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CASE REPORT

ST ELEVATION ANTEROSEPTAL MYOCARDIAL INFARCTION


ONSET > 24 HOURS KILLIP II

BY:
MOHAMAD HAIKAL ZAINOL C11113853
Supervisor :
Dr. Pendrik Tandean. Sp. PD, KKV FINASIM
PATIENT BACKGROUND

• Name : Mr T

• Age : 53 y/o (25/5/1964)

• Sex : Male

• MR No : 792596
CHIEF COMPLAINT

• Shortness of breath

• Chest pain
PRESENT ILLNESS HISTORY

He suffered chest pain since 3 days ago and this

chest pain radiated to back part of his body. This

chest pain was described by him as being buried

with a shortness of breath as including factor.

Diaphoresis and nausea without vomiting.


PAST ILLNESS HISTORY

• STEMI Anteroseptal

(Admitted in Takalar Hospital)


RISK FACTOR

Modifiable

Smoking since 20 y/o with about 1 pack of cigarette daily.

Non-modifiable

Gender : Male

Age : 53 y/o
PHYSICAL EXAMINATION
General status:

• Moderate illness / Composmentis/ Good nutrition.

• Weight : 69 kg

• Height : 171 cm

• BMI : 23.6 kg/m2 (Normal)

Vital sign:

• Blood pressure : 140/80 mmHg

• Heart rate : 65 x / Minute (N 60-100)

• Respiratory rate : 22 Rpm (N 12-24)

• Temperature : 36.5 Degree Celsius


PHYSICAL EXAMINATION
Airway : Clear

Breathing : Spontaneous

Circulation : Heart beat – strong

: CRT < 2 sec

: Skin Color – Normal

: Bleeding (-ve)

: Skin turgor – Good


PHYSICAL EXAMINATION

Disability / Neurological

Respond : Alert

Pupil : Isochoric (2.5mm)

Refleks :(+/+)

GCS : E4 V5 M6 ( 15 )
PHYSICAL EXAMINATION

JVP : R + 1 Cm H20

Auscultation : Vesicular ( Base )


ELECTROCARDIOGRAPHY
Anteroseptal ( V1 & V2 )
ELECTROCARDIOGRAPHY
Anteroseptal (V1 & V2)
Rhythm : Sinus rhythm

Heart rate : 75 x/min ( 300/4 large square)

Regularity : Regular

P wave : 0.12 ( 3 small box 0.04x3)

PR interval : 0.16 (4 small square 0.04x4)

Axis :

QRS Complex : : Pathologic Q wave in III

Duration of QRS : : 0.08 ( 2 small square 0.04x2)

ST segment : Elevation in VI & V2

T Wave : T inverted in V1 & aVR

CONCLUSION : STEMI anteroseptal


LABORATORY FINDINGS
TEST RESULT NORMAL VALUE UNIT

WBC 11.19 4.00-10.00 10ˆ3/ul

RBC 4.88 4.00-6.00 10ˆ6/ul

HGB 14.4 12.0-16.00 g/dl

HCT 42.7 37.00-48.00 %

PLT 236 150-400 10ˆ3/ul

Interpretation : Mild Leukocytosis


LABORATORY FINDINGS
TEST RESULT NORMAL VALUE UNIT

Urea 18 10 - 50 mg/dl
Creatinine 1.00 L (<1.3), P (<1.1) mg/dl
SGOT 24 < 38 U/L
SGPT 39 < 41 U/L
CK 104.87 L (<190), P (<167) U/L

CK-MB 13.3 < 25 U/L

Sodium 143 136 -145 mmol/L

Potassium 3.3 3.5 – 5.1 mmol/L

Interpretation : Hypokalemia
LABORATORY FINDINGS
TEST RESULT NORMAL VALUE UNIT

GDP 89 110 mg/dl

Total Cholesterol 224 200 mg/dl

HDL Cholesterol 31 L (>55), P(>65) mg/dl

LDL Cholesterol 154 <130 mg/dl

Triglyceride 131 200 mg/dl

Uric Acid 8.9 P(2.4-5.7), L(3.4-7.0) mg/dl

Interpretation: Dyslipidemia
Hyperuricemia
ECHOCARDIOGRAPHY
ECHOCARDIOGRAPHY
ECHOCARDIOGRAPHY
• Decrease left ventricle systolic function
(EF39%)
• Left ventricle dilatation.
• Eccentric left ventricle hypertrophy.
• Hypokinetic segment
• Mild mitral regurgitation.
• Mild Left ventricle diastolic dysfunction.
DIAGNOSIS

ST Elevation Anteroseptal Myocardial Infarction


(STEMI) onset >24 hours, KILLIP II
TREATMENT
DRUG NAME DOSAGE INDICATION
Aspilet 20mg / oral / 24 hours Anti- thrombolytic
Clopidogrel 300mg / oral / 24 hours Anti- platelet
Valsartan 40mg / oral / 24 hours Anti- hypertension
Furosemid 40mg / oral / 24 hours Diuretic
KSR Oral / 24 hours K+ correction
Atrovastatin 40mg / oral / 24 hours Lipid
Alopurinol 30 mg / oral / 24 hours Hyperuricemia
Alprazolam 5 mg / oral / 24 hours Sedation
Laxadin 10 mg / oral / 24 hours Bowel function
DISCUSSION
• Acute coronary syndromes (ACS) is a term for
situations where the blood supplied to the
heart muscle is suddenly blocked.
• described as 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).
HOW THIS HAPPENED ?
SHORTNESS OF BREATH ?
INFARCT MIOCARDIAL ( STEMI & NSTEMI )
HOW TO DIAGNOSE MI ? (1)
HOW TO DIAGNOSE MI ? (2)
HOW TO DIAGNOSE MI ? (3)
TREATMENT GOLDS

• Relieve the pain


• Hemodynamic stabilization.
• Myocardial reperfusion ( PCI / Thrombolytic)
• Prevent incoming complication.
TREATMENT GOLDS
TREATMENT GOLDS

Drug example:
1) B-Blocker : Bisoprolol ( Decrease re-infarct)
2) Nitrates
3) Analgesic : Morphine (Pain control)
4) Anti-thrombolytic : Aspirin
5) Statin : Atorvastatin (Plaque stabilization)
6) ACE : Captopril (Anti- remodelling)
COMPLICATION
PROGNOSIS
KILLIP CLASSIFICATION
Wednesday 15 March 2017

THANK YOU