PEMERIKSAAN PENUNJANG

UNTUK MENYINGKIRKAN
DIAGNOSIS BANDING

EKG
The ECG is pivotal for identifying patients with
ongoing ischemia as the principal reason for their
presentation as well as secondary cardiac
complications of other disorders.
Professional society guidelines recommend that an
ECG be obtained within 10 min of presentation.
ST-segment elevation MI
ST-segment depression and symmetric T-wave
inversions at least 0.2 mV in depth MI in the
absence of STEMI , indicative of higher risk of
death or recurrent ischemia

 Abnormalities of the ST segment and T wave may occur in a

variety of conditions, including pulmonary embolism,
ventricular hypertrophy, acute and chronic pericarditis,
myocarditis, electrolyte imbalance, and metabolic disorders.
Notably, hyperventilation associated with panic disorder can
also lead to nonspecific ST and T-wave abnormalities.
Pulmonary embolism is most often associated with sinus
tachycardia but can also lead to rightward shift of the ECG
axis, manifesting as an S-wave in lead I, with a Q-wave and Twave in lead III
In patients with ST-segment elevation, the presence of diffuse
lead involvement not corresponding to a specific coronary
anatomic distribution and PR-segment depression can aid in
distinguishing pericarditis from acute MI.

RADIOGRAFI DADA
The chest radiograph is most useful for
identifying pulmonary processes, such as
pneumonia or pneumothorax.
Findings are often unremarkable in patients
with ACS, but pulmonary edema may be
evident.
Other specific findings include widening of the
mediastinum in some patients with aortic
dissection, Hamptons hump or Westermarks
sign in patients with pulmonary embolism, or
pericardial calcification in chronic pericarditis.

BIOMARKER JANTUNG
Laboratory testing in patients with acute chest pain
is focused on the detection of myocardial injury.
Because of superior cardiac tissue-specificity
compared with creatine kinase MB, cardiac troponin
is the preferred biomarker for the diagnosis of MI
and should be measured in all patients with
suspected ACS at presentation and repeated in 36
h.
Testing after 6 h is required only when there is
uncertainty regarding the onset of pain or when
stuttering symptoms have occurred.

PX LAB LAIN
Other laboratory assessments may include
the D-dimer test to aid in exclusion of
pulmonary embolism.
Measurement of a B-type natriuretic peptide is
useful when considered in conjunction with
the clinical history and exam for the diagnosis
of heart failure.
B-type natriuretic peptides also provide
prognostic information regarding patients with
ACS and those with pulmonary embolism.

EKOKARDIOGRAFI
in patients with an uncertain diagnosis, particularly
those with nondiagnostic ST elevation, ongoing
symptoms, or hemodynamic instability, detection
of abnormal regional wall motion provides
evidence of possible ischemic dysfunction.
Echocardiography is diagnostic in patients with
mechanical complications of MI or in patients with
pericardial tamponade.
Transthoracic echocardiography is poorly sensitive
for aortic dissection, although an intimal flap may
sometimes be detected in the ascending aorta.

CT-ANGIOGRAPHY
Coronary CT angiography is a sensitive
technique for detection of obstructive
coronary disease, particularly in the proximal
third of the major epicardial coronary arteries.
contrast-enhanced CT can detect focal areas
of myocardial injury in the acute setting as
decreased areas of enhancement.
At the same time, CT angiography can
exclude aortic dissection, pericardial effusion,
and pulmonary embolism.

MRI
Cardiac magnetic resonance (CMR) imaging is an evolving,
versatile technique for structural and functional evaluation of
the heart and the vasculature of the chest.
Gadolinium-enhanced CMR can provide early detection of MI,
defining areas of myocardial necrosis accurately, and can
delineate patterns of myocardial disease that are often useful
in discriminating ischemic from non-ischemic myocardial injury.
CMR can be a useful modality for cardiac structural evaluation
of patients with elevated cardiac troponin levels in the absence
of definite coronary artery disease.
MRI also permits highly accurate assessment for aortic
dissection but is infrequently used as the first test because CT
and transesophageal echocardiography are usually more
practical.