DISCUSSION

ST ELEVATION MYOCARDIAL INFARCTION (STEMI)

DEFINITION

Acute coronary syndromes (ACS) is a term for situations where the blood supplied to the heart muscle is suddenly blocked.

• 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).

INTRODUCTION

Histology

Pathophysiology

STEMI

PATHOPHYSIOLOGY

PATHOPHYSIOLOGY

PATHOPHYSIOLOGY

PATHOPHYSIOLOGY

PATHOPHYSIOLOGY

ACUTE CORONARY SYNDROME

DIAGNOSIS

Presenting symptoms

Electrocardiography

Serum markers

severe, persistent, typically chest pail; radiating to neck, jaw, or left shoulder and arm

CLINICALMANIFESTATION

Pathomechanism of Symptoms Angina Chest Pain

Acute Coron

ary Syndrome

Oxygen

supply

decrease ; Oxyg

en dema

nd increa

se

Ischemic of Heart

Metabolism aerob

to anaer

ob

Result ->

Lactate Acid increa

se

pH increase in

miocardium

Angina

Chest Pain

Electrocardiography

Electrocardiography

Because troponin and CK-MB levels do not become elevated in the serum until at least a few hours after the onset of MI symptoms and the diagnostic utility of these biomarkers is limited in that critical period. As a result, early decision making in patients with ACS often relies most heavily on the patient’s history and ECG findings.

Serum markers

DIAGNOSIS

GOAL OF TREATMENT

Relieve pain

Hemodynamic stabilization

Myocardial reperfusion

Prevent the complication

MANAGEMENT - Medications -

MANAGEMENT - Reperfusion Therapy -

MANAGEMENT - Reperfusion Therapy -

MANAGEMENT - Reperfusion Therapy -

Absolute contraindications• Any prior ICH• Known structural cerebral vascular lesion (e.g. arteriovenous

malformation)• Known malignant intracranial neoplasm (primary or metastatic)

Ischaemic stroke within 3 mo EXCEPT acute ischaemic stroke within 4.5 h

• Suspected aortic dissection• Active bleeding or bleeding diathesis (excluding menses)• Significant closed-head or facial trauma within 3 mo• Intracranial or intraspinal surgery within 2 mo• Severe uncontrolled hypertension (unresponsive to emergency

therapy)• For streptokinase, prior treatment within the previous 6 mo

MANAGEMENT - Reperfusion Therapy -

Relative contraindications• History of chronic, severe, poorly controlled hypertension• Significant hypertension on presentation (SBP >180 mmHg or DBP

>110 mmHg)• History of prior ischaemic stroke >3 mo• Dementia• Known intracranial pathology not covered in absolute

contraindications• Traumatic or prolonged (>10 min) CPR• Major surgery (<3 wk)• Recent (within 2 to 4 wk) internal bleeding• Non-compressible vascular punctures• Pregnancy• Active peptic ulcer• Oral anticoagulant therapy

COMPLICATIONS

PROGNOSIS