Laporan Kasus

Farhan Rizqi Rahmadhani

Pembimbing :
Dr. Hari Yudha Sp. JP (K)
 Kasus
Diskusi
Nama Identitas
: Tn.Kc
Tgl Lahir : 28 /
06 / 1967
Usia : 55 Thn
Kelamin : Laki-Laki
MRS : 13/03/2022

Pekerjaan: supir truck muat

timah
Alamat : Pucuk
Lamongan
Ruangan: Marwah 6.4
 Anamnesis
Keluhan utama : Nyeri dada

RPK &
RPD RPS RSos

Nyeri dada (+) Pasien mengeluhkan ngongsrong 2 minggu - Pasien merokok 2 1/2 pack/hari, namun -
Demam, Bapil (-) terakhir, terasa memberat 2 hari terakhir. Pasien berhenti semenjak 2 minggu terakhir saat
Mual muntah (-)  sempat muntah saat di IGDmerasakan nyeri dada saat melakukan aktifitas muncul keluhan.
Riwayat HT (-) berat dan membaik saat digunakan istirahat. terasa - Merasa banyak pikiran akhir ini
Riwayat DM (+) semakin parah 1hari smrs. Durasi nyeri +- 20 menit - Pasien sering membantu mengangkat
Riwayat penyakit jantung (-) menjalar ke punggung hingga pasien tidak sadarkan timah
Nyeri perut ulu hati (+) diri. - Riwayat konsumsi obat tidak ada
- Riwayat penyakit jantung keluarga yaitu
kakak pasien (jantung bocor)
 Pemeriksaan Fisik
Status Generalis
KU : tampak lemas K/L : Normocephal
Kesadaran : Compos Thorax : I  simetris
Mentis P  Sonor +/+, batas
GCS : 456 jantung kesan normal
TB : x P  Fremitus N/N
BB : x A  Cor ; S1 S2 tunggal,
murmur (+), gallop (-)
TTV Pulmo : Ves +/+, Rh
TD : 132/81 +/+, Wz -/-
Nadi : 112 Abdomen : I  Flat
RR : 22 A  BU + N
Suhu : 36 P  Soepel, NT (-), H/L
ttb, NK CVA -/-
Akral HKM, CRT <2 sec, oedema ekst
-/-
Pemeriksaan Laboratorium
Pemeriksaan ( 12-3-2022 ) Hasil Nilai Normal
360
Gula Darah Acak
18.1 (buruk) <6
HbA1C
41 0-1
Laju Endap Darah
Pemeriksaan EKG

1. Irama : sinus
2. Frekuensi HR : 110
5. Gelombang T : normal
3. Ritme : reguler 6. Interpretasi : sinus rithm dengan HR 110, axis
4. Segmen ST : elevasi lead I, normal dengan ST elevasi pada Lead I, AvL, V1-V6
AvL,V1-V6
5. Aksis : Normal
6. PR interval : normal, 3-5 kotak
kecil
Pemeriksaan Radiologi
Interpretasi

Apex : downward
Pinggang Jantung : menghilang
Aorta : Cardiomegaly (CTR 60%)
Sudut Costo : Tampak tajam kedua sisi
Seg. Pulmonal : normal
Seg. Aorta : normal
Corakan : Corakan bronko vasklr
meningkat
Kesimpulan : cardiomegaly
Diagnosis Kerja
Dx Fungsional
Acute
STEMI
Dx Anatomi
Cardiomegaly

Dx Etiologi
Aterosklerosis
Tanggal S O A P
13-03-22 Keluhan nyeri Rhonki  DM II  O2 simple mask 6 lpm
dada dan basah  Hyperkalemia  Inf. PZ 500 CC/24 jam
sesak basal +/+  IMA anterior  Inj. Lasik 3 x 20 mg jika
 ALO TDS > 90
 Dyspnoe  Pump dopamin 2
 Cardiogenic shock mikro/kg/mnt
 Pump heparin 750 iu/jam
 Inj. Ceftriaxon 2x1 gram

PO

 ASA 1 x 100
 CPG 1 x 75 mg
 Atorvastatin 1x40 mg

Pemeriksaan
Harian
Tanggal S O A P
14-03-22 Keluhan Rhonki  DM II  O2 simple mask 6 lpm
nyeri dada basah  Hyperkalemia  Inf. PZ 500 CC/24 jam
dan sesak sabal +/+  IMA anterior  Inj. Lasik 2 x 20 mg
berkurang berkurang  ALO  Pump dopamin 3
 Dyspnoe mikro/kg/mnt
 Inj. Ceftriaxon 2x1
 Cardiogenic shock
gram

