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    Presented By: Ayu Aqilah Binti Khazani Nurul Dhiya Binti Hassannuddin Narisa Samaradhantia Supervisor: DR .Dr. Khalid Saleh SPPD-KKV, Finasim

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    The document describes a 47-year-old male patient presenting with chest pain. Examination found elevated cardiac enzymes and ECG showing ST elevation. He has a history of smoking 2 packs per day. He was diagnosed with an ST elevation myocardial infarction (STEMI) and treated medically in accordance with guidelines.

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    Presented By: Ayu Aqilah Binti Khazani Nurul Dhiya Binti Hassannuddin Narisa Samaradhantia Supervisor: DR .Dr. Khalid Saleh SPPD-KKV, Finasim

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    The document describes a 47-year-old male patient presenting with chest pain. Examination found elevated cardiac enzymes and ECG showing ST elevation. He has a history of smoking 2 packs per day. He was diagnosed with an ST elevation myocardial infarction (STEMI) and treated medically in accordance with guidelines.

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    The document describes a 47-year-old male patient presenting with chest pain. Examination found elevated cardiac enzymes and ECG showing ST elevation. He has a history of smoking 2 packs per day. He was diagnosed with an ST elevation myocardial infarction (STEMI) and treated medically in accordance with guidelines.

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    Download as pptx, pdf, or txt
    150 views34 pages

    Presented By: Ayu Aqilah Binti Khazani Nurul Dhiya Binti Hassannuddin Narisa Samaradhantia Supervisor: DR .Dr. Khalid Saleh SPPD-KKV, Finasim

    Uploaded by

    ekhysyifka
    The document describes a 47-year-old male patient presenting with chest pain. Examination found elevated cardiac enzymes and ECG showing ST elevation. He has a history of smoking 2 packs per day. He was diagnosed with an ST elevation myocardial infarction (STEMI) and treated medically in accordance with guidelines.

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    ST ELEVATION

    MIOCARD INFARCT
    Presented by :
    1. Ayu Aqilah Binti Khazani
    2. Nurul Dhiya Binti Hassannuddin
    3. Narisa Samaradhantia

    Supervisor :
    Dr .dr. Khalid Saleh SpPD-KKV, FINASIM
     Name : Mr. P. A

     Age : 47-year-old

     Address : Pare – pare

     Gender : Male

     Mariatal status : Married

     MR : 781791

     Date of Admission : 07/12/2016


     Chief complaint : Chest pain
     Present Illness History :
     Left chest pain felt since 6 hours before admission while the patient
    is resting.
     Pain described as compressed pain and radiating to left arm
     duration of pain : 15- 20 minutes
     Nausea and cold sweating is present
     Dyspnea (-)
     No fever, cough and vomiting
     Micturition and defecation are normal
     Past Illness History :
     History of hypertension - denied
     History of Diabetes Mellitus - denied
     No family history with heart disease
     No history of chest pain before

     Lifestyle History:
     History of smoking (+) 2 packs per day since highschool
     No history of alcohol consumption
     General Status
     Moderate illness / Overweight / Composmentis
     GCS : 15 (E4M6V5)
     Weight : kg
     Height : cm
     BMI : kg/m2

     Vital Status
     Blood pressure :120/80 mmHg
     Heart rate : 64 bpm
     Respiratory rate : 24 rpm
     Temperature : 36,5 oC
     Head : anemic (-) icteric (-)
     Neck : JVP R+1 cmH2O,
     Lung :
     Inspection : symmetry left and right
     Palpation : mass (-), no tenderness, normal vocal fremity
     Percussion : sonor
     Auscultation : vesicular, ronchi -/-, wheezing -/-
     Cor :
     Inspection : ictus cordis not visible
     Palpation : ictus cordis not palpable, thrill (-)
     Percussion :
     Upper border 2nd ICS sinistra
     Right border 4th ICS linea parasternalis dextra
     Left border 5th ICS linea axillaris anterior sinistra

     Auscultation : heart sound I/II pure, regular, murmur (-)


     Abdomen :
     Inspection : flat, follows breath movement
     Auscultation : peristaltic (+), normal
     Palpation : liver and spleen not palpable
     Percussion : tympani

     Extremities :
     Edema (-)
    Sinus rhythm
    I Heart rate : 58bpm
    II Axis : Normoaxis (45°)
    P Wave : 0,08s
    III
    PR interval : 0,12 s
    AVR QRS complex : 0,08s
    AVL ST segment : ST elevation on lead
    AVF
    V1, V2 ,V3,V4
    T Wave : normal
    V1

    V2
    V3 Conclusion :
    V4
    Sinus rhytm, HR 58x/mnt,
    normoaxis, STEMI Anteroseptal
    V5

    V
    6
    TEST RESULT NORMAL VALUE

    GDS 198mg/dL <140


    TEST RESULT NORMAL VALUE
    SGOT 114 u/L <38
    WBC 14,4 x 103/uL 4.0 – 10.0 x 103
    SGPT 35 u/L <41
    RBC 5,01 x 106/uL 4.0 – 6.0 x 106
    Ureum 23 mg/dL 10-50
    HGB 14,1 g/dL 12 – 18
    Kreatinin 1,25 mg/dL 0,5-1,2
    HCT 44,6% 37 – 48
    CK 1878,00 u/L <190
    PLT 333 x 103/uL 150 – 400 x 103
    CKMB 147,3 u/L <25
    Trop I 3,88 <0.01
    Natrium 146 mmol/L 136 - 145
    Kalium 3,4 mmol/L 3,5 - 5,1
    Klorida 105 mmol/L 97 - 111
    TEST RESULT NORMAL VALUE

