i(a ) ti4a6 $en(a0a$i .e0e'aran – &er(era6an ) si$etris – 0it ) ti4a6 a4a 8arin(an .art- s.i4er ne:i ; – I6ts ,or4is ) ta$.a6 ti4a6 6at an(6at

&E7ERISAAN FISI



Palpasi :

• o6a0 <re$its ) nor$a0- 6anan J 6iri

• I,ts ,or4is

-

9o6asi ) tera'a 4i ICS $i4ai00ary 0ine- Intensitas ) ti4a6 6at an(6at

- Tri00 ) ;

&E7ERISAAN FISI



Perkusi• Paruparu :

- anan ) sonor

- iri ) sonor

- Batas .ar #e.ar ) ICS $i4,0a:i60ar 0ine4etra- .eran8a6an 1 se0a i(a

• !"R

- Batas atas ) ICS II $i4,0a:i,0ar 0inesinistra

- Batas 6iri ) ICS $i4ai00ary 0inesinistra

- Batas 6anan ) ICS .arasterna0 0ine

&E7ERISAAN FISI



Auskultasi :

• Paruparu )

- Sara .erna<asan ) BS- 6anan J 6iri

- o6a0 resonans ) nor$a0- 6ananJ6iri- Sara ta$'a#an ) ron,#i ;/;- 3#eeKin(

;/;- s0a$ ;/;

• !"R :

• Bnyi 8antn( ) S1- S2 $rni re(0ar• 7r$r ) ;

• Ga00o. ) ;

&E7ERISAAN FISI



• A#do$en :

– Inspeksi ) 4atar- 0e$'t- 4istensi ;- $assa ;-

– Palpasi )

•

Din(in( .ert ) ti4a6 tera'a a4anya $asa• Nyeri te6an ) ; e.i(astri6

• He.ar ) ti4a6 tera'a .e$'esaran

• 9ien ) ti4a6 tera'a .e$'esaran

– Perkusi ) &e6a6 sa$.in( ;- .e6a6 .in4a# ; – Auskultasi ) Bisin( ss nor$a0 12/ $enit

&E7ERISAAN FISI



DIAGN+SIS BANDING



DIAGN+SIS BANDING

1* Coronary artery 4isease STE7I- N+N STE7I- An(ina&e,toris Ti4a6 Sta'i0

2* Ane$ia?* Dia'etes $e0its ti.e II"* Hi.ertensi!* Nero.ati 4ia'eti6$



USU9AN &E7ERISAAN



DIAGN+SIS ER5A



DIAGN+SIS ER5A

1* Coronary artery 4isease2* Dia'etes 7e0its Ti.e II?* Hi.ertensi (ra4e I



&ENATA9ASANAAN



N+N FAR7A+9+GI

1* Tira# 'arin(2* ons0 4o6ter 5antn(?* Diet D7Berat Ba4an I4a$an BBI J 1!! @ 1 ; 1O J "-!6(

Berat 'a4an ) ! 6(Berat 'a4an ratio BBR / stats (iKi J !/"-! 1O J11-J1O P Berat 'a4an nor$a0&enentan 6a0ori )

"-! 6( 2! J 12?-! 6a0oriore6si )Usia > " ta#n ) @ !O J %1-! 6a0oriA6ti:itas se4an( ) 2O J 2"-! 6a0oriBB nor$a0 ) ti4a6 4i6ore6si

Stress $eta'o0i6 ) 2O J 2"-! 6a0ori



FAR7A+9+GI

C0 -O In<s 2 t.$0sartan 1 1% $( ta'

o$'oas.i0et 1 $( ta'or:astatin 1 2 $( ta's0in 'asa0 4an ins0in .ran4ia09e:e$ir 1 Unit/#ari 4i'eri6an .60 22*No:ora.i4 " Unit ? .er#ari



.ro(nosis



&R+GN+SIS

Qo a4 :ita$ ) 4'ia a4 'ona$Qo a4 sanan,tiona$ ) 4'ia a4 $a0a$Qo a4 <n,tiona$ ) 4'ia a4 'ona$

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