ST SEGMENT ELEVATION MYOCARDIAL INFARCTION (STEMI) PRESENTED BY : NUR RAISAH ULFAH- C 111 09382 SUPERVISED BY :Prof. dr. Peter Kabo, PhD, Sp. FK, Sp. JP (K), FIHA, FASCC Department of Cardiology and Vascular Medicine Medical Faculty of Hasanuddin University Makassar 2014
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ST SEGMENT ELEVATIONMYOCARDIAL INFARCTION (STEMI)
PRESENTED BY : NUR RAISAH ULFAH- C 111 09382
SUPERVISED BY :Prof. dr. Peter Kabo, PhD, Sp. FK, Sp. JP (K), FIHA, FASCC
Department of Cardiology and Vascular MedicineMedical Faculty of Hasanuddin University
Makassar2014
PATIENT IDENTITY
• ID Number : 651739• Name : MR TP• Age : 68 years old• Gender : Male• Date of Admission : November 14th 2014
HISTORY TAKINGChief complaint : Chest pain
History of present illness Occurred 3 weeks ago before entering the hospital and was advancing in last
couple of days so that patient have been referred to the RSWS from toraja’s hospital cause there was no significant improvement of symptoms.
At the beginning, Chest pain is suddenly felt in a substernal area, pain is like crushed with heavy load. The pain wasn’t radiated. Duration of pain continuously more than 20 minutes with a cold sweating, and not relieved by rest then increased by activity.
There are shortness of breath, nausea and vomiting, and so complain about a heart burn. Patient didint have a fever and no previous history of fever.
Defecation and urination : normal
# Past Ilness historyNo History of HypertensionNo History of DMNo History of high blood cholesterolNo History of previous heart diseaseNo History of epigastric painNo History of asthma# Family historyNo family history of heart disease# Personal history:History of smoking one pack each day for more 30 years.History of drinking alcohol, once in a week.
HISTORY OF DISEASE
Modifiable
- Drink alcohol
- Smoker
Non Modifiable
- Gender : male (+)- Age : 68th years old (+)
RISK FACTOR
PHYSICAL EXAMINATION
General status• Moderate illness/well
nourished/compos mentis
Vital sign• BP: 120 / 90 mmHg• HR: 72 x/min• RR: 28 x/min• T : 36.80 C
Anti Platelet Aggregation– Loading Aspilet 160 mg, maintenance 80 mg every 24 hours– Loading Clopidogrel 300mg, maintenance 75 mg every 24 hours
• Anti cholesterol – HMG-Co A reductase inhibitor (Simvastatin 1 x 20 mg)
• Diuretik– Furosemide 40 mg every 12 hours intravena.
• Laxative– Laxadin syrup 1 x 2 cth
• Anti Anxietas– Alprazolam 0,5 mg every 24 hours in night.
ACUTE CORONARY SYNDROME ST SEGMENT ELEVATION MYOCARDIAL INFARCTION
DISCUSSION
DEFINITIONAcute Coronary Syndrome (ACS) is a term for situations where the blood supplied to the heart muscle is suddenly blocked.
STEMI is a clinical syndrome defined by characteristic symptoms of myocardial ischemia in association with persistent electrocardiographic (ECG) ST elevation and subsequent release of biomarkers of myocardial necrosis.
3 point typical chest painTend to be Stable Angina Pectoris than Acute Coronary Syndrome
2 point atypical chest painTend to be Acute Coronary Syndrome than Non Cardiac Chest Pain
1 point or none non cardiac chest pain
Retrosternal or substernal chest pain
1 point Increased by
activity or emotion
1 point Relieved by
resting or nitrate SL
1 point
At least 2 of the following:
DIAGNOSIS OF ACS
1. Ischemic symptoms
2. Diagnostic ECG changes
3. Serum cardiac marker elevations
No
Yes
YesNo
STEMIAcute Myocardial Infarction
( Q-wave, non-Q wave )
NSTEMI(No ST-Segment Elevation
Myocardial Infarction)
Unstable Angina
Signs of myocardial ischemia
ST segmen elevation ?
Biochemical cardiac markers ?
ECG
Lab
ALGORITMA
INITIAL TREATMENT
Fixing the chest pain and fearness
• Bed rest• Diet• O2 2-4 lpm via nasal prongs or face mask• Sublingual/oral/IV nitroglycerine• Antiplatelet: aspirin and clopidogrel• Morfin/petidine• Diazepam 2-5mg/8 hour
Stabilizing the hemodynamic (blood pressure and peripheral pulse control)• β-blocker if there is no contraindication• Calcium channel blocker (CCB)• ACE-Inhibitor
Reperfusion of the myocard
Initial Treatment
JACC Vol. 61, No. 4, 2013 2013ACCF/AHA STEMI Guideline: Full Text January 29, 2013:e78–140
COMPLICATION
Arrythmia Heart failure Cardiogenic shock
Rupture of ventricle
septum/wall
Rupture of chordae tendineae Pericarditis
Tromboemboli
PrognosisKILLIP CLASSIFICATION
Class Description Mortality Rate (%)
I No clinical signs of heart failure 6
IIRales or crackles in the lungs, an S3, and elevated jugular venous pressure
17
III Acute pulmonary edema 30 - 40
IVCardiogenic shock or hypotension (systolic BP < 90 mmHg), and evidence of peripheral vasoconstriction
60 – 80
Prognosis – TIMI SCOREHistorical Age 65-74 >/= 75
2 points3 points
DM/HTN or Angina 1 pointExam SBP < 100 3 points HR > 100 2 points Killip II-IV 2 points Weight > 67 kg 1 pointPresentation Anterior STE or LBBB 1 point