lapsus myocard infark type 2 _ english

8/16/2019 Lapsus Myocard Infark Type 2 _ English

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BAGIAN KARDIOLOGI & LAPORAN KASUS

KEDOKTERAN VASKULAR APRIL 2016

FAKULTAS KEDOKTERANUNIVERSITAS HASANUDDIN

MYOCARDIAL INFARCTION TYPE 2

DISUSUN OLEH :

Sadly Sadikin

SUPERVISOR PEMBIMBING :

dr. Akhtar Fajar Muzakkir, Sp.JP., FIHA

DIBAWAKAN DALAM RANGKA KEPANITERAAN KLINIK

BAGIAN KARDIOLOGI & KEDOKTERAN VASKULAR

FAKULTAS KEDOKTERAN

UNIVERSITAS HASANUDDIN

MAKASSAR

2016



LEMBAR PENGESAHAN

Yang bertanda tangan di bawah ini menyatakan bahwa

!ama Sadly Sadikin

!IM "### #$ %&'

(ni)er*ita* (ni)er*ita* Ha*anuddin

Judul +apran -a*u* Myardial In/artin 0ype $

telah menyele*aikan tuga* kepaniteraan klinik pada 1agian -ardilgi dan

-edkteran 2a*kular Fakulta* -edkteran (ni)er*ita* Ha*anuddin.

Maka**ar, April $%#&

Super)i*r Pembimbing

dr. Akhtar Fajar Muzakkir, Sp.JP., FIHA



BAB I

LAPORAN KASUS

A. IDENTITY OF PATIENS

!ame 0n. A-

3ate / 1irth 4 Age $56%76#'&$ 4 85 year* ld

9egi*tratin !. 7###$#

Jb P!S

Marital Statu* MArry

Addre** 3u*un Makwng, +uwu (tara

0elp4HP 6Admi**in %'4%:4$%#&

B. ANAMNESIS

Main "mplaint

"he*t Pain

3i*ea*e Hi*try

+e/t he*t pain e;periened by appr;imately # mnth ag be/re entering the

h*pital and wa* ad)aning abut a day ag. "he*t pain n the le/t *ide /ill liketertusuk , tran*luent bak* ampanied by ul *weat. 3uratin / pain mre

than $% minute*. "he*t pain i* /elt gain weight when in hea)y ati)itie*. !w,

he*t pain had ea*ed. Hi*try / he*t pain pre)iu*ly denied. Shrtne** /

breath i* nt there. ! nau*ea, n )miting heartburn, n headahe, n /e)er

while in the h*pital. <d appetite. 1A1 u*ual, yellw, 1A- nnurrent, A

hi*try / jaundie there. 3enied pre)iu* hi*try / heart di*ea*e.

Pa! I""#$ H%!'(

= Pre)iu* hi*try / *imilar mplain*

= ! hi*try / hyperten*in

= Patient* with a hi*try / hemdialy*i* a*a muh a* $: *ine la*t : mnth

= A hi*try 3M type $ *ine appr;imately #% year* ag

= 3enied pre)iu* hi*try / heart di*ea*e

= ! hi*try / dringking alhl



C. PHYSICAL E)AMINATION*

<eneral Situatin

1eing *ik 4 nutritin pretty 4 <"S #8 > mp* menti* ?

2ital Sign

6 1ld Prea**ure #%%4&% mmHg

6 Pul*e 9ate @& time*4*end, reguler

6 9e*piratr rate $: time*4*end

6 0emperature >ak*illa? 5&,%"

Head

3e/rmita* !

Fae Simetri* Simetri*

Hair Hard t be re)ked

Size !rmephal

Frm Me*ephal

ye

k*/talmu* !

-njungti)a Anemi* >B?

-rnea 9e/lek* krnea >B?

nptalmu* 0idak ada

Sklera Ikteru* >B?

Pupil I*kr $,8 mm4$,8 mm

ar

aring !rmal

Ctrrhea !

!*e

pi*tak*i* !

9hinrrhea!



Muth

+ip* 3ry >6? 0ngue 3irty >6?

