IN ENGLISH

1. BIOMEDIK ASPEK

Anatomi

The heart is located above the diaphragm, in the middle of the chest cavity to the left, in a
room called the mediastinum. Next to the front of the heart, the heart is limited by the
sternum, in the back by the arrangement of the spine or vertebral column. On the left and
right side, the heart is limited by the lungs.

The heart has a cavity in it. The cavity inside the heart consists from 4 spaces, namely 2
upper space and 2 lower ventricle space. The size of the roof is approximately the size of the
individual fist of the owner. The end of the heart is called the apex, and the base which leads
upward is called the heart base, which is formed from the atrium, especially the left atrium.
The atrium serves to fill the blood into the ventricles that he receives from the vena cava.
Whereas the ventricles,serves to drain blood to the truncus pulmonalis.

A pocket-shaped structure that encloses and protects the heart is called the Pericardium. The
pericardium consists of two parts, namely fibrous pericardium and serous pericardium. The
fibrous pericardium located on the outside is formed from a rigid, inelastic fibrous connective
tissue. While the serous pericardium is the innermost layer of the pericardium. Serous
pericardium is divided into two layers, namely the outer layer called the parietal layer and the
visceral layer

Inside the heart there are 2 Atrioventricular valves namely :

1. Bikuspidalis / mitral valve that is between the right atrium and the right ventricle

2. The tricuspidal valve is between the left atrium and the ventricle

In addition to the atrioventricular valve, there are also 2 Semilunar Valves, namely :

1. Pulmonary valve

2. Aortic valve

2. Patomekanism and patofisiologi of the chest pain

- Patomekanisme

Pathomechanism of the occurrence of chest pain:

Chest pain in the cardiovascular system is caused by a lack of supply of O2 in the blood
vessels in the heart, its compensation changes metabolism from aerobes to anaerobes, there is
accumulation of lactic acid, spurred pain receptors in the heart (bradykinin), chest pain
occurs.

-Patofisiologi
Atherosclerosis process → blockage of blood vessel → demand O2 increases → anaerobic
process → chest pain

The occurrence of endothelial dysfunction in the coronary arteries which can occur naturally
through degeneration can also be caused by several risk factors such as smoking. Due to the
presence of endothelial dysfunction, increased permeability, increased adhesion and
infiltration of monocytes, increased vasoactive and inflammatory molecular secretions,
increased platelet adhesion and aggregation, and increased coagulation activity and
fibrinolytic disorders. Endothelial dysfunction also results in easy LDL small dense
molecules infiltrating into the intima tunica. LDL entering the tunica intima is still closely
related to endothelial dysfunction which can invite monocytes to clear LDL in the intima by
phagocytes. The phagocyte LDL becomes macrophages that contain LDL-LDL and then
lysis, so that many fats are in the intima tunica. There is a build-up of the fat which later
becomes plaque. Plaques that are getting longer will accumulate will inhibit blood flow, so
that it can affect the supply of blood that transports oxygen to the tissue decreases. Therefore,
the body compensates so that less blood-flowing tissue will still obtain oxygen from the
anaerobic process. Where the anaerobic process occurs the breakdown of glucose into lactic
acid. Lactic acid itself will activate pain stimuli at the site of the obstacle, namely in the
coronary artery.

3. Explain patomekanism of each symptom

-Fever patomekanism

The word fever refers to an increase in body temperature due to infection or inflammation. In
response to the entry of microbes, certain phagocytic cells (macrophages) secrete a chemical
known as endogenous pyrogens that act on the hypothalamic thermoregulation center to
increase the benchmark thermostat. The hypothalamus now maintains temperature at a new
level and does not maintain it at normal body temperature. for example, endogenous
pyrogens increase the benchmark point to 102 ° F (38.9 ° C), the hypothalamus detects that
the pre-fever normal temperature is too cold so that this part of the brain triggers cold
response mechanisms to increase the temperature to 102 ° F. So that there is a fever.

