Report
ST ELEVATION MYOCARDIAL INFARCTION
WHOLE ANTERO SEPTAL >12 HOURS
KILLIP I
Presented by:
L.M. Dila Pramashari
Supervisor:
dr. Pendrik Tandean, Sp.PD-KKV, FINASIM
PATIENT IDENTITY
Name
: Mr. M
Age
: 56 years old
Address
: Lingkungan Tompobalang
Occupation
: not working
MR
: 79766
HISTORY TAKING
HISTORY TAKING
Gout (+)
RISK FACTOR
Modifiable:
Hypertension, since 10 years a go, medicine control
irregularly
Smoking, 6 cigarettes per day
Non modifiable:
Age (56 y.o)
PHYSICAL EXAMINATION
General Status
Weight
: 55 kg
Height
: 160 cm
Vital Status
Blood pressure
:150/90 mmHg
Heart rate
: 88 bpm
Temperature : 37,2 oC
PHYSICAL EXAMINATION
Head
Neck
Lung
Inspection
: symmetry left=right
Palpation
vocal
Percussion
: sonor
Auscultation
PHYSICAL EXAMINATION
Cor
Inspection
Palpation
Percussion
PHYSICAL EXAMINATION
Abdomen :
Inspection
Palpation
Percussion
: tympani
Extremities :
Edema (-)
ELECTROCARDIOGRAPHY
Sinus rhythm
Heart rate : 94x/minutes
Duration QRS
: 0,08 s
Axis : normoaxis
Pathological Q in V1-V3
P Wave
: 0,08 s
ST segment : ST elevation on lead V1, V2, V3
PR interval : 0,16 s
R Wave : Poor R Wave Progression in V1-V3
Conclusion :
Sinus rhythm, HR 94 bpm, normoaxis, ANTEROSEPTAL ST elevation myocardial infarction
LABORATORY RESULTS
TEST
RESULT
NORMAL VALUE
WBC
10,0 x 103/uL
RBC
4,02 x 106/uL
HGB
12,0g/dL
HCT
TEST
RESULT
NORMAL
VALUE
GDS
116 mg/dL
<140
SGOT
27 u/L
<38
12 18
SGPT
30 u/L
<41
37,6%
37 48
Ureum
14
10-50
PLT
217 x 103/uL
Kreatinin
0,7
0,5-1,2
PT
10,2
10 - 14
Troponin I
>10,0
<0,05
APTT
26,9
22,0 - 30,0
CK
983,00
<190
T. Chol
102
200
CKMB
71,0
<25
LDL
98
<130
Na
143
136 - 145
HDL
45
>55
3,5
3,5 - 5,1
Trig
91
200
Cl
109
97 - 111
Uric Acid
9,0
3,4-7,0
CHEST X-RAY
- CTI 0,56
- Aorta dilatation
- Normal bronchovascular
marking on both of parahilar
- Normal sinus and diaphragm
Result :
Cardiomegaly (CTI index : 0.56)
with aortae dilatation
ECHO CARDIOGRAPHY
Conclusion:
Segmental Hipokinetik
WORKING DIAGNOSIS
TREATMENT
O2 4 lpm via nasal cannula
IVFD NaCl 0,9% 500 cc/24 hours
Aspilet 160 mg (loading dose), maintenance 1x80 mg
tab
Clopidogrel 300 mg(loading dose), maintenance 1x75
mg tab
Cedocard 0,5 mg/24 hours/SP
Captopril 6,25 mg/ 8 hours/ oral
Bisoprolol 1,25 mg/ 24 hours/ oral
Arixtra 2,5mg /24 hours/ subcutan
Atorvastatin 40 mg/24 hours/oral
Allopurinol 100 mg/24 hours/oral
DISCUSSION
INTRODUCTION
Acute coronary syndromes (ACS) is a
term for situations where the blood
supplied to the heart muscle is suddenly
blocked.
ST-Elevation Myocardial Infarction
There is a transmural infarction of the
myocardium. Entire thickness of the
myocardium has undergone necrosis.
Usually occurs when blood flow of
artery coronary suddenly decreased
after occlusive thrombus on
atherosclerotic plaque.
Coronary plaques tend to rupture if it
has a thin fibrous cap and a lipid-rich
core.
RISK FACTORS
Modifiable
Smoking
Hypertension
Diabetes mellitus
Hypercholesterolemia
Obesity
Psychosocial stress
Lack of physical activity
NonModifiable
Gender & Age
Men > 45 years old
Women > 55 years old
Family history
Heart
Heart disease
disease in
in biological
biological
brother
or
father
brother or father >
> 55
55 years
years
old
old
Heart
Heart disease
disease in
in biological
biological
sister
or
mother
>
sister or mother > 65
65 years
years
old
old
NSTEMI
STEMI
Complete
Thrombus
Occlusion
ST Elevations on
ECG or new
LBBB
Elevated Cardiac
Enzymes
CLINICAL MANIFESTATION
Characteristic pain : severe, persistent,
typically substernal
Sympathetic effect : Diaphoresis, cool
and clammy skin
Parasympathetic (vagal effect) :
Nausea, vomiting, weakness
Inflammatory response : mild fever
Pathophysiology
Pathophysiology
ECG CHANGES
CARDIAC BIOMARKERS
DIAGNOSIS
GOAL OF TREATMENT
Relieve pain
Hemodynamic
stabilization
Myocardial
reperfusion
Prevent the
complication
MANAGEMENT
COMPLICATIONS
PROGNOSIS
KILLIP CLASSIFICATION
CLASS
DESCRIPTION
MORTALITY RATE
(%)
II
III
30 - 40
IV
Cardiogenic shock or
hypotension (systolic BP < 90
mmHg), and evidence of
peripheral vasoconstriction
60 80
6
17
Thank You