Seorang Pasien Penyakit Jantung Koroner dengan “Silent Angina”

Abstract

Abstract: Coronary artery disease (CAD) is the leading cause of death for men and women in the United States. Prevalence of CAD in Indonesia in 2013 based on doctor’s diagnosis was 0.5%. Clinical manifestations of CAD may vary from asymptomatic (silent angina) to sudden cardiac death. Episodes of this asymptomatic myocardial ischemia were approximately 25-50% in CAD. Diagnostic criteria of CAD are clinical manifestation, laboratory examination, ECG, and cardiac catheterization. Management of CAD patients consists of lifestyle modification, pharmacological therapy, and myocardial revascularization. We reported a male aged 50 years with reccurent epigastric pain. Echocardiography resulted in mild MR cc annulus dilatation with ischemia as the differential diagnosis. The angiography revealed 80% stenosis in the proximal RCA and distal RCA as well as 70% stenosis in mid LAD. A percutaneous coronary intervention (PCI) was performed on this patient with BMS stent in mid RCA, DES stent in proximal RCA, and POBA in mid LAD. The patients was treated with Thrombo aspilets, clopidogrel, simvastatin, lisinopril, and Nitrokaf retard. The general condition of the patient was good without any complaint. Modification of changeable risk factors had been done. The five-year survival rate of this patient was 70% with dubia prognosis.

Keywords: coronary artery disease, silent angina

Abstrak: Penyakit jantung koroner (PJK) merupakan penyebab utama kematian pria dan wanita di Amerika Serikat. Manifestasi klinis PJK dapat bervariasi mulai dari tanpa gejala (silent angina) hingga kematian mendadak. Angka kejadian silent angina berkisar 25%-50% dari keseluruhan PJK. Pemeriksaan penunjang yang diperlukan antara lain EKG, ekokardiografi, enzim jantung, CT kardiak, treadmill test, hingga pemeriksaan invasif seperti kateterisasi jantung. Penatalaksanaan PJK meliputi penangangan non farmakologik dan farmakologik. Penanganan non farmakologik berupa modifikasi gaya hidup, sedangkan terapi farmakologik berupa obat-obatan sampai pada revaskularisasi jantung. Kami melaporkan seorang penderita PJK laki-laki berusia 50 tahun dengan keluhan utama nyeri ulu hati hilang timbul. Hasil ekokardiografi menyimpulkan MR mild cc dilatasi anulus dd iskemik. Pemeriksaan angiografi mendapatkan stenosis 80% di proksimal RCA, dan distal RCA, stenosis 70% di mid LAD. Pada penderita ini dilakukan intervensi koroner perkutan dan dilakukan pemasangan stent BMS pada mid RCA, stent DES pada proksimal RCA, POBA pada mid LAD. Pengobatan yang diberikan ialah Thrombo aspilets, clopidogrel, simvastatin, lisinopril, dan Nitrokaf retard. Keadaan umum penderita baik, keluhan menghilang dan telah dilakukan upaya modifikasi terhadap faktor risiko yang bisa diubah. Five-year survival rate penderita ini 70% dengan prognosis dubia.

Kata kunci: penyakit jantung koroner, silent angina