Manajemen Sindrom Koroner Kronik: Laporan Kasus
DOI:
https://doi.org/10.35790/msj.v7i2.59509Abstract
Abstract: Over the last decades, the management of chronic coronary syndromes (CCS) has improved rapidly that contributes in the decreasing of cardiovascular mortality. After myocardial infarction, the patient’s condition can improve with the usage of reperfusion therapy with thrombolysis or primary angioplasty and preventive treatment with aspirin and antiplatelet agents, statin, beta-blockers, and renin-angiotensin antagonists. Moreover, percutaneous coronary intervention (PCI) can improve the survival of patients suffering from acute coronary syndrome (ACS). We reported a 49-year-old man, who complained of chest pain for the last one year, which worsened with activity. One day before hospitalization, the chest pain worsened. The patient was diagnosed with CCS CCS (Chronic Coronary Syndrome Canadian Cardiovascular Society) II-III, GERD, hyponatremia, dyslipidemia, hyperuricemia, and dyspepsia. After further examination, a RF-CL of 20% (moderate) was obtained. A Dobutamine Stress Echocardiography examination was carried out resulting a positive ischemic response, then DCA-PCI was performed. The patient went home without any complaints. The management of this patient from diagnosis to therapy is in accordance with the ESC CCS 2024 guidelines. In conclusion, regarding the importance of acute chest pain management, patients with chest pain should not be underestimated and there are many modalities that can be used to confirm the diagnosis of chronic coronary syndromes.
Keywords: chronic coronary syndrome; dobutamin stress echocardiography; percutaneous coronary intervention; risk factor-clinical likelihood
Abstrak: Selama beberapa dekade terakhir, manajemen sindrom koroner kronis telah meningkat pesat yang menyebabkan mortalitas kardiovaskular telah menurun secara stabil. Kondisi pasien setelah infark miokard dapat menjadi lebih optimal dengan adanya terapi reperfusi dengan trombolisis atau angioplasti primer dan terapi pencegahan seperti aspirin dan agen antiplatelet lainnya, statin, beta-blocker, dan antagonis renin-angiotensin. Intervensi koroner perkutan (IKP) dapat meningkatkan kelangsungan hidup pasien yang mengalami sindrom koroner akut (SKA). Kami melaporkan seorang laki-laki berusia 49 tahun, dengan keluhan nyeri dada sejak 1 tahun terakhir, diperberat dengan aktivitas. Sehari sebelum masuk rumah sakit, nyeri dada dirasakan memberat. Pasien didiagnosis dengan sindroma koroner kronik CCS CCS (Chronic Coronary Syndrome Canadian Cardiovascular Society) II-III, GERD, hiponatremia, dislipidemia, hiperurisemia, dan dispepsia. Pada pemeriksaan lanjut, didapatkan RF-CL 20% (moderate), kemudian dilakukan pemeriksaan dobutamin stress echocardiography dan didapatkan hasil iskemik respons positif, sehingga dilanjutkan dengan IKP. Penatalaksanaan pasien ini sejak konfirmasi diagnosis sampai terapi telah sesuai dengan Guidelines ESC CCS 2024. Pasien dipulangkan dengan tidak ada keluhan. Simpulan kasus ini ialah terkait tatalaksana nyeri dada akut, pasien dengan nyeri dada tidak boleh diremehkan, dan telah banyak modalitas yang dapat digunakan untuk mendiagnosis sindroma koroner kronik.
Kata kunci: sindrom koroner kronik; dobutamin stress echocardiography; intervensi koroner perkutan; risk factor-clinical likelihood
References
Sorbets E, Fox KM, Elbez Y, Danchin N, Dorian P, Ferrari R, et al. 2019. Long-term outcomes of chronic coronary syndrome worldwide: insights from the international CLARIFY registry. Eur Heart J. 2020;41(3):347–56. Doi: 10.1093/eurheartj/ehz660
Vrints C, Andreotti F, Koskinas KC, Rosello X, Adamo M, Ainslie J, et al. 2024 ESC Guidelines for the management of chronic coronary syndromes. Eur Heart J. 2024;45(36):3415-537. Doi: 10.1093/eurheartj/ehae177
Rasmussen LD, Williams MC, Newby DE, Dahl JN, Schmidt SE, Bottcher M, et al. External validation of novel clinical likelihood models to predict obstructive coronary artery disease and prognosis. Open Heart. 2023;10(2):1-8. Doi: 10.1136/openhrt-2023-002457
Saraste A, Barbato E, Capodanno D, Edvardsen T, Prescott E, Anchenbach S, et al. Imaging in ESC clinical guidelines: chronic coronary syndromes. Eur Heart J Cardiovasc Imaging. 2019;20(11):1187-97. Doi: 10.1093/ehjci/jez219.
Lala RI, Mercea S, Jipa RA, Puschita M, Moldovan AP. The chronic coronary syndrome-Heart failure roundabout: A multimodality imaging workflow approach. Front Cardiovasc Med. 2022;9:1-8. Doi: 10.3389/fcvm.2022.1019529
Mafrica D, Franculli G, Esposito A, Sarto G, Sabouret P, Biondizoccai G. Chronic coronary syndromes: diagnosis, management and gaps in evidence. Heart, Vessels and Transplantation. 2024;8(3):391-410. Doi: 10.24969/hvt.2024.508
Gosciniak EP, Gackowski A, Kukulski T, Kasprzak JD, Szyszka A, Braksator W, et al. Stress echocardiography. Part I: Stress echocardiography in coronary heart disease. J Ultrason. 2019;19(76):45–8. Doi: 10.15557/JoU.2019.0006
Pelika PA, Olson AA, Chaudhry FA, Chen MH, Marshall JE, Porter TR. Guidelines for performance, interpretation, and application of stress echocardiography in ischemic heart disease: from the American Society of Echocardiography. J Am Soc Echocardiogr. 2020;33(1):1-34. Available from: doi.org/10.1016/j.echo.2019.07.001
Kadoglou NPE, Papadopoulos CH, Khattab E, Velidakis N, Lambropoulos S. The diagnostic value of stress echocardiography with limited myocardial ischemia in high-risk patients. Hellenic J Cardiol. 2024;S1109-9666(23)00233-6. Doi: 10.1016/j.hjc.2023.12.007.
Kossaify A, Elie B, Kossaify M. Stress Echocardiography: Concept and Criteria, Structure and Steps, Obstacles and Outcomes, Focused Update and Review. Cardiol Res. 2020;11(2):89-96. Doi: 10.14740/cr851
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