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
8/17/2019 Kardio Stemi
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-$i 2.8 263&
8/17/2019 Kardio Stemi
3/31
HISTORY TA9IN
• C8i#7 "-!i/ : C8#' -!i/
• P$#'#/ 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 $#i#
8/17/2019 Kardio Stemi
4/31
HISTORY TA9IN
P!' 8i'$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,'
8/17/2019 Kardio Stemi
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/
8/17/2019 Kardio Stemi
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!)
8/17/2019 Kardio Stemi
7/31
P8y'i! E>!"i/!i/ H#!* :N$"8#-!i
Ey# :A/#"i' ()= I#$i ()
P,-i :E,!= $,/*= *i!"##$ 2=5 ""=
$#!i
8/17/2019 Kardio Stemi
8/31
P8y'i!
E>!"i/!i/ C!est "#a$inationI/'-#i/ : Sy""#$i! #7 $i%8
P!-!i/ : M!'' ()= #/*#$/#'' ()=
P#$,''i/ :S/$ #7$i%8L,/%i
8/17/2019 Kardio Stemi
9/31
PHYSICAL EAMINATION
• C$ :
– I/'-#i/ : i,' $*i' i'
8/17/2019 Kardio Stemi
10/31
P8y'i! E>!"i/!i/ A%do$inal "#a$ination
– I/'-#i/ : C/= 7;i/% $#!8 "
8/17/2019 Kardio Stemi
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/,' $8y"= HR
8/17/2019 Kardio Stemi
12/31
&A'(RA)(R* RESULTS TEST RESULT NORMAL
VALUE
WBC 3.366 >
361,L
G.6 36.6 >
36
RBC G= G.6 &.6 >
36&
HB 32. 32 3&
HCT &=2 4 G?
PLT 25>361,L
356 G66 >
36
PT . 36 3G
APTT 25.2 22=6 6=6
INR 6.5DS 334"%1* 3G6
D2P
P
266
SOT &6,1L ?
SPT 26 ,1L G3
TEST RESULT NORMAL
VALUE
T!
C8#'#$
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
8/17/2019 Kardio Stemi
13/31
CHEST RAY
R#', :• Ai
8/17/2019 Kardio Stemi
14/31
DIANOSIS
• ST ELEVATION MYOCARDIALINFARCTION INFERIOR + LATERAL
5 HOURS ONSET
8/17/2019 Kardio Stemi
15/31
TREATMENT
– O>y%#/ 2G i#$' -#$ "i/,#
– Bi'-$ 2=5 "%12G 8,$'1$!
8/17/2019 Kardio Stemi
16/31
DISC+SSI(N
8/17/2019 Kardio Stemi
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).
8/17/2019 Kardio Stemi
18/31
I/$*,i/
8/17/2019 Kardio Stemi
19/31
PATHOPHYSIOLOY
A"#$i!/ H#!$ A''i!i/: 8-:11;!8#!$/i
8/17/2019 Kardio Stemi
20/31
A"#$i!/ H#!$ A''i!i/: 8-:11;!8#!$/i
8/17/2019 Kardio Stemi
21/31
SYMPTOMS
8/17/2019 Kardio Stemi
22/31
EC
• ST '#%"#/ ##
8/17/2019 Kardio Stemi
23/31
RELATION BETWEEN INFARCT LOCATIONWITH WAVE AND ST ELEVATION
&oation Coronar-Arteries
"CG &eads
8/17/2019 Kardio Stemi
24/31
CARDIAC MAR9ER
8/17/2019 Kardio Stemi
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 *
8/17/2019 Kardio Stemi
26/31
ALORITMA EVALUASI S9A
8/17/2019 Kardio Stemi
27/31
MANAEMENT
8/17/2019 Kardio Stemi
28/31
INITIAL MANAEMENT• E
• B#* $#'• O>y%#/ (2G -"
8/17/2019 Kardio Stemi
29/31
REPERFUSION THERAPY• Fi$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#-!$i/
• I/#$
8/17/2019 Kardio Stemi
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*'#$/ !/!%/i'
8/17/2019 Kardio Stemi
31/31
COMPLICATION
• H#"*y/!"i *i',$!/#
– H#!$ 7!i,$#
– A$$8y8"i!
• C!$*i! "-i!i/
– Mi$! $#%,$%i!i/
– H#!$ $,-,$#
– V#/$i,!$ '#-," $,-,$#
– Ri%8