PO

 ASA 1 x 100
 CPG 1 x 75 mg
 Atorvastatin 1x40 mg

Pemeriksaan
Harian
Tanggal S O A P
15-03-22 Keluhan Rhonki  DM II  O2 nasal 4 lpm
nyeri dada basah  Hyperkalemia  Inf. PZ 500 CC/24 jam
dan sesak sabal +/+  IMA anterior  Inj. Lasik 2 x 20 mg
berkurang berkurang  ALO stop ganti oral besok 1 x
 Dyspnoe 40 mg
 Pump dopamin 3
 Cardiogenic shock mikro/kg/mnt stand by
off
 Pump heparin 1250 iu /
jam
 Inj. Ceftriaxon 2x1
gram
PO
 ASA 1 x 100
 CPG 1 x 75 mg

 Atorvastatin 1x40 mg

Pemeriksaan
Harian
Tanggal S O A P
16-03-22 Keluhan  Rhonki basah  DM II  O2 nasal 4 lpm
nyeri dada basal tidak  Hyperkalemia  Inf. PZ 500 CC/24 jam
dan sesak ada  IMA anterior  Pump heparin 1250 iu /
berkurang  Terdengar  ALO jam
suara murmur  Dyspnoe  Inj. Ceftriaxon 2x1
gram
Cardiogenic
PO
 VSD as current
complication  ASA 1 x 100
following IMA  CPG 1 x 75 mg
Atorvastatin 1x40 mg
 ISDN 3 x 5 mg
 Candesartan 1 x 4 mg
 Spirolakton 1 x 25 mg
 Glimepirid 1 x 3 mg
 Digoxin naik 2 x 0,25
mg


Betaone 1 x 2,5 mg
Coralan 1 x 2,5
Pemeriksaan


Furosemid 1 x 40 mg
Pro KRS besok
Harian
Tinjauan
Pustaka
 Definisi
Kondisi tidak tercukupi pasokan darah dan
oksigen ke miokardium akibat adanya thrombus
yang menyumbat arteri coroner dan
menyebabkan nekrosis miokard
 Etiologi

oklusi PJK
Disebabkan Obstruksi
trombus progresif
Patofisiologi
Manifestasi Klinis
Diagnosis
Terapi
Pembahasan
 Dari hasil anamnesa didapatkan pasien menderita Infark Miocard
Acute anterior, dilihat dari pemeriksaan fisik yang didapatkan nyeri dada terus
menerus di bagian bawah sternum serta perut bagian atas serta menjalar hingga
ke punggug. Pasien juga merasakan nafas yang susah saat serangan terjadi, dan
sempat muntah 1x di IGD. Pada hasil lab juga didapatkan hiperkalemi, hal ini
bisa juga dikarenakan Riwayat DM yang dimiliki pasien.

EKG yang didapatkan pada pasien juga mendukung diagnosis IMA

Anterior, dimana didapatkan gambaran ST elevasi pada Lead I, aVl, V1-V3 dan
didapatkan juga peningkatan troponin pada pasien yang menandakan serangan
baru terjadi.
 Didapatkan syok cardiogenic akibat infark pada pasien yang
disebabkan kelemahan otot jantung karena kurangnya suplai oksigen pada
jantung. Di IGD keadaan pasien juga sempat tidak sadar akibat sesak nafas.
Sesak nafas yang terjadi pada pasien akibat syok kardiogenik yang dialami
karena kurangnya aliran oksigen pada tubuh karena tidak adekuatnya pompa
jantung

Ditemukan Acute Lung Oedema yang dilihat melalui auskultasi pada

pemeriksaan fisik yang terdengar adanya bunyi ronchi halus basal pada
permukaan lapang paru pasien akibat dari dekompensasi akut pada gagal
jantung kronik maupun akibat gagal jantung akut pada infark miokard dimana
terjadinya bendungan dan peningkatan tekanan di jantung dan paru karena
melemahnya pompa jantung
 Kenaikan tekanan hidrostatik kapiler paru  transudasi cairan ke
dalam ruang interstisial paru, dimana tekanan hidrostatik kapiler paru lebih
tinggi dari tekanan osmotik koloid plasma. Pada tingkat kritis, ketika ruang
interstitial dan perivaskular sudah terisi, maka peningkatan tekanan hidrostatik
menyebabkan penetrasi cairan ke dalam ruang alveoli. Didapatkan juga adanya
sesak saat beraktifitas, sesak saat berbaring juga karena adanya cardiomegaly

