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Luke Bennett
Luke Bennett

Laporan Pendahuluan Chest Pain Pdf

Due to ineffective erythropoiesis and bone marrow failure, patients experience a variety of symptoms including recurrent infections, anemia, easy bruising, excessive bleeding, headaches, and bone pains. Depending on the degree of anemia, they can experience generalized weakness, fatigue, shortness of breath, and chest tightness. The physical examination can reveal bruises, pallor, hepatomegaly, and splenomegaly. Lymphadenopathy is rare. DIC is common in patients with AML. Signs of organ infiltration are not uncommon; they may include hepatosplenomegaly and lymphadenopathy. Sometimes a skin rash due to infiltration of leukemic cells will occur.

Laporan pendahuluan chest pain pdf

Aortic dissection is the surging of blood through a tear in the aortic intima with separation of the intima and media and creation of a false lumen (channel). The intimal tear may be a primary event or secondary to hemorrhage within the media. The dissection may occur anywhere along the aorta and extend proximally or distally into other arteries. Hypertension is an important contributor. Symptoms and signs include abrupt onset of tearing chest or back pain, and dissection may result in aortic regurgitation and compromised circulation in branch arteries. Diagnosis is by imaging tests (eg, transesophageal echocardiography, CT angiography, MRI, contrast aortography). Treatment always involves strict blood pressure control and serial imaging to monitor progression of dissection. Surgical repair of the aorta and placement of a synthetic graft are needed for ascending aortic dissection and for certain descending aortic dissections. Endovascular stent grafts are an option for some descending dissectionsused for certain patients, especially when dissection involves the descending thoracic aorta.

Aortic dissection must be considered in any patient with chest pain, thoracic back pain, unexplained syncope, unexplained abdominal pain, stroke, or acute-onset heart failure, especially when pulses or blood pressures in the limbs are unequal. Such patients require a chest x-ray; in 60 to 90%, the mediastinal shadow is widened, usually with a localized bulge signifying the site of origin. Left pleural effusion is common.

Patients presenting with acute chest pain, electrocardiography (ECG) changes of acute inferior myocardial infarction, and a previously undocumented murmur of aortic insufficiency (AI) are of particular concern for a type I aortic dissection into the right coronary artery (causing inferior myocardial infarction), and the aortic valve (causing AI).

MRA has nearly 100% sensitivity and specificity for aortic dissection. But it is time-consuming and ill-suited for emergencies. It is probably best used for stable patients with subacute or chronic chest pain when dissection is suspected.


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