Kardio Stemi

8/17/2019 Kardio Stemi

1/31

STEMI(ST ELEVATION MYOCARDIAL INFARCTION INFERIOR + LATERAL 5

HOURS ONSET)By:

A.YUSRIANA AZZAHRA

SUCIATI

SITI ARIFAH

NURUL INDAH PERTIWI

BESSE JUMRANA

ARMAWATi

SRI MEAWATI

Supervisor :DR dr. Idar Mapangara, SpPD, SpJP, FIHA, FICA, FINASIM

DEPARTMENT OF CARDIOLOGY AND VASCULAR MEDICINE

MEDICAL FACULTY OF HASANUDDIN UNIVERSITY

MAKASSAR

2016


2/31

PATIENT IDENTITY

• N!"# : M$. Y

• A%# : &5 y#!$' *

• O,-!i/ : $#i$#*• A**$#'' : P/*0 A'$i II B0 E123

• MR : 45536

• D!# 7 A*"i''i/ : A-$i 2.8 263&


3/31

HISTORY TA9IN

• C8i#7 "-!i/ : C8#' -!i/

• P$#'#/ I/#'' Hi'$y :

– L#7 8#' -!i/ 7# 'i/# 5 8,$' #7$#

!*"i''i/ – D#'$i#* !' -$#''#* -!i/ ;8i8 $!*i!#' 8#

!0 !/* $i%8 !$". D,$!i/ 7 -!i/ i' "$# 8!/

26 "i/,#'. P!i/ i' !''i!#* ;i8 * ';#!i/%.

– N 7,y $#i#


4/31

HISTORY TA9IN

P!' 8i'$y:

– T8#$# i' 8i'$y 7 8y-#$#/'i/ 7$ 5

y#!$'= ;8i8 i' / ;# /$#* – T8#$# i' / 8i'$y 7 8#' -!i/

– T8#$# i' / 8i'$y 7 8#!$ *i'#!'#

– T8#$# i' / 8i'$y 7 Di!##'M#i,'


5/31

HISTORY TA9IN

• P#$'/! Li7# Hi'$y :

– N 8i'$y 7 '"0i/%

–

N 8i'$y 7 !8 /',"-i/ – N 8i'$y 7 8#!$ *i'#!'# i/ 8# 7!"iy

– N 8i'$y 7 *i!##' i/ 8# 7!"iy

• P!' T$#!"#/ Hi'$y : – N 8i'$y 7 8'-i! !*"i''i/


6/31

P8y'i! E>!"i/!i/ General state:

M*#$!# I/#''1 W# /,$i'8#*1C"-'"#/i'

B*y W#i%8 : 46 0%

B*y H#i%8 : 345 "B*y M!'' I/*#> : 22=? 0%1"2

ital state

B* P$#'',$# : 361?6 ""H%H#!$ R!# : ?6 >1"/

R#'-i$!$y R!#: 3?>1"/

B*y T#"-#$!,$#: &=5 @C (!>i!)


7/31

P8y'i! E>!"i/!i/ H#!* :N$"8#-!i

Ey# :A/#"i' ()= I#$i ()

P,-i :E,!= $,/*= *i!"##$ 2=5 ""=

$#!i


8/31

P8y'i!

E>!"i/!i/ C!est "#a$inationI/'-#i/ : Sy""#$i! #7 $i%8

P!-!i/ : M!'' ()= #/*#$/#'' ()=

P#$,''i/ :S/$ #7$i%8L,/%i


9/31

PHYSICAL EAMINATION

• C$ :

– I/'-#i/ : i,' $*i' i'


10/31

P8y'i! E>!"i/!i/ A%do$inal "#a$ination

– I/'-#i/ : C/= 7;i/% $#!8 "


11/31

ELECTROCARDIORAPHY

Si/,' $8y"

HR : 6 -"R#%,!$iy:$#%,!$A>i' :/$"!>i'PR i/#$

6.32 'RS $!# : 6.6?'RS "-#> :/$"!ST '#%"#/ :ST '#%"#/##

C/,'i/ :Si/,' $8y"= HR


12/31

&A'(RA)(R* RESULTS TEST RESULT NORMAL

VALUE

WBC 3.366 >

361,L

G.6 36.6 >

36

RBC G= G.6 &.6 >

36&

HB 32. 32 3&

HCT &=2 4 G?