0n*il 0#60# !t Hyperemia Faring !t Hyperemia

!ek

-<1 ! nlargement 32S 9B: mH$C

0yrid ! nlargement Sti// !ek !

"he*t

Frm +e/t6right *ymmetri eDual*

1rea*t* +e/t6right *ymmetri eDual*, n abnrmalitie*

1etween the rib* +e/t6right *ymmetri eDual*

+ung

Palpa*i Fremitu* +e/t6right *ymmetri eDual*

! 0enderne**

Perku*i* I"S li)er lung marking* I2 dek*tra

9ight behind lung marking* I"S IE

+ung marking* le/t behind I"S E

Au*kulta*i 0he *und / breathing 2e*iular

Additinal *und* rnkhi > 6 ? , wheezing > 6 ?

Heart

In*petin Itu* rdi* de* nt *eem

Palpa*i Itu* rdi* wa* nt palpable

Perku*i +imit tp le/t I"S $ +inea para*ternali* *ini*tra

9ight brder I"S $ linea para*ternali* dek*tra

1ttm right brder I"S : linea para*ternali* de;tra



1ttm le/t brder I"S : linea medi la)iulari* *ini*tra

Aukulta*i 1J I 4 II regular pure

Heart murmur* > 6 ?

Abdmen

In*petin Flat , tk a breath mtin

Palpa*i +i)er and +ien impalpable

0umr ma** > 6 ? , tenderne** > 6 ?

Perku*i 0impani >B?

Au*kulta*i Peri*taltik >B? nrmal impre**in

k*tremita*

! edema

D. ELEKTROKARDIOGRAM



+22,0-,2016

Interpretatin

1. Irama Sinu*

2. +aju 9S &: kali4menit

-. 9egularita* 9egular :. Ak*i* !rma;i*

8. <elmbang P %,%:*

6. Inter)al P69 %,#& *

/. 9S -mplek* lebarG %,%@ *. AmplitudG 58 mm

. Segmen S0 S0 depre*i pada lead 25, 2:, 28, 2&,

"nlu*in* *inu* nrmkardi , myardial i*hemia anterlateral in/artin , hypertrphy /

the le/t )entrile

E. LABORATORIUM

0e* Ha*il Satuan !ilai !rmal

Hematlgi 9utin

Hemglbin

Hematkrit

91"

M"H"

7.:

$5.'

$.:5

5%.'

g4dl

mm5

+

#$ 6 #&

:% 6 8:

:.8% 6 &.8%

5$ 5&

+euk*it

0rmb*it

-agula*i

P0

I!9

AP00

#$.$

$8#

','

%,'8

$5,@

#%54Kl

#%54Kl

detik

detik

:,%% #%,%%

#8% 6 :%%

#%6#:

66

$$.%65%.%

Fung*i Hati

S<C0 >AS0?

S<P0 >A+0?

Fung*i <injal

(reum

"reatinine

<luk*a

<3S

::

8:

@%

:.@#

$%8

u4l

u4l

mg4dl

mg4dl

mg4dl

L5@

L:#

#%68%

+>L#.5?GP>L,#.#?

#:%



<3$PP $7$ mg4dl L$%%

Penanda Jantung

"-

"-6M1

##8

5.@

(4+

(4+

+L#'%, PL#&7

L$8

Imun*erlgi

0rpnin I %,5@ ng L%.%#

lektrlit

!atrium

-alium

-lrida

#5'

5.'

#%'

mml4l

mml4l

mml4l

#5&6#:8

5,868,#

'76###

0abel # +abratry e;aminatin

F. RADIOLOGI

#. Ft 0hra; PA >$:6%56$%#&?

