ANGINA PEKTORIS

Definitions Angina is the clinic pektoris marked with malaise or pain in the chest due to heart muscle iskemia network. The clinical forms of angina divided in two forms, namely stable angina and unstable. Angina is an unstable form of a more serious that can be become and / or is a form of early infark so miokard people need to be examined further and diobservasi in the hospital. Causes Iskemia this occurred because the supply of oxygen carried by the coronary blood flow not sufficient oxygen miokardium needs. This occurs when the demand miokardium increased oxygen (for example, because of physical, emotional, tirotoksikosis, hypertension), or when the coronary blood flow is reduced (for example, or on spasme trombus coronary) or when they occur. Clinical picture - People complain of chest pain and various forms of location. - Nyeri started feeling as terhimpit, feeling squeezed or feel the burn spread to the inside of the left arm and sometimes up to the neck, shoulder neck and left, even to the left pinkie. - The same can be spread to the waist, throat, teeth and jaw also have to submit the right arm. - Men do not feel can be felt also in the Ulu heart, but rarely felt in the region apeks kordis. - Pain may be accompanied by painful beberapan or one of the following symptoms: sweating cold, nausea and vomiting, feeling weak, feeling the pulse and fainting (fainting). - Usually angina occur when physical activity (stable angina). - The attack will be lost if patients stop the physical activity is and rest. - The attack lasted only a few minutes (1 - 5 minutes) but can be up to more than 20 minutes. - Nyeri angina is constant. When changes occur, for example long attacks increased, more intense pain, the incidence of attacks threshold Basic guidelines Medicine Clinic in 2007 17 - Decreased or when the attack came up to bed, then the interference is necessary to diwaspadai. This change may be a sign prainfark (angina not stable). - A form of change (variant), which is called angina Prinzmetal usually arise when people are resting. - Angina said gain weight when the attack occurred after the next physical work that is lighter, for example, after eating. This is also classified unstable angina. - Check out the physical attack does not generally show a deviation means. At the time of attacks, increased heart rate, blood pressure and increased in the region prekordium hard jolt the heart feels. - On auskultasi, the voice sounded much the heart, the sound noisy sistolik mid or late sistol and heard the sound of the fourth. - Usually found risk factors: hypertension, or diabetes melitus Obesity. Diagnosis - Retrosternal chest pain - Checking EKG Penatalaksanaan - Aberration preference angina pektoris be searched, then reduced or treated. Factors that aggravate such as smoking, body weight excessive, drinking habits and coffee should be avoided. - High blood pressure treated. - Stress is - Angina is not stable, it is treated in the hospital. 1. Treatment of acute - Acute attacks with the rest in order to overcome the heart of activity is reduced. Vasodilator work to improve the provision of oxygen and reduce oxygen consumption, heart. - Sublingual nitroglycerine 0.15 - 0.6 mg is very effective. Tablet can be used several times each day without side effects except headaches. 1 When the tablet has not been repeated may help, but when repeated after 3 times symptoms do not diminish the possibility has occurred infark. - Isosorbid dinitrat (ISDN) sublingual 2.5 - 5 mg can also be repeated oral tablet or 5 - 30 mg. Basic guidelines Medicine Clinic in 2007 18 2. Prevention of attacks - Propranolol for angina pektoris effective because it can reduce the work heart muscle so that the heart needs oxygen. Effect clinic propranolol achieved when the heart rate in the rest 60 - 70 times / minute. Initial dose: 20 mg x 2 a day. Maximum dose: 120 mg a day. This medicine should not be used in angina Prinzmetal. - Nitrate working long: ISDN oral tablet 10 - 20 mg x 2 a day. - Nifedipin 10 - 20 x 4 mg a day, or diltiazem 30 - 60mg x 3 a day, verapamil or 40 - 80mg x 3 a day. - Angina unstable: need special care. - Angina variants: strong dilator: nitrate, calcium antagonis, prazosin 0.5 - 1mg X 3 a day with titrasi.
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