PLT 25>361,L

356 G66 >

36

PT . 36 3G

APTT 25.2 22=6 6=6

INR 6.5DS 334"%1* 3G6

D2P

P

266

SOT &6,1L ?

SPT 26 ,1L G3

TEST RESULT NORMAL

VALUE

T!

C8#'#$

266

HDL 5

LDL 36

T$i%y#$i*# 266

U$#," 34 3656

C$#!i/i/# 6.& 6=53=2

T$-/i/ I 2=G? 6=63

C9 52=66 36

C9MB 5.5 25

N!$i," 3G2 3& 3G5

9!i," =5 =5 5=3

C8$i*# 333 4 333

U$i Ai* =G4=6


13/31

CHEST RAY

R#', :• Ai


14/31

DIANOSIS

• ST ELEVATION MYOCARDIALINFARCTION INFERIOR + LATERAL

5 HOURS ONSET


15/31

TREATMENT

– O>y%#/ 2G i#$' -#$ "i/,#

– Bi'-$ 2=5 "%12G 8,$'1$!


16/31

DISC+SSI(N


17/31

I/$*,i/

Aute oronar- s-ndro$esACS/ i' ! #$" 7$ 'i,!i/';8#$# 8# * ',--i#* 8#

8#!$ ",'# i' ',**#/y0#*.• *#'$i#* !' ! %$,- 7

/*ii/' $#',i/% 7$"!,# "y!$*i! i'8#"i!(i/',Qi#/ * ; 8#!$ ",'#)

• $!/%i/% 7$" ,/'!# !/%i/!(i/$#!'i/%= ,/-$#*i!#8#' -!i/) "y!$*i!i/7!$i/ (8#!$ !!0).


18/31

I/$*,i/


19/31

PATHOPHYSIOLOY

A"#$i!/ H#!$ A''i!i/: 8-:11;!8#!$/i


20/31

A"#$i!/ H#!$ A''i!i/: 8-:11;!8#!$/i


21/31

SYMPTOMS


22/31

EC

• ST '#%"#/ ##


23/31

RELATION BETWEEN INFARCT LOCATIONWITH WAVE AND ST ELEVATION

&oation Coronar-Arteries

"CG &eads


24/31

CARDIAC MAR9ER


25/31

CARDIAC MAR9ER

Bi8#"i! "!$0#$ 7$ *##i/ 7 "y!$*i!/#$'i'

Fi$' $i'#

!7#$ AMI

P#!0 !7#$

AMI

R#,$/

/$"!

C9MB G 8 2G 8 42 8

My%i/ 2 8 &? 8 2G 8

T$-/i/ T G 8 2G G? 8 5 23 * T$-/i/ I G 8 2G & 8 5 3G *


26/31

ALORITMA EVALUASI S9A


27/31

MANAEMENT


28/31

INITIAL MANAEMENT• E

• B#* $#'• O>y%#/ (2G -"


29/31

REPERFUSION THERAPY• Fi$i/yi 8#$!-y:

• S$#-0i/!'# 3.5 "ii/ ,/i' i/ 366 "L *#>$'# 5 $ N!C

6= /i'8#* i/ 6 &6 "i/,#'

• Aiy'# : 35 "% ,' i<

6.45"%10% ;#i%8 *y i/ 6 "i/,#'

!/* 6=5 "%10% ;#i%8 *y i/ &6 "i/,#'

• A/i!%,!i/ 8#$!-y ( 7$ STEMI -!i#/ ;i8 $i/yi

8#$!-y= %i!-!$i/#) 6.G1'

• U/7$!i/!#* 8#-!$i/

• I/#$


30/31

LON TERM THERAPY

3. C/$ $i'0 7!$'= ',8 !' 8y-#$#/'i/=*i!##'= !/* ! /',"-i/.

2. A/i-!## 8#$!-y ;i8 ; *'# !'-i$i/.

. B#!0#$'G. Li-i* -$# /$.

5. Hi%8 *'# '!i/'

&. ACEI1ARB4. A*'#$/ !/!%/i'


31/31

COMPLICATION

• H#"*y/!"i *i',$!/#

– H#!$ 7!i,$#

– A$$8y8"i!

• C!$*i! "-i!i/

– Mi$! $#%,$%i!i/

– H#!$ $,-,$#

– V#/$i,!$ '#-," $,-,$#

– Ri%8

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