beby kardio translate
TRANSCRIPT
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STEMI INFERIOR ONSET > 24 HOURS
KILLIP 1
Presented by:Viesna Beby Auliana
Pembimbing :
dr. Abubakar S Zubeidi
Department of Cardiology and Vascular MedicineMedical Faculty of Hasanuddin University
Makassar
2013
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IDENTITAS PASIEN
Medical Record : 624749
Nama : Ms.MR
Jenis kelamin : Female
Usia : 58 years old
Alamat : Jl.Rappokalling
Tanggal Masuk : September 9th
2013
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ANAMNESIS Keluhan utama:
Nyeri dada
Anamnesis terpimpin:
TheNyeri dada dirasakan sejak 1 hari sebelum masuk rumah sakit (13.00, 1September). Nyeri dirasakanseperti tertindih benda berat pada dada dan menjalar ke
lengan kiri tembus ke belakang. Terdapat riwayat nyeri dada 3 bulan yang lalu tetapi
membaik dengan beristirahat. Nyeri dada disertai dengan keringat dingin. Mual (-),
muntah (-), sesak (-), BAB dan BAK normal
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RIWAYAT
Riwayat Penyakit Sebelumnya:
Riwayat nyeri dada 3 bulan yang lalu namun membaik
dengan beristirahat
Riwayat HT (+) 10 tahuin yang lalu tidak berobat teratur
Tidak ada riwayat penyakit jantung sebelumnya. Riwayat
keluarga dengan penyakit yang sama tidak ada.
Riwayat DM (+) sejak tahun 2007 tidak berobat teratur
Tidak ada riwayat dislipidemia
Tidak ada riwayat asma
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FAKTOR RESIKO
Usia : 58
tahun
NonModifiable
Hipertensi(+)DM (+)
Modifiable
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PEMERIKSAAN FISIK Keadaan umum
Sakit sedang/gizi cukup/sadar
Tanda Vital BP : 120/80 mmHg HR : 72 bpm, regular RR : 20 tpm
T : 36.7C BW : 55 kg H : 159 cm
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PEMERIKSAAN FISIK Pemeriksaa kepala
Mata : Anemic -/-, Icterus -/- Bibir : Cyanosis (-)
Leher : Lymphadenopathy (-), JVP R+1 cmH2O
Pemeriksaan Dada Insp. : Symmetrical R=L, normochest Palp. : Mass (-), NT(-), VF R=L Perc. : Sonor
Ausc. : BronchovesicularRonchi -/-,Wheezing -/-
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PEMERIKSAAN FISIK
Pemeriksaan Jantung
Insp. : IC tidak terlihat
Palp. : IC tidak teraba
Perc. : Dull
Batas kanan : garis parastrenalis kanan
Batas kiri : 2 jari setelah linea midclavicularis kiri
Ausc. : BJ I/II murni reguler, gallop (-)
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PEMERIKSAAN FISIK
Pemeriksaan abdomen
Insp. : Datar, ikut gerak napas
Ausc. : peristaltik(+), normal Palp. : Liver and spleen tidak teraba
Perc. : Tympani (+), ascites (-)
Ekstremitas Oedema : Pretibial -/-, Dorsum pedis -
/-
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ELECTROCARDIOGRAPHYECGInterpretationSinus Rhythm
Heart Rate :75x/I
P Wave : 0.08
PR interval :0.16
ST elevasi III &AVF
T inverted di II,III, dan AVF V3-V5
Axis :normoaxis
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LABORATORY EXAMINATION
WBC : 9,50
HB : 16,7 gr/dl
PLT : 288.000
HCT : 45,6 %
GDS : 358mg/dl
Ureum : 17mg/dlCreatinin : 0,5 mg/d
CK : 640 U/L
CKMB : 79U/L
Trop. T : 0,59 Na : 134mmol/l
K : 3,8mmol/
Cl : 103mmol/l
SGOT : 94U/L SGPT : 20U/L
Albumin : 41
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DIAGNOSIS
- STEMI inferior, onset
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INITIAL MANAGEMENT Bed rest
O2 2-4 LPM (via nasal canule)
Heart Diet
IVFD NaCl 0,9% loading 500 cc/24 hours 140/90 mmHg Anti Platelet Aggregation
ASA (Aspilet) loading dose 160 mg (2 x 80 mg) maintenance 1-0-0
Clopidogrel (Plavix) loading dose 300 mg (4 x 75 mg) maintenance 0-1-0
Anti cholesterol
HMG-Co A reductase inhibitor (Simvastatin 1 x 20 mg)
Anti coagulant
Low Molecule Weight Heparin(Fondaparinux(Arixtra)) 2,5 mg/24 jam/SC Anxiolytic
Benzodiazepin (Alprazolam 1 x 0,5 mg)
Laxative
Laxadin syrup 1 x 2 cth
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PLANNING
Echocardiography
Coronary angiography
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ACUTE CORONARYSYNDROME
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DIAGNOSIS OF CHEST PAIN
3 point typical chest pain
Tend to be Stable Angina Pectoris than AcuteCoronary Syndrome
2 point atypical chest painTend to be Acute Coronary Syndrome than NonCardiac Chest Pain
1 point or none non cardiac chestpain
Retrosternalor substernalchest pain
1point Increased
by activityor emotion
1point Relieved by
resting ornitrate SL
1point
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DEFINITIONAcute Coronary Syndrome (ACS) is a term for
situations where the blood supplied to the
heart muscle is suddenly blocked.