Kenaikan tekanan hidrostatik kapiler paru menyebabkan transudasi

cairan ke dalam ruang interstisial paru, dimana tekanan hidrostatik kapiler paru
lebih tinggi dari tekanan osmotik koloid plasma. Pada tingkat kritis, ketika
ruang interstitial dan perivaskular sudah terisi, maka peningkatan tekanan
hidrostatik menyebabkan penetrasi cairan ke dalam ruang alveoli. Didapatkan
juga adanya sesak saat beraktifitas, sesak saat berbaring juga karena adanya
cardiomegali
 Temuan patologis yang paling umum dari septum infark adalah
nekrosis koagulasi, yang didefinisikan sebagai denaturasi kering protein karena
kekurangan oksigen sebagai akibat dari hilangnya suplai darah. Ini berkembang
menjadi penipisan dan melemahnya septum. Proses ini biasanya memakan
waktu tiga sampai lima hari setelah infark miokard akut. Ruptur septum
ventrikel juga dapat terjadi dalam waktu 24 jam setelah infark miokard karena
diseksi hematoma intramural atau perdarahan ke dalam miokardium yang sakit.
Mekanisme utama di balik ruptur septum ventrikel adalah stresor geser fisik,
terutama di persimpangan area infark dan miokardium sehat yang normal.
Karena mekanisme ini, aneurisma ventrikel, ruptur dinding bebas, atau ruptur
otot papiler berhubungan dengan ruptur septum ventrikel.
1. Terapi yang diberikan pada pasien adalah O2 nasal 4 lpm digunakan untuk
infark miocard dan sesak nafas pasien, untuk mensuplai kekurangan O2
pada pasien dan meredakan sesak nafas
2. Pump heparin 1250 iu/jam digunakan untuk re-oklusi arteri coroner pada
IMA setelah terapi trombolitik
3. nj. Ceftriaxone 2x1 gram yang merupakan antibiotic broad spectrum.
4. Aspirin berfungsi untuk menghambat metabolism prostaglandin. untuk
menghambat agregasi platelet melalui penghambatan thromboxane A2.
5. clopidogrel 1 x 75 mg berfungsi untuk menghambat agregasi thrombus
platelet ADP induced dan harus diberikan segera pada pasien STEMI.
6. atorvastatin 1 x 40 mg untuk menghambat pembentukan thrombus oleh lipid
sehingga mengurangi risiko untuk terjadi sumbatan di cabang lainnya.
7. ISDN 3 x 5 mg Nitrat memiliki peran dalam meningkatkan pelepasan oksida
nitrat dari endotelium yang mengakibatkan vasodilatasi pada bagian arteri
dan vena. Vasodilatasi dapat menurukan preload dan permintaan oksigen
pada miokard. Menurunkan nyeri dada
8. . Candesartan 1 x 4mg n merupakan angiotensin II receptor antagonist
dengan kerja yang mirip seperti losartan. Candesartan digunakan untuk
manajemen hipertensi.
9. Spironolakton 1 x 25 mg Spironolactone merupakan potassium-sparing
diuretic (water pill) yang mencegah tubuh dari penyerapan garam yang
terlalu banyak dan menjaga tubuh dari kekurangan kadar potassium serta
mencegah hipokalemi
10.Glimepirid 1 x 3 mg berguna untuk terapi DM tipe II. Digoxin 2 x 0,25
digunakan untuk menormalkan irama jantung serta membantu pompa
jantung agar lebih kuat
11. Beta one 1 x 2,5 mg mengandung zat aktif Bisoprolol yang merupakan obat
anti hipertensi golongan Beta-Blocker Kardioselektif.
12. Coralan 1 x 2,5 mg menurunkan detak jantung, dapat membantu
meningkatkan fungsi jantung dan kondisi vital.
13.Furosemide 1 x 40mg Loop diuretics (furosemide) dapat menurunkan
preload melalui 2 mekanisme, yaitu: diuresis dan venodilatasi.
Terimaa
kasih
 01 02 03
Methods of
Cause of Death Murder Murder Scene
You can describe the You can describe the You can describe the
topic of the section topic of the section topic of the section
here here here

04 05 06
Evidence of the Emotional
Crime Status Report Situation
You can describe the You can describe the You can describe the
topic of the section topic of the section topic of the section
here here here
 Contents of this template
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How to play a Murder Mystery Game
Do you know what helps you make
your point clear? Lists like this one:

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💣 You can organize your ideas clearly
💣 You’ll never forget to buy milk!