Impre**in

"ardimegaly with *ign* / lung dam

G. ASSESSMENT

#. A"S IM 0ype $$. 3M 0ype $

5. Anemia 9enal

:. S93 n H3 9eguler

H. THERAPY

#. I2F3 !a"l %,' 8%% 4$: jam4I2

$. Alprazlam %.8 mg4$: jam4ral5. 3butamin 5 mg4-g114menit4Syringe Pump

:. 0rimetazidine Hydrhlride 58 mg4#$ jam4ral

8. I**rbid 3initrat %.5 mg4jam4Syringe Pump



I. PLANNING

#. hardigraphy

$. Perawatan "2"(

. RESUME

+e/t he*t pain e;periened by appr;imately # mnth ag be/re admi**in and wa*

ad)aning mre r le** the la*t day . "he*t pain n the le/t /elt like puntured , penetrating t

the bak with a ld *weat . 3uratin / pain $% min . "he*t pain i* /elt gain weight when

n the m)e . "urrently he*t pain ha* been redued. Cn e;aminatin di*)ered "< *inu*

nrmkardia with H9 &: beat* per minute , with le/t )entriular hypertrphy , i*hemi

myardial in/artin anterlateral . +abratry te*t* /und 0rp I %,5@ , #$,$%% N1" , Hb

7.: , Plt $8#,%%% . "ardimegaly n he*t radigraph* wa* /und with *ign* / lung dam .

D$%#%!%#



Aute Myardial In/artin > AMI ? i* an interruptin / bld /lw t the heart that

au*e* the heart mu*le ell* die . 0he /lw / bld in the bld )e**el* halted a/ter an aute

rnary lu*in , e;ept /r a *mall amunt / llateral /lw / the bld )e**el* in the

)iinity. 0he mu*le* *urrunding area* wh did nt reei)e bld /lw r /lw )ery little that it

an nt maintain the /untin / the heart mu*le, i* *aid t ha)e in/ark.#

Arding t Alpert>$%#% ? , the di)i*in i* al* alled myardial in/artin r aute myardial in/artin , ba*ed

n the au*e / hetergeneu*, between$

#. In/ark mikard type #

Myardial in/artin urred *pntaneu*ly due t plaDue rupture , /i**ure , er*in r

di**etin / ather*lerti plaDue in the arterie* that make adabang derea*ed bld /lw t

the arterie* . In additin , an inrea*ed need /r and the a)ailability / ;ygen and nutrient* i*

inadeDuate trigger myardial in/artin . Patient* may ha)e a hi*try / hrni "A3 but nt

being b*truted r withut "A3 it*el/

$. In/ark mikard type $

Myardial in/artin i* au*ed by an imbalane between *upply and r need /r ;ygen.

0he au*e / the*e, endthelial dy*/untin , rnary artery *pa*m , rnary embli*m ,

tahyarrhythmia* , bradyarrhythmia* , anemia , hypten*in and hyperten*in with r withut

le/t )entriular enlargement .

5. In/ark mikard type 5

In the*e irum*tane* , the inrea*e bihemial *ign i* nt /und . 0hi* i* due t the patientO* bld *ample i* nt btained r the patient died be/re the bihemial *ignal le)el* had

inrea*ed .

:. a. In/ark mikard type :a

Inrea*ed le)el* / bihemial *ign* / myardial in/artin > eg trpnin ? 5 time*

greater than the nrmal )alue due t the in*tallatin / perutaneu* rnary inter)entin

> P"I ?, whih trigger a myardial in/artin .

b. In/ark mikard type :b

Myardial in/artin ari*ing /rm plaement / *tent thrmb*i* .

8. In/ark mikard type 8

Inrea*ed trpnin le)el* /i)e time* greater than nrmal )alue . 0hi* type / inident

myardial in/artin a**iated with rnary bypa** *urgery .



0hu* , myardial in/artin, type $ i* an imbalane between *upply and *upply ;ygen

and wa* nt the re*ult / A"S di*ea*e it*el/. keep in mind that in meeting the need* / ardia

;ygen there are 5 /atr* at play ie , ntratility , *y*tli wall ten*in , and heart rate . A* /r

hi* wn ;ygen *upply i* regulated by rnary bld /lw and n the arrying apaity

k*igennya.3

R%3 Fa4!'

