1.

Cardovascular

a. Stable Angina

Pain in the chest that subsides when resting and triggered with

activity. b. Unstable Angina

Pain that does not disappear when resting and can arise at any time. c. Acute myocardial infarction

Pain such as squeezing and radiating to the arms and neck, appears

attack and last up to 30 minutes or more. And pain subsides after

administration of nitroglycerin tablets. d. Myocarditis

Pain in myocarditis is usually characterized by fever

e. Pericardiac

IndonesiaPain caused by pericarditis can be blunt and sharp, painful

will increase when supine, when coughing, inspiration and will improve if

sitting leaning forward. f. Acute aortic dissection

Tearing of the aorta is caused by various things such as trauma, hypertension. Pain felt on the chest can
spread to the back. 2. Repiratory

a. Pulmonary Embolism

Pulmonary embolism can cause pain in the chest, on examination

physical edema usually occurs in the legs, dipsnue and there can be pain

during breathing. b. Pleuritis

There is pain during breathing and fever

c. Pneumothorax

History of trauma, physical examination found breath sounds

lost / weakened on one side, tracheal deviation

d. Pneumonia

in severe pneumonia patients, there can be pain in the chest. On physical examination can be found
crackles and fever. 3. Gastro Intestinal
a. Gastro Esophageal Reflux Disease

Pain often arises after eating and will increase pain when

lie down. Antacid administration responds well. The taste is like

burning, sore, nausea and vomiting and bitter taste in the mouth. b. Peptic Ulcer Disease

Pain in epigastric suppression, and need to be explored for use

NSAIDs and herbal entertainment. Pain can occur after eating or even

improve if after eating depends on the location of the ulcer. c. Cholycistitis

There is tenderness in the right quonscious over the abdomen.

Symptoms are given like angina and are not specific.

4. Musculoskeletal

a. Costhocondritis

The presence of inflammation in the cost bone causes chest pain. And pain

will increase with emphasis. b. Muscle spasm

Heavy activities such as lifting weights, work using chest muscles

excessive can cause chest pain. c. Rib fracture

Pain will increase if the patient is told to raise his hand up

indicates the presence of musculoskeletal lesions

5. Devotion

a. If there is no abnormality in the physical examination and support, the problem is

psychology is the most recent diagnosis.

IndonesiaPathomechanism of chest pain

1. Narrowing of the coronary arteries occurs

Like other organs, the coronary arteries in the body also experience the aging process. Where there is a
process such as thickening of the intima layer, reduced elasticity of calcium buildup, and increased
diametration of the intima layer.
At the age of 10 years coronary arteries are still in normal condition, along with eating time fat lines will
be formed, added by risk factors then the fat line will become a fibrus plaque, then into complex lesions,
there will be grafted fibrus plaque

2. Reduced oxygen supply

If myocardial oxygen demand increases, the supply of oxygen must also increase. To increase the supply
of adequate amounts of oxygen, coronary artery flow must be increased, because myocardial oxygen
extraction from arterial blood is almost maximal, at rest. Normal coronary vessels can widen and
increase blood flow around 5-6x above the resting level. However, the blood vessels that are disrupted
cannot widen, resulting in a lack of oxygen if the oxygen demand increases over the capacity of the
vessels to increase flow

3. Ischemia occurs

Ischemia is a temporary lack of oxygen and is reversible.

4. Myocardial infarction occurs

Long ischemia will cause muscle death or myocardial infarction / infarction

5. The occurrence of emphasis on nerves

6. Pain.

Causes of paleness, cold skin, sweating & weakening pulse

Cardiogenic shock occurs when pump work or the heart becomes inefficient so that cardiac output
decreases and tissue perfusion is inadequate. Classic cardiogenic shock is associated with systolic
dysfunction or the inability of the heart to pump blood. The result, is a decrease in volume as soon as
possible and then the cardiac output will decrease. The work of the heart can be inefficient due to
various things including myocardial infarction (in particular, any significant disturbance in the left
ventricular myocardium, especially in patients with ischemic heart disease) and pulmonary embolism.

Symptoms vary according to circumstances that cause pumping failure. Because of reduced cardiac
output, stimulation of the sympathetic nervous system and decreased peripheral perfusion the
nonspecific symptoms include cold and wet skin, decreased pulse pressure with a weak peripheral pulse,
feelings of fatigue, weakness and hypotension. (Oman Kathleen. S, et al. (2002). Emergency Nursing
Study Guide Jakarta: Medical Book EGC)

Relationship to smoking history with thrombosis

It is known that smoking triggers atherosclerotic plaques. This plaque triggers hypertension and
occlusion of the heart blood vessels including the coronary arteries. Myocardial ischemia occurs which
will eventually cause pain in the chest through the mechanism described above.
Previously it was known that thrombosis is a term commonly used for blood vessel blockage, both
arteries and veins. Nicotine activates platelets with the result of platelet adhesion (clotting) to the walls
of blood vessels.

The contents of cigarettes: cigarettes contain thousands of chemical compounds that are toxic,
carcinogenic, and terotogenik. The chemical compounds contained in cigarettes include nicotine, tar,
caffeine, diethyl ether, polyphenols, naphthalene, and other dangerous compounds. Chemical
compounds in cigarettes reduce HDL in the body resulting in atherosclerotic plaques, for example in the
coronary arteries. This plaque easily triggers thrombosis that forms a thrombus resulting in myocardial
ischemia which causes chest pain.