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01
Cause of
Death
You can enter a subtitle
here if you need it
 The foremost roles of the game

Detective Murderer Forensics

Despite being red, Mars

It’s the closest planet to Venus has a beautiful
is actually a cold place.
the Sun and the smallest name and is the second
It’s full of iron oxide
in the Solar System planet from the Sun
dust
 What happened?

Mercury Venus
Mars Mercury is the closest Venus has a beautiful Jupiter
Despite being red, planet to the Sun name, but it is hot It’s the biggest planet
Mars is actually a in the Solar System
cold place

01 02 03 04
 Murder mystery riddles
These mystery cards have some useful clues to solve this murder mystery. Each player can
uncover one card and name one suspect according the riddle in their card.

1 2 3 4
They were Large bank 15 steps I revoke my
wearing black transfer South 30 Will and
steps West testament
 1236
This is a useful clue to solve this mystery murder game
 Forensic evidence

Mercury Venus Mars

It’s the closest planet Venus is the second Mars is actually a
to the Sun planet from the Sun very cold place

Jupiter Saturn Neptune

Jupiter is the biggest It’s composed of It’s the farthest planet
planet of them all hydrogen and helium from the Sun
 What we know about the murder

Neptune 1
Neptune is the
farthest planet
2 Saturn
Yes, Saturn is the
Jupiter ringed one
Jupiter is the
4
biggest planet
Venus
3 Venus has a
beautiful name
 02
Methods of
murder
You can enter a subtitle
here if you need it
 Murder weapons
Venus is the second planet from the Sun. It’s terribly hot,
Venus even hotter than Mercury

It is actually a cold place. It's full of iron oxide dust,

Mars which gives the planet its reddish cast

Jupiter is the biggest planet in the Solar System. It's the

Jupiter fourth-brightest object in the night sky

Saturn is a gas giant and has several rings. It's composed

Saturn mostly of hydrogen and helium
Murder mystery games in the world

Mercury
Mercury is the closest
planet to the Sun

Saturn
Saturn is the ringed one
and a gas giant

Jupiter
It’s the biggest planet in
the Solar System
“The nice thing about your police
procedural as opposed to your
classic murder mystery is that in a
murder mystery you don't know
who did it.”
—Terry Pratchett
03
Murder
Scene
You can enter a subtitle
here if you need it
 Steps to solve a murder

Step 1 Step 2 Step 3 Step 4

Neptune Saturn Mars Mercury

It’s the farthest planet It’s composed of Despite being red, Mercury is the closest
from the Sun hydrogen and helium Mars is a cold place object to the Sun
9h 55m 23s
is Jupiter's rotation period

333,000.000
earths is the Sun’s mass

386,000 km
is the distance between Earth and the Moon
A picture is
worth a
thousand
words
 Analyzing the suspects

Thomas
Mercury is the
closest planet to the 60%
Sun

Alice
Venus is the second
planet from the Sun
80%
Peter
Jupiter is the biggest
planet of them all
40%
 Where were the suspects?

Before During After

Had dinner with He was smoking He was sleeping, but
Thomas Alice, Peter and his outdoors with Peter his wife didn’t know
wife it

Had dinner with She was in her She was talking with
Alice Thomas and Peter bedroom reading a Peter’s wife
book

Had dinner with Alice He was smoking Alice saw him getting
Peter and Peter outdoors with Thomas out from his bedroom
Murder scene reconstruction
Use the furniture and the different elements to
reconstruct the murder scene
 Emotional situation

Angry
20% Mercury is the closest
object to the Sun

Fear
Despite being red,
40% Mars is actually a cold
place

Follow the link in the graph to modify its data and then paste the new one here.
For more info, click here
Murder mystery game online

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 How to solve a murder game app

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Murder game in
your mobile
You can replace the image
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Conclusions
Mercury is the closest planet to
the Sun and the smallest one in
the Solar System—it’s only a bit I
larger than the Moon mu was
rde
Mercury is the god of red
commerce, messenger of the
gods, mediator between gods
and mortals
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 JANUARY FEBRUARY MARCH APRIL MAY JUNE

PHASE 1

Task 1

Task 2

PHASE 2

Task 1

Task 2

JANUARY FEBRUARY MARCH APRIL

PHASE
1

Task 1

Task 2