1a*ed etilgi nted earlier there are *e)eral ri*k /atr* /r the urrene / myardial

in/artin type $ i* di)ided int traditinal ri*k /atr*, the ri*k /atr* that an be mdi/ied,

and nn6traditinal ri*k /atr*. "n)entinal ri*k /atr* *uh a* age, /amily hi*try, and

rae. 0he mdi/iable ri*k /atr* are dy*lipidemia, hyperten*in, diabete*, *mking,

metabli *yndrme, lak / phy*ial akt)ita*, a* well a* depre**in. A* /r ther au*e* that

au*e thi* di*ea*e ba*ed n a*e *tudie* nduted by <iden, et al $%#: ie, a hi*try /

"A1<, P"I hi*try, heart /ailure, P23, 3iabete* Mellitu*, Hyperten*in, "-3, "CP3, p*t

0IA:

Nmen are *aid t ha)e a higher mrtality than men. 0hi* may be due t wmen

e;periening AMI in lder age, are mre prne t *u//er /rm diabete*, /ten reei)e le**

aggre**i)e therapy. Nmen mre /ten ha)e atypial he*t pain that ame late t the h*pital

and wa* nt allwed t d trmblitik.5

Pa!5"(

Myardial i*hemia ur* when there i* a derea*e in rnary bld /lw wa* *

hea)y /r myardial ;ygen a)ailability i* nt *u//iient /r the need* / ti**ue ;ygen.

1ilgial nept, ba*ed n priniple* / general bilgy / li)er and brain ell*, *hwed tw

pha*e* / adaptatin, the *6alled de/en*e / *hrt6term and lng6term *al)atin. 0he purp*e /

*hrt6term de/en*e mehani*m i* t e*tabli*h a new balane between *upply and demand / ;ygen, with a mbinatin / ntratin dwnregulatin and upregulatin / anaerbi energy

prdutin )ia glyly*i*. +ng6term re*ue until nw nt knwn learly, but that apparently wa*

able t indue hyp;ia i*hemia thrugh a *erie* / ellular *ignal* that au*e the prteti)e

mehani*m* / geneti reprgramming. Nhen the tw pha*e* / thi* adaptatin /ail*, beau*e the



i*hemia that ur* )ery hea)y there will be ell ner*i*. Adaptatin i* a lng6term prteti)e

re*pn*e t the urrene / i*hemia, *uh a* hibernatin and *tunning 8.

At the n*et / i*hemia with )ery Duikly , there i* an imbalane / energy , e*peially

ph*preatinin , whih keep* the le)el* / Aden*ine 0riph*phat > A0P ? a* lng a* p**ible

thrugh an inrea*e in intraellular inrgani ph*phate . 0he *ub*trate i* al* a majr *ignal t

the dwnregulatin / ntratin . Simultaneu* redutin in energy *tatu* i* a majr *ignal an

inrea*e in anaerbi glyly*i* . C/ anaerbi glyly*i* i* prei*ely btained main *ure /

glygen breakdwn in the aute n*et , immediately /llwed by an inrea*e in glu*e

tran*prt due t the tran*latin / the glu*e tran*prter <+(0 # and <+(0 : t *arklema8.

At the time / i*hemia , there wa* de)elpment / intraellular aid*i* whih

ntributed t the redutin in ntratin* . S wh e;periened i*hemi myardium an

*ur)i)e in a gi)en time thrugh a mbinatin / inhibitin / ntratin and the initiatin /

anaerbi glyly*i* . Nhen dne reper/u*in , there will be impr)ement / mehanial

/untin , and impr)ement / metabli abnrmalitie*8.

I*hemia i* nt re*tred an be in/artin . <enerally pathphy*ilgy ur in tw pha*e* ,

namely a hange in the beginning and the reent hange* . In the initial pha*e , the e)lutin /

in/artin and /untinal di*rder* / the ;ygen derea*e in myardial ntratility . 0he*e

initial hange* it* peak in the urrene / myardial ner*i* kagulati/ within $6: day* .

Alng with a derea*e in myardial ;ygen whih the bld )e**el* that ga)e nutritin terklu*i

, there are rapid *hi/t* /rm aerbi metabli*m tward* anaerbi metabli*m8.

