UNSTABLE

ANGINA PECTORIS (UAP)

Presented by:

ANDI BATARI TOJA

Supervisor :

dr. Pendrik Tandean, Sp.PDKKV. FINASIM

CARDIOLOGY DEPARTMENT
MEDICAL FACULTY
MAKASSAR
2015

UAP - CASE REPORT

CARDIOLOGY DEPARTMENT

PATIENTS IDENTITY
Name

: Mr .H H

Age

: 44 years old

Address

: Makassar

Medical record : 694703

Date of admission

: 21 january 2015

UAP - CASE REPORT

CARDIOLOGY DEPARTMENT

HISTORY TAKING
Chief Complaint : Chest pain
Structural anamnesis
It was felt since 2 weeks ago and heavy in 2 hours
before admitted to the hospital. The pain was felt in left
chest, with the characteristic of pressure sensation. The
pain didnt trigger by activity and not relief by rest. Pain
was last more than 20 minutes. Chest pain
accompanied by shortness of breath and sweating. The
patient complaint about tightness while walking since 5
months ago, which became worse, and it was not relief
by rest. DOE (-) PND (-) orthopneu (-)

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CARDIOLOGY DEPARTMENT

PAST MEDICAL HISTORY

History of diabetes (-)
History of hypertension (+) since 17 years old
History of dyslipidemia (-)
History of smoking (+)

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CARDIOLOGY DEPARTMENT

RISK FACTORS
Modifiable

Unmodifiab
le

- Hypertension
- Diabetes Mellitus

- Gender : male
- Age : 44 y.o
- Family history

PHYSICAL
EXAMINATION

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CARDIOLOGY DEPARTMENT

General Appearance :
Moderate-illness /good
nutrition/composmentis

Vital Sign :
BP : 140/80 mmHg
Pulse : 100 x/minute, regular
RR : 20 x/minute ;
Temp : 36,7 C (per axilla)
Head Examination :
Eyes : anemia(-), icterus(-), cyanosis(-)
Neck : JVP R+2 cmH20

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Thoracic Examination :
Inspection : Symmetric left and right
Palpation : No mass, no tenderness
Percussion : Sonor
Auscultation : Breath Sound : vesicular,
Rh -/- , wh -/-

Cardiac Examination :
Inspection : Ictus Cordis not visible
Palpation : Ictus Cordis not palpable
Percussion: Dull, normal limit
Right Border : Linea parasternalis dextra
Left Border: Linea midclavicularis sinistra
Auscultation : Regular of I/II Heart Sound,
murmur (-) gallop (-)

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Abdominal Examination :
Inspection : Convex, following breath
Palpation

unpalpable
Percussion
Auscultation
normal

Extremities :
Oedema (-)

movement
: Liver and spleen

: Tympani
: Peristaltic sound (+),

ECG Examination (21/1/2015)

Rhythm

: Sinus

Heart Rate : 100 bpm

Regularity : Reguler
Axis

: Normo Axis

P Wave

: Normal

PR interval : 0,16
QRS complex

: Normal

ST Segmen : Normal
T wave

: T Inverted
on V2-V6, I, and AvL

Conclusion

: Sinus
rhythm, HR 100
bpm,Normo
Axis,Whole Anterior

LABORATORY FINDINGS (21-1-15)

HEMATOLOGY

VALUE

REFERENCE

UNIT

VALUE
WBC

9,48

4,00-10,0

(10/UI)

RBC

4,19

4,00-6,00

(106/UI)

HGB

13,2

12,0-16,0

(gr/dL)

HCT

38,9

37,0-48,0

(%)

PLT

290

150-400

(103/uL)

GDS

120

140

Mg/dL

Ureum

37

10-50

Mg/dL

Creatinin

1,2

<1,3

Mg/dL

SGOT

16

<38

mmol/L

SGPT

12

<41

Mg/dL

Total Cholesterol

152

200

Mg/dL

HDL Cholesterol

55

L(>55), P(>65)

Mg/dL

LDL Cholesterol

114

<130

Mg/dL

Trygliceride

118

200

Mg/dL

CK

43

L(<190),P(<167)

U/L

CKMB

10,5

<25

U/L

Troponin T

0,02

<0,05

---

Natrium

138

136-145

mmol

Kalium

4,2

3,5-5,1

mmol

Chloride

116

97-111

mmol

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CARDIOLOGY DEPARTMENT

WORKING
DIAGNOSIS
Unstable Angina Pectoris

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MANAGEMENT
O22-4 LPM (via nasal kanul)
Infus NaCl 0,9% 500ml/24 hours
Anti Agregasi Platelet :
Aspilet 80mg/24hours/oral
Clopidogrel 75mg/24hours/oral

Nitrat : Fasorbid 10mg/8hours/oral

Anti coagulant : Arixtra 2,5 mg/24hours/subkutan
Anti hipertensi : ACE-I : Captopril 25mg/8 hours/oral
Laxadine syrup 10 ml/24 hours
Anti ansietas : Alprazolam 0.5 mg/24 hours/oral

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DISCUSSION

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DEFINITION
Angina
pectoris
is
a
syndrome
characterized by chest pain resulting from
an imbalance between O2 supply & demand,
and is most commonly caused by the
inability of atherosclerotic coronary arteries
to perfuse the heart under conditions of
increased myocardial O2 consumption.

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CLASSIFICATION

Based
on
CANADIAN
CARDIOVASCULAR
SOCIETY FUNCTIONAL CLASSIFICATION

CLASS I

No angina with ordinary activity.

Angina with strenuous, rapid or prolonged
exertion.

CLASS II Slight limitation of ordinary

activity ; angina when walking up stairs
briskly, or walking on a cold or windy day.

CLASS III Marked limitation ; angina when

walking at normal pace up flight of stairs, or
walking 1-2 blocks distance.

CLASS IV Angina on minimal exertion or at

rest.

ETIOLOGY

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CARDIOLOGY DEPARTMENT

Plaque rupture
Thrombus formation
Vasospasme of coronary
artery

Cardiology, Desmond G. Julian, J.Campbell Cowan, James M.

McLenachan, 8th edition, Elsevier, 2005

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CARDIOLOGY DEPARTMENT

UAP
If the plaque become unstable caused by
bleeding, rupture, or fissure and result in
thrombus formation which blocked the
vascularisation, angina may occur. Angina
become progressive crescendo and have
no relation to activity. Moreover, angina
can occur anytime, even resting time.
This kind of angina called by the
Unstable Angina Pectoris

CLINICAL
MANIFESTATIONS
Substernal chest pain / chest discomfort radiated to the left
arm, shoulder, neck, jaw. Penetrated to the back.
The chest discomfort may also be described as a dull pain,
pressure, squeezing or crushing sensation or burning
sensation
Duration more than 20 minutes. More intense and persistent

Not fully relieved by rest or nitroglycerine

Often accompanied by systemic symptoms: nausea, vomiting,

palpitation, fatigue, cold sweat, light headness

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CARDIOLOGY DEPARTMENT

CORONARY ARTERY DISEASE

UAP

CAD

ACS

NSTEMI

Stable
Angina
Pectoris

STEMI

DIAGNOSIS

Oxford Handbook of Clinical Medicine 6th

Edition

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CARDIOLOGY DEPARTMENT

Unstable Angina
Therapeutic Goals
Treatment for unstable angina focuses on three
goals:
Stabilizing any plaques that may have
ruptured in order to prevent a heart attack,
Relieving symptoms
Treating the underlying coronary artery
disease (CAD).

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MANAGEMENT

http://www.cardiosmart.org/HeartDisease

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THANK YOU