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EVALUATION OF ED PATIENTS

PRESENTING WITH CHEST PAIN


Budi Baktijasa, MD, FIHA
Alisia Yuana Putri, MD, FIHA
INTRODUCTION
Mortality Rate of Ischemic Heart Disease

1.8 million/year
20% all cause mortality
5-6% in hospt. mortality
7-18% all cause mortality
Typical Chest Pain for ACS

Retrosternal chest discomfort > 20 minutes

Heavy or burning sensation, not “pin-point” type of pain

Radiates to left arm, neck/jaw, back, or abdomen

De Novo or crescendo type of pain, angina post infarction (2 weeks after heart
attack)
HOW TO DIAGNOSE ???
Less Typical Symptoms

Dyspneu

Nausea
Elderly
Vommiting

Women Syncope

Diabetes
Mellitus
DIFFERENTIAL DIAGNOSIS FOR CHEST PAIN

Cardiovascular • Pericarditis
Problem • Aortic Dissection

Pulmonary • Pleuritic, Pneumonia


Problem • Pulmonary Embolism, Costo chondritis

Chest Wall • Costae Fracture


Problem • Costo chondritis

Psychogenic
Angina
ELECTROCARDIOGRAM (ECG)
ELECTROCARDIOGRAM (ECG)
ELECTROCARDIOGRAM (ECG)
CARDIAC BIOMARKER
MANAGEMENT
MANAGEMENT – TRANSFER SYSTEM
MANAGEMENT – REPERFUSION THERAPY
MANAGEMENT
MANAGEMENT – PERIPROCEDURAL PHARMACOTHERAPY
• Relief pain,
breathlessness, and
anxiety
• Antiplatelet
MANAGEMENT – PERIPROCEDURAL PHARMACOTHERAPY
MANAGEMENT

• Oral beta-blockers is indicated in patients with heart failure


Beta Blocker and/or LVEF ≤ 40% unless contraindicated

• starting within the first 24 h of STEMI in patients with evidence


ACE-I of heart failure, LV systolic dysfunction, diabetes, or an anterior
infarct.

Lipid • It is recommended to start high-intensity statin therapy as early


Lowering as possible, unless contraindicated, and maintain it longterm
• An LDL-C goal < 70 mg/dL or a reduction of LDL at least 50%
Therapy
TAKE HOME MASSAGE

• Chest Pain Patients in ED need quick and precise examination to diagnose


whether the patients has ACS or not

• Anamnesis, physical examination, ECG, and biomarker need to be done,


and diagnosis should be establish within 10 minutes

• Reperfusion therapy should be done if the STEMI is diagnosed and PPCI is


over thrombolytic therapy

• Management of NSTEMI/UA depend on the risk stratification.


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