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7/21/2019 PEMERIKSAAN PENUNJANG & DD ANGINA PEKTORIS

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PEMERIKSAAN PENUNJANG

UNTUK MENYINGKIRKAN

DIAGNOSIS BANDING



EKG

• The ECG is pivotal for ie!tif"i!# patie!ts $itho!#oi!# is%he&ia as the pri!%ipal reaso! for theirprese!tatio! as $ell as se%o!ar" %aria%%o&pli%atio!s of other isorers'

• Professio!al so%iet" #(ieli!es re%o&&e! that a!ECG )e o)tai!e $ithi! *+ &i! of prese!tatio!'

• ST,se#&e!t elevatio! MI

• ST,se#&e!t epressio! a! s"&&etri% T,$ave

i!versio!s at least +'- &. i! epth MI i! thea)se!%e of STEMI / i!i%ative of hi#her ris0 ofeath or re%(rre!t is%he&ia



• A)!or&alities of the ST se#&e!t a! T $ave &a" o%%(r i! avariet" of %o!itio!s/ i!%l(i!# p(l&o!ar" e&)olis&/ve!tri%(lar h"pertroph"/ a%(te a! %hro!i% peri%aritis/&"o%aritis/ ele%trol"te i&)ala!%e/ a! &eta)oli% isorers'

• Nota)l"/ h"perve!tilatio! asso%iate $ith pa!i% isorer %a!also lea to !o!spe%i1% ST a! T,$ave a)!or&alities'

• P(l&o!ar" e&)olis& is &ost ofte! asso%iate $ith si!(sta%h"%aria )(t %a! also lea to ri#ht$ar shift of the ECGa2is/ &a!ifesti!# as a! S,$ave i! lea I/ $ith a 3,$ave a! T,$ave i! lea III

• I! patie!ts $ith ST,se#&e!t elevatio!/ the prese!%e of i4(selea i!volve&e!t !ot %orrespo!i!# to a spe%i1% %oro!ar"a!ato&i% istri)(tio! a! PR,se#&e!t epressio! %a! ai i!isti!#(ishi!# peri%aritis fro& a%(te MI'



RADIOGRA5I DADA

• The %hest raio#raph is &ost (sef(l forie!tif"i!# p(l&o!ar" pro%esses/ s(%h asp!e(&o!ia or p!e(&othora2'

•

5i!i!#s are ofte! (!re&ar0a)le i! patie!ts$ith ACS/ )(t p(l&o!ar" ee&a &a" )eevie!t'

• Other spe%i1% 1!i!#s i!%l(e $ie!i!# of the

&eiasti!(& i! so&e patie!ts $ith aorti%isse%tio!/ 6a&pto!7s h(&p or 8ester&ar07ssi#! i! patie!ts $ith p(l&o!ar" e&)olis&/ orperi%arial %al%i1%atio! i! %hro!i% peri%aritis'



BIOMARKER JANTUNG

• 9a)orator" testi!# i! patie!ts $ith a%(te %hest pai!is fo%(se o! the ete%tio! of &"o%arial i!:(r"'

• Be%a(se of s(perior %aria% tiss(e,spe%i1%it"%o&pare $ith %reati!e 0i!ase MB/ %aria% tropo!i!

is the preferre )io&ar0er for the ia#!osis of MIa! sho(l )e &eas(re i! all patie!ts $iths(spe%te ACS at prese!tatio! a! repeate i! ;<=h'

• Testi!# after = h is re>(ire o!l" $he! there is(!%ertai!t" re#ari!# the o!set of pai! or $he!st(tteri!# s"&pto&s have o%%(rre'



P? 9AB 9AIN

• Other la)orator" assess&e!ts &a" i!%l(ethe D,i&er test to ai i! e2%l(sio! ofp(l&o!ar" e&)olis&'

•

Meas(re&e!t of a B,t"pe !atri(reti% peptie is(sef(l $he! %o!siere i! %o!:(!%tio! $iththe %li!i%al histor" a! e2a& for the ia#!osisof heart fail(re'

•

B,t"pe !atri(reti% pepties also proviepro#!osti% i!for&atio! re#ari!# patie!ts $ithACS a! those $ith p(l&o!ar" e&)olis&'



EKOKARDIOGRA5I

• i! patie!ts $ith a! (!%ertai! ia#!osis/ parti%(larl"those $ith !o!ia#!osti% ST elevatio!/ o!#oi!#s"&pto&s/ or he&o"!a&i% i!sta)ilit"/ ete%tio!of a)!or&al re#io!al $all &otio! provies

evie!%e of possi)le is%he&i% "sf(!%tio!'• E%ho%ario#raph" is ia#!osti% i! patie!ts $ith

&e%ha!i%al %o&pli%atio!s of MI or i! patie!ts $ithperi%arial ta&po!ae'

• Tra!sthora%i% e%ho%ario#raph" is poorl" se!sitivefor aorti% isse%tio!/ altho(#h a! i!ti&al @ap &a"so&eti&es )e ete%te i! the as%e!i!# aorta'





CT,ANGIOGRAP6Y

• Coro!ar" CT a!#io#raph" is a se!sitivete%h!i>(e for ete%tio! of o)str(%tive%oro!ar" isease/ parti%(larl" i! the pro2i&al

thir of the &a:or epi%arial %oro!ar" arteries'• %o!trast,e!ha!%e CT %a! ete%t fo%al areas

of &"o%arial i!:(r" i! the a%(te setti!# ase%rease areas of e!ha!%e&e!t'

•

At the sa&e ti&e/ CT a!#io#raph" %a!e2%l(e aorti% isse%tio!/ peri%arial e4(sio!/a! p(l&o!ar" e&)olis&'





MRI

• Caria% &a#!eti% reso!a!%e CMR i&a#i!# is a! evolvi!#/versatile te%h!i>(e for str(%t(ral a! f(!%tio!al eval(atio! ofthe heart a! the vas%(lat(re of the %hest'

• Gaoli!i(&,e!ha!%e CMR %a! provie earl" ete%tio! of MI/e1!i!# areas of &"o%arial !e%rosis a%%(ratel"/ a! %a!

eli!eate patter!s of &"o%arial isease that are ofte! (sef(li! is%ri&i!ati!# is%he&i% fro& !o!,is%he&i% &"o%arial i!:(r"'

• CMR %a! )e a (sef(l &oalit" for %aria% str(%t(ral eval(atio!of patie!ts $ith elevate %aria% tropo!i! levels i! the a)se!%eof e1!ite %oro!ar" arter" isease'

• MRI also per&its hi#hl" a%%(rate assess&e!t for aorti%isse%tio! )(t is i!fre>(e!tl" (se as the 1rst test )e%a(se CTa! tra!sesopha#eal e%ho%ario#raph" are (s(all" &orepra%ti%al'