    Total Cholesterol 190 mg/dl 200

    HDL 25 mg/dl > 55

    LDL 142 mg/dl < 130

    TRIGLYCDERIDE 160 mg/dl 200


     Echocardiography
     Cek Profil Lipid
     Catheterization
    Chest pain felt since 6 hours before admission to the hospital. The pain radiating to
    the back and the left arm. Cold sweating during the chest pain. The patient felt
    nausea. GDS : 198 mg/dl, SGOT : 114 ul, CK : 1878,00 ul, CKMB : 147,3 ul. Troponin :
    3,88 ng/ml, Na : 146 mmOl/L. LDL : 142 mg/dl, HDL : 25 mg/dl. ECG Sinus
    anteroseptal. History of smoking since 20 years ago (more thsn 2 pack/day).
    ST Elevation Inferior Myocardial Infarction
    (STEMI) onset <12 hours, KILLIP I
     IVFD NaCl 0,9% 500 cc / 24 hours / intravena
     Aspilet 80 mg / 24hours / oral
     Brilinta 90mg /12 hours / oral
     Farsorbid 10 mg / 8 hours / syringe pump
     Arixtra 2,5 mg / 24 hours / subcutaneous
     Acetyl cysteine 400mg / 12 hours / oral
     Atorvastatin 40mg / 24 hours / oral
     Bisoprolol 1,25 mg / 24jam / oral
     Captropril 6,25mg / 8 hours / oral
     Laxadine syrup 10cc / 24 hours / oral
     Alprazolam 0,5 mg / 24 hours / oral
     ACUTE MYOCARDIAL INFARCTION (MI) is the term used for cell
    death secondary to ischemia.
     Common cause of MI is atherosclerotic narrowing of the coronary
    arteries.
     The immediate precursor to MI is rupture of an atherosclerotic plaque
    and the formation of thrombus over the plaque, resulting in rapid
    occlusion of the vessel.
     Depending upon the rate of vessel occlusion dan the degree of
    occlusion of the vessel by thrombus, a number of clinical conditions
    can result plaque rupture.
     These conditions are termed the acute coronary syndrome.
    Acute coronary syndromes
    (ACS) is a term for situations
    where the blood supplied to the
    heart muscle is suddenly
    blocked.
    • described as a group of
    conditions resulting from acute
    myocardial ischemia
    (insufficient blood flow to heart
    muscle)
    • ranging from unstable angina
    (increasing, unpredictable
    chest pain) to myocardial
    infarction (heart attack).
    Unstable
    Angina NSTEMI STEMI

    Occluding thrombus Complete thrombus


    Non occlusive sufficient to cause occlusion
    thrombus tissue damage & mild
    myocardial necrosis ST elevations on
    Non specific ECG or new LBBB
    ECG ST depression +/-
    T wave inversion on Elevated cardiac
    Normal ECG enzymes
    cardiac
    enzymes Elevated cardiac More severe
    enzymes symptoms
    Non-
    Modifiable
    Modifiable
    Smoking Gender & Age
    Hypertension • Men > 45 years old
    Diabetes mellitus
    • Women > 55 years old

    Hypercholesterolemia Family history


    Obesity • Heart disease in biological
    brother or father > 55 years old
    • Heart disease in biological
    Psychosocial stress sister or mother > 65 years old

    Lack of physical activity


    Hyper acute Complete Old Infarct
    Phase Evolution • Q-Pathologic
    • Non specific ST- • Specific ST-Elevation • ST segment
    Elevation • T inverted isoelectric
    • T taller and wider • Q-Pathologic • T normal or inverted
    Initial diagnosis and early risk stratification

    Relief of pain, breathlessness, and anxiety

    Restoring coronary flow and myocardial tissue


    reperfusion

    Prevent the complication


    TREATMENT
    Clinical Study shows:
    Bisoprolol -Limit area of MI
    -re-infarction risk decrease
    -prolong life span
    Relieve symptom
    NTG
    Vasodilatation

    -Plaque stabilization
    -LDL decrease Atorvastatin
    target: <70mg/dl -Anti-remodelling
    -decrease mortality

    Captopril
    ACC/AHA 2007 recommendation:
    Loading: Aspirin 300mg Decrease mortality
    Decrease re-infarction rate
    Clopidogrel 300mg

    CURE study reported:


    Maintanance:
    Aspirin 80mg+Clopidogrel 75mg (for1year)

    decrease 20% mortality risk,


    infark myocardial non fatal,
    stroke
    COMPLICATION
    MORTALITY RATE
    CLASS DESCRIPTION
    (%)

    I No clinical signs of heart failure 6

    Rales or crackles in the lungs, an


    II S3, and elevated jugular venous 17
    pressure

    III Acute pulmonary edema 30 - 40

    Cardiogenic shock or
    hypotension (systolic BP < 90
    IV 60 – 80
    mmHg), and evidence of
    peripheral vasoconstriction

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