Mithndria are nt able t ;idize /at r prdut / glyly*i*, there/re, a deline in

high6energy ph*phate and anaerbi metabli*m lead* t aumulatin / lati aid. 9edued

high6energy ph*phate *uh a* A0P a//et the !a 4 - A0Pa*e tran*membrane, re*ulting in

inrea*ed intraellular !a and - e;traellular. Membrane leakage and an inrea*ed nentratin

/ e;traellular - au*e hange* in eletrial ptential tran*membrane, predi*p*e* t ptentially

lethal arrhythmia* intraellular alium aumulate* in the damaged myyte* ntribute t the

n*et mehani*m / ellular damage thrugh ati)atin / enzyme* *uh a* lipa*e and prtea*e



degradatin. "lleti)ely the*e metabli hange* ur the /a*te*t tw minute* a/ter

thrmb*i*. Nithut inter)entin irre)er*ible ell damage will ur within $% minute*, marked

by a membrane de/et*. Prtelyti enzyme* leaking thrugh the myyte membrane, damaging

the *urrunding myardium, and rem)ing marmleule* that *er)e a* marker* / aute

myardial in/artin. Inrea*ed apillary permeability and inrea*ed inter*titial nti pre**ure

>due t leakage / intraellular prtein*? will au*e myardial edema in :6#$ hur*8

9eent hange* ie myardial purge by marphage* and nerti ti**ue by *ar ti**ue

dep*itin . Funtinal hange* al* ur a* a re*ult / IMA in the /rm ntratility di*rder*

and mpliant , *tunning and hibernatin . C;ygen deli)ery t the heart a**iated with rnary

bld /lw , there/re, the abrupt terminatin / reginal per/u*in due t thrmbti lu*in

/ rnary and Duikly *tp the aerbi metabli*m , reatine ph*phate depletin and

anaerbi metabli*m ur* . 0hi* wa* /llwed by the aumulatin / lati netwrk ,

derea*ed A0P prdutin netwrk , atablite aumulatin , inlude* adenine nukletide .

Alng with ntinued i*hemia , ti**ue aid*i* and e//lu; / pta**ium int the e;traellular

*pae . A0P deline in )alue belw that reDuired t maintain the /untin / the membrane ,

au*ing the death / the myyte8.

C"%#%4a" S(78!7

0he linial /eature* / myardial in/artin *ub*ternum generally in the /rm / he*t

pain that /eel* hea)y , pre**ing, like a rumpled and *metime* dijalarkan t the nek , jaw ,

epiga*tri , *hulder r le/t arm , r ju*t di*m/rt in the he*t . IMA i* /ten preeded by an

attak / angina petri* in appr;imately 8% / patient* . Hwe)er , pain in the IMA u*ually

la*t* a /ew hur* t a day , rarely ha)e anything t d with phy*ial ati)ity and u*ually nt

muh redued by admini*tratin / nitrglyerin , u*ually rapid and weak pul*e , patient* al*

/ten e;periene diaphre*i* . In a minrity / patient* > $% t 5% ? IMA de* nt au*ehe*t pain . Silent AMI i* e*peially true in patient* with diabete* mellitu* and hyperten*in a*

well a* in elderly patient*.#,$

D%a#%



0he diagn*i* / myardial in/artin type $ i* e*tabli*hed ba*ed n a typial hi*try /

he*t pain and i* u*ually a**iated with a nditin that au*e* high ;ygen demand , r a

deline in myardial bld /lw . In angigraphy in general d nt indiate plaDue rupture .

P$7%

Phy*ial e;aminatin *hwed the patient lk* an;iu* and unable t re*t > re*tle**ne** ? r

patient* pre*ent with weak , pale e;tremitie* with ld *weat . 0he mbinatin / *ub*ternal

he*t pain 5% minute* and a lt / *weat. $

Arding t the nditin* / the patient* wh me in , there are tw nditin* that

need t be n*idered , namely , Nhen *upply derea*e* , the anemia with hemglbin L 8.8

mml 4 + /r men and L 8.% mml 4 l /r wmen. Shk > *y*tli L '% mm Hg ? with *ign* /

rgan dy*/untin . 1radyarrhythmia , re*piratry /ailure with arterial ;ygen pre**ure L @ kPa

and linial *ign* / re*piratry /ailure $% min . !e;t up i* the inrea*e in demand G )entriular

tahyarrhythmia* la*ting $% minute* , *upra)entriular tahyarrhythmia* la*ting $% minute* ,

edema pulmnary hyperten*in > *y*tli #&% mm Hg ? with *ign* / pulmnary edema ,

arterial hyperten*in with *y*tli bld pre**ure #&% .