describe 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).
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CLASSIFICATION
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PATHOPHYSIOLOGY Vulnerable Plaque
Thrombosis
Vasospasme
Plaque disruption andthrombosis that result incomplete coronaryartery occlusion leadsto transmural ischemia
and necrosis, thehallmark of ST-segmentelevation myocardialinfarction (STEMI)
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Lipid transport disorder Inflamation
Plaque deposition
Stable plaque Plaque ruptureErosion
Stable angina pectorisThrombosis
Thrombus
Acute coronary syndrome:
Unstable angina
Myocardial infarction :
- Non Q waves
- Q waves
PATHOGENESIS
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RISK FACTOR
Gender and Age
Men, increased risk after age 45
Women, increased risk after age
55
Family History
Heart disease diagnosed before
age 55 in father or brother
Heart disease diagnosed before
age 65 in mother or sister
Non- Modifiable Modifiable
Smoking
Hypertension
Diabetes Mellitus
Dyslipidemia
Obesity
Lack of physical activity
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At least 2 of the following:DIAGNOSIS OF ACS
1. Ischemic symptoms
2. Diagnostic ECG changes
3. Serum cardiac marker elevations
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CLINICAL FEATURES
Substernal chest pain / chest discomfort radiated to the left arm,shoulder, neck, jaw. Penetrated to the back.
The chest discomfort may also be described as a dull pain,pressure, squeezing or crushing sensation or burning sensation
Duration more than 20 minutes. more intense and persistent.
Not fully relieved by rest or nitroglycerine
Often accompanied by systemic symptoms: nausea, vomiting,SOB, palpitation, fatigue, cold sweat, light headness
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2. DIAGNOSTIC ECG
CHANGES
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3. SERUM CARDIAC MARKER
ELEVATIONS
TroponinT CK-MB CK
SGOT LDH Myoglobin
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DIAGNOSIS
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INITIAL MANAGEMENT Fixing the chest pain and fearness
Bed rest
Diet
O2 2-4 lpm
Nitroglycerin: 0,4 mg SL tablets every 3-5 minutes up to 3 times; if effect is notsustained, can continue with an IV drip of 50 mg in 250 ml dextrose 5%
Antiplatelet :
Aspirin: 162-325 mg chewed immediately and 81-162 mg continuedindefinetely
Clopidogrel 300-600 mg loading dose and 75 mg daily continued for at least14 days and up to 12 months.
Morphine 2-5 mg IV every 5-30 minutes
Pethidine 12,5 mg/IV
Diazepam 2-5mg/8 hour Stabilizing the hemodynamic (blood pressure and pheripheral pulse control)
-blocker
Calcium channel blocker (CCB)
ACE-Inhibitor
Reperfusion of the myocard
Thrombolytic: streptokinase 1,5 million units/IV
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PROGNOSIS
KILLIP CLASSIFICATIONClass Description Mortality Rate (%)
I No clinical signs of heart failure 6
IIRales or crackles in the lungs, an S3,and elevated jugular venouspressure
17
III Acute pulmonary edema 30 - 40
IV
Cardiogenic shock or hypotension(systolic BP < 90 mmHg), andevidence of peripheralvasoconstriction
6080
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THANK YOU