-Takikardi patomekanism

If inflammation reaches the heart, it can cause a buildup of fluid in the pericardial cavity
called pericardial effusion. The hemodynamic effect of pericardial effusion is determined by
the amount and speed of formation of pericardial fluid. Large or rapid effusions will quickly
inhibit ventricular filling, decrease in final diastolic volume. So that cardiac output is as close
as possible and a minute is reduced and the compensation is tachycardia.

-Limfadenopati patomekanism

Lymph nodes (KGB) are part of our body's defense system. In healthy people, it is normally
palpable in the sub mandibular, axillary and inguinal regions. KGB is composed of a
collection of cells that form the body's defenses and is a place for filtering antigens from
lymph vessels who passed it. If there are antigens that pass through the KGB, then
many body defense cells will be produced to overcome the antigen. So the KGB is enlarged.
Enlargement comes from the addition of body defense cells from the KGB itself such as
lymphocytes, plasma cells, monocytes, etc., to deal with infections that occur due to the
arrival of inflammatory cells.

-3 sound component patomekanism

There are 3 sound compositions in the presystolic, systolic, and diastolic sounds as
"scratching" or "grunting" or the sound of walking on snow, also called Pericardial Friction
Rub. Pericardial Friction Rub sound most clearly in the lower left sternum, more clearly if the
patient is sitting and leaning forward. Pericardial friction rubs are often inconsistently found
and can sometimes disappear in some time so repeated examinations need to be done if
effusions occur in large amounts and there will be a heart temponade.

4. causes flu-like illness

Flu-like illness is a symptom or clinical sign that resembles flu, which is caused by the
mechanism of the body's immune response to viral infections, but not influenza viruses.
Relationship to chest pain with flu like illness is chest pain caused by an infection of
the virus that initially infects the respiratory tract. Therefore, flu symptoms are formed as a
clinical manifestation of infection with the virus.

5 -. feel pain when he deeply breathing

Breathe -> lungs filled with air -> lung volume increases -> lungs expand -> space between
the lungs and heart narrows -> pleura and inflamed pericard rub against each other -> CHEST
PAIN

In this case there is inflammation of the pericardium so when we breathe, the boundary
between the pleura and the pericardium gets narrower as a result of pleural and pericardium
friction which causes the chest to feel more painful.

-Improved pain when leaning forward?

When driving to the front of the piston and cost can be more widespread, so that when
breathing the space between the pleura and pericardium is wider, when during breathing there
is no pleural and pericardium friction which reduces pain.

6. The appearance of clear mucus in the nasal cavity, and mild erythema in the
oropharynx

Occurrence of clear mucus and mild erythema in the oropharynx caused by the infection
process. In clear mucus itself indicates that the infection is caused by a virus, not bacteria.

7. Why the examination of abdomen in extremitas normal

Based on DD and DS, pure chest pain occurs due to abnormalities of the heart, which do not
cause abnormalities or disorders of the extremities and abdomen. This is what causes a
normal examination of the abdomen and extremities.

8. What the meaning of 3 high intensiti of sound component

The three sound components with high intensity that are referred to are presystolic, systolic,
and diastolic, sounding as "scratching" or "grunting" or the sound of walking on snow, which
is also called Pericardial Friction Rub. Pericardial Friction Rub is a medical sign used to
diagnose pericarditis, the cause is most likely because inflammation of the pericardium
causes the walls to rub against each other, and this friction which is then clearly heard by
auscultation.

9. Are There Age Associations with Symptoms of Chest Pain in Patients

In these cases there are symptoms of fever that are caused by infection by pathogenic
creatures that enter the body, causing inflammation of the heart and causing pericarditis. so
the immune system works to compensate for the incoming pathogen. So that the ability of the
immune system is the main defense for the body, but many factors cause the immune system
not to work maximally, for example the body is attacked by the HIV virus, an autoimmune
process occurs in the body, and an age factor. . Age factors make all metabolic processes in
the body will not work well as when a person is young, including the immune system will
decrease the intensity of the immune work, so that pathogens will easily replicate when
attacking the body. But, basically,in that case the age factor will not be too influential
because this is again due to the influence of infection by pathogenic creatures, in which the
infection itself can attack in any age group. So the conclusion is that age is not too influential.