1. Supporting

Inrea*ing the )alue / enzyme* ab)e twie the upper limit / nrmal )alue* indiate the

pre*ene / ardia ner*i*.$

$.# . "-M1 inrea*ed a/ter 5 hur* when there i* myardial in/artin and peak* within

#%6$: hur* and returned t nrmal within $6: day* . Heart *urgery , myarditi* , and eletrial

ardi)er*in an inrea*e "-M1 .

$.$ . "0! there are tw type* / 0 and "0! "0! I. 0hi* enzyme inrea*ed a/ter $ hur*

when there i* myardial in/artin and peak* within #%6$: hur* and "0! 0 an *till be

deteted a/ter 86#: day* while "0! I a/ter 86#% day* .

;aminatin / ther heart enzyme* that myglbin , reatinine kina*e > "- ? , +ati

dehydrgena*e > +3H ?

!n6*pei/i reatin again*t myardial injury i* a plymrphnulear leukyt*i* may

ur within a /ew hur* a/ter the n*et / pain and per*i*t /r 567 day* . +eukyte* an reah

#$,%%%6#8,%%% 4 ul.$



#$ *andapan "< *huld be per/rmed n all patient* with mplaint* / he*t pain

within #% minute* /rm arri)al in the emergeny rm . "< luminane at inter)al* / 86#%

minute* r #$ *andapan "< mnitring *huld be dne ntinuu*ly t detet ptential

de)elpment / S0 *egment ele)atin . Myardial in/artin type $ an be /und *igni/iant

S0 ele)atin , *metime* enuntered +111 , a* well a* pathlgial $.

! +atin -<

# Anterir le)a*i *egmen S0 dan4atau gelmbang di 2#6

2:428

$ Anter*eptal le)a*i *egmen S0 dan4atau gelmbang di 2#625

5 Anterlateral le)a*i *egmen S0 dan4atau gelmbang di 2#62&

dan I dan a2+

: +ateral le)a*i *egmen S0 dan4atau gelmbang di 2862&

dan in)er*i gelmbang 04ele)a*i S04gelmbang di I

dan a2+

8 In/erlateral le)a*i *egmen S0 dan4atau gelmbang di II, III,

a2F, dan 2862& >kadang6kadang I dan a2+?.

& In/erir le)a*i *egmen S0 dan4atau gelmbang di II, III,

dan a2F

7 In/er*eptal le)a*i *egmen S0 dan4atau gelmbang di II, III,

a2F, 2#625

@ 0rue p*terir <elmbang 9 tinggi di 2#62$ dengan *egmen S0

depre*i di 2#625. <elmbang 0 tegak di 2#62$

' 92 In/ratin le)a*i *egmen S0 di prerdial lead >25962:9?.

1ia*anya ditemukan knjung*i pada in/ark in/erir.

-eadaan ini hanya tampak dalam beberapa jam

pertama in/ark.



Management

he main bjeti)e management / IMA i* t diagn*e Duikly , relie)e he*t pain , a**e**

and implement *trategie* reper/u*in p**ible , gi)e antithrmbti and anti6 platelet , gi)ing the

drug in)e*tigatin. 0here are *me guideline* > guideline* ? in the management / IMA , butneed* t be adapted t the nditin* / /ailitie* 4 amenitie* at eah )enue and e;pert

apabilitie* that ada.$,& g)ernane /r IM type $ it*el/ i* ba*ed n the etilgi au*e ;ygen

per/u*in di*turbane r the urrene / primary au*a myardial in/artin that reDuired in

the implementatin / r**6*etr llabratin in *l)ing the prblem.

P'4$9'$ $a'"(

a. C;ygen C;ygen *upplementatin *huld be gi)en the patient* with ;ygen *aturatin L'%.

In all patient* withut mpliatin* an be gi)en ;ygen during the /ir*t & hur*.

b. !itrglyerin *ublingual nitrglyerin an be admini*tered *a/ely at a d*e / %.: mg and

an be admini*tered up t three d*e* with an inter)al / 8 minute*.

. . Mrphine )ery e//eti)e in relie)ing he*t pain. Mrphine an be admini*tered at a d*e

/ $6: mg and an be repeated at inter)al* / 86#8 minute* up t a ttal d*e / $% mg.

d. d. A*pirin the ba*i management / patient* *u*peted IM type $ and e//eti)e n the

*petrum / aute rnary *yndrme*. Inhibitin / platelet yl;ygena*e ntinuing

rapid redutin / thrmb;ane A$ le)el* ahie)ed by bual ab*rptin / a*pirin at a d*e

/ #&%65$8 mg in the emergeny rm. Furthermre, gi)en rally at a d*e / 786#&$ mg.

$. e. 1eta blker* I/ mrphine /ailed t redue he*t pain, intra)enu* admini*tratin / beta

blker* an be e//eti)e. 0he bene/it* that ur immediately i/ the drug i* admini*tered

autely and that gi)en the lng term i/ the drug i* gi)en /r *endary pre)entin a/ter

in/artin. Intra)enu* beta blker* impr)e relatin* myardial ;ygen *upply and

demand, redue pain, redue the e;tent / in/artin, and redue the ri*k / )entriular

arrhythmia e)ent* that *eriu*9egimen mmnly gi)en i* metprll 8 mg e)ery $68 minute*

until a ttal / 5 d*e*, with the pr)i* heart rate &% time* per minute, *y*tli bld

pre**ure #%% mmHg, P9 inter)al L%.$: *end* and rakle* n mre than #% m /rm the

diaphragm. Fi/teen minute* a/ter the la*t d*e / I2 /llwed by ral metprll 8% mg e)ery

& hur* /r :@ hur*, /llwed by #%% mg e)ery #$ jam.$,7



Ma#a$7$#! %# !5$ H8%!a"

I""(

a. Ati)itie* patient* *huld re*t within the /ir*t #$ hur*

b. 3iet patient* *huld be /a*ting r ju*t drink a liDuid with a muth in :6#$ hur* beau*e

/ the ri*k / )miting and a*piratin immediately a/ter myardial in/artin .

. Sedatin patient* reDuiring *edatin during treatment t maintain a perid / inati)ity

with a *edati)e . 3iazepam 8mg , k*azepam #865% mg , r %.86$ mg lrazepam , gi)en 56:

time* 4 day

d. 3ige*ti)e trat > bwel* ? bed re*t and the e//et* / taking narti* /r pain /ten au*e

n*tipatin , * it i* remmended the u*e / *eat kmd bed*ide , high6/iber diet , and

u*e a mild la;ati)e regularly, *uh a* dityl *dium *ulph*uinate > $%% mg 4 day?.$,7



DAFTAR PUSTAKA

1. <uytn A". Hall, J. 1uku Ajar Fi*ilgi -edkteran. Jakarta <". $%%7

2. Sudy AN, Setiyhadi 1, Alwi I, dkk. 1uku Ajar Ilmu Penyakit 3alam Jilid II di*i 2.

Jakarta Interna Publi*hing. $%#%.

-. Sant* M, Setiawan 0. Penyakit Jantung -rner. "ermin 3unia -edkteran. $%%8G #:7 &6

'

:. 9bbin* S+, "tran 9S, -umar 2. 1uku Ajar Patlgi 9bbin*. Jakarta <". $%%7.8. Sand)al, Yader et al. $%#:. Supply43emand 0ype $ Myardial In/artin. Jurnal / the

Amerian llage / "ardilgy&. 0hyge*en -ri*tian et al. $%#&. 0hird (ni)er*al 3e/initin / Myardial In/artin.

S"4A""F4AHA4NHF. http44ir.ahajurnal*.rg7. Alpert et al. $%#:. 3iagn*ti and 0herapeuti Impliatin* / 0ype $ Myardial In/artin

9e)iew and "mmentary. 0he Amerian Jurnal / Mediine

@. Steln et al. $%#:. 0ype $ Myardial In/artin, Patient "harateri*ti*, Management and

Cutme*. P+CS Cne I*rael

http://circ.ahajournals.org/

http://circ.ahajournals.org/

lapsus myocard infark type 